Ureteral Cancer

Ureteral Cancer Care at Southland Urology

Ureteral cancer is a rare type of cancer that forms in the ureter, the tube that connects the kidney to the bladder. The disease often originates in the cells lining the ureter, known as transitional cells, and is most commonly found in older adults. If caught early, it can often be treated effectively, but because symptoms can be vague, a thorough diagnosis is essential for proper management.

Understanding Ureteral Cancer

What Is Ureteral Cancer?

Ureteral cancer is a rare malignancy that arises from the cells lining the ureter. The ureter is the narrow tube that carries urine from the kidney down to the bladder. Most ureteral cancers are a type of cancer called transitional cell carcinoma (or urothelial carcinoma), which is the same type of cancer that commonly forms in the bladder. Because the ureter and the bladder share the same type of lining, these cancers often have similar causes and risk factors as bladder cancer.

Causes and Risk Factors

The exact cause of ureteral cancer is not fully understood, but it is strongly linked to several risk factors. The most significant risk factor is smoking, as the harmful chemicals from tobacco can accumulate in the urine and damage the cells in the urinary tract. Other risk factors include occupational exposure to certain chemicals (such as those used in the textile, rubber, and plastics industries), a family history of urinary tract cancers, and a history of chronic urinary tract infections or kidney stones. Men are also more likely to develop ureteral cancer than women.

Common Symptoms

Ureteral cancer may not cause any symptoms in its early stages. When symptoms do appear, the most common sign is hematuria, or blood in the urine. This blood may be visible to the naked eye (gross hematuria) or only detectable with a lab test (microscopic hematuria). Other symptoms can include pain in the back or side, a persistent ache in the groin, or a sudden, severe pain that feels like a kidney stone. This pain is often caused by the tumor blocking the flow of urine, which can lead to swelling in the kidney.

Diagnosis

Diagnosing ureteral cancer can be challenging due to its vague symptoms. A urologist will begin with a physical exam and a review of the patient’s medical history. A urinalysis will be performed to check for blood in the urine. If cancer is suspected, a CT scan with contrast (CT urogram) is often the primary imaging test used, as it provides detailed images of the entire urinary tract. A definitive diagnosis is typically made with a procedure called a ureteroscopy, where a thin, lighted scope is inserted into the urethra and bladder, and then up into the ureter to visualize the tumor and take a biopsy.

Non-Surgical Treatment Options

For some cases of ureteral cancer, non-surgical treatment may be an option. For very small, low-grade, or non-invasive tumors, endoscopic laser ablation may be used, which involves using a laser passed through a scope to destroy the tumor. In some cases, chemotherapy may be used before surgery to shrink a large tumor or after surgery to eliminate any remaining cancer cells. For patients with advanced or metastatic disease, chemotherapy and newer immunotherapy drugs are the mainstays of treatment.

Surgical Management

Surgery is the most common and effective treatment for ureteral cancer. The type of surgery depends on the size, location, and stage of the cancer. For tumors in the lower part of the ureter, a surgeon may perform a distal ureterectomy, which removes the tumor and a portion of the ureter and then reconnects the remaining ureter to the bladder. For larger or more aggressive tumors, the standard of care is a nephroureterectomy, which involves the surgical removal of the entire kidney, ureter, and a small cuff of the bladder. This is often performed using a minimally invasive laparoscopic or robotic-assisted technique, which leads to a faster recovery.