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

Conclusions

Multiple therapeutic options exist for the management of patients with upper urinary tract TCC. Radical nephroureterectomy with an ipsilateral bladder cuff, by whatever technique, is the gold-standard therapy for upper-tract cancers. An apparent stage migration of upper-tract TCC[21,58] suggests that some upper-tract lesions might be overtreated by complete extirpative surgery. While long-term oncologic data have been maturing, less radical surgical options have evolved into mainstream practice.

Distal ureterectomy is an alternative treatment for patients with high-grade, invasive, or bulky tumors of the distal ureter. In the appropriately selected patient, outcomes following subtotal ureterectomy are similar to that of radical nephroureterectomy. 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.

Bladder cancer occurs in 15–50% of patients after the management of upper-tract TCC. As such, surveillance with cystoscopy and cytology following surgical management of upper urinary tract TCC is essential. Extrapolating from data on bladder TCC, neoadjuvant chemotherapy regimens and regional lymphadenectomy are likely to be beneficial for upper-tract TCC, particularly in the setting of large, bulky tumors.


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