Management of Patients With Upper Urinary Tract Transitional Cell Carcinoma

Jay D Raman; Douglas S Scherr*

Disclosures

Nat Clin Pract Urol. 2007;4(8):432-443. 

In This Article

Summary and Introduction

Multiple therapeutic options are available for the management of patients with upper urinary tract transitional cell carcinoma (TCC). Radical nephroureterectomy with an ipsilateral bladder cuff is the gold-standard therapy for upper-tract cancers. However, less invasive alternatives have a role in the treatment of this disease. Endoscopic management of upper-tract TCC is a reasonable strategy for patients with anatomic or functional solitary kidneys, bilateral upper-tract TCC, baseline renal insufficiency, and significant comorbid diseases. Select patients with a normal contralateral kidney who have small, low-grade lesions might also be candidates for endoscopic ablation. Distal ureterectomy is an option for patients with high-grade, invasive, or bulky tumors of the distal ureter not amenable to endoscopic management. In appropriately selected patients, outcomes following distal ureterectomy are similar to that of radical nephroureterectomy. Bladder cancer is a common occurrence following the management of upper-tract TCC. Currently, there are no variables that consistently predict which patients will develop intravesical recurrences. As such, surveillance with cystoscopy and cytology following surgical management of upper-tract TCC is essential. Extrapolating from data on bladder TCC, both regional lymphadenectomy and neoadjuvant chemotherapy regimens are likely to be beneficial for patients with upper-tract TCC, particularly in the setting of bulky disease.

Upper urinary tract transitional cell carcinoma (TCC) refers to malignant changes of the transitional epithelial cells lining the urinary tract from the renal calyces to the ureteral orifice. Although over 60,000 new cases of bladder cancer are diagnosed annually in the US, upper-tract TCC is much less common, accounting for approximately 5% of urothelial malignancies, and less than 10% of renal tumors.[1] Although upper-tract TCC represents only a small fraction of urothelial neoplasms, evidence suggests that the frequency of upper-tract TCC is increasing.[2] Proposed etiologies for developing upper-tract TCC are similar to that of bladder cancer and include environmental factors (cigarette smoking), occupational exposures (aniline dyes), and treatment with anti-inflammatory (phenacetin) or chemotherapy (cyclophophamide, ifosfamide) agents.[3,4,5]

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