What are the NCCN recommendations for the treatment of UTUC bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

The NCCN provides treatment recommendations based on the location and disease extent, as follows [1] :

  • Tumors that originate in the upper ureter typically are treated with nephroureterectomy with a cuff of bladder plus regional lymphadenectomy for high-grade tumors; a portion of the bladder is removed to ensure complete removal of the entire intramural ureter
  • Endoscopic resection of upper ureter tumors is acceptable, but those are more commonly treated with nephroureterectomy with a bladder cuff, plus regional lymphadenectomy for high-grade tumors.
  • Neoadjuvant chemotherapy should be considered in select patients, including patients with retroperitoneal lymphadenopathy, bulky (> 3cm) high-grade tumor, sessile histology, or suspected parenchymal invasion.
  • Tumors that originate in the mid-portion are divided into small, low-grade tumors and large, high-grade tumors. 
  • Treatment of small, low-grade tumors is excision and ureteroureterostomy or complete ureterectomy and ileal ureter in highly selected patients; endoscopic resection; or, if the tumor cannot be managed endoscopically and the ureteral extent is too great, nephroureterectomy with a cuff of bladder may be considered.
  • Nephroureterectomy with a cuff of bladder and regional lymphadenectomy is used for larger, high-grade lesions; neoadjuvant chemotherapy should be considered for selected patients.
  • Distal ureteral tumors may be managed with a distal ureterectomy and reimplantation of the ureter (preferred if clinically feasible); endoscopic resection; or, in some cases, a nephroureterectomy with a cuff of bladder, with the addition of regional lymphadenectomy recommended for high-grade tumors.
  • Nephroureterectomy is contraindicated in patients with bilateral disease, solitary kidney, renal insufficiency, or a hereditary predisposition to genitourinary cancer; such patients should receive nephron-sparing treatment.

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