Management of Patients With Upper Urinary Tract Transitional Cell Carcinoma

Authors and Disclosures

Jay D Raman and Douglas S Scherr*

JD Raman is a Chief Resident in Urology and DS Scherr is an Assistant Professor of Urology at the New York Presbyterian Hospital–Weill Cornell Medical Center, New York, NY, USA.

Sidebar: Key Points

While upper-tract transitional cell carcinoma (TCC) accounts for only 5% of urothelial malignancies, evidence suggests that the frequency of these lesions is increasing

Radical nephroureterectomy by either the open or laparoscopic approach is the gold-standard therapy for upper-tract TCC; however, less invasive alternatives such as endoscopic ablation or segmental ureterectomy also have a role in treatment

Although TCC represents malignant degeneration of the urothelium, molecular and genetic studies indicate differences in the biologic mechanisms underlying upper-tract and bladder urothelial carcinoma

Bladder cancer occurs in 15–50% of patients following upper-tract TCC, underscoring the necessity for regular postoperative interval cystoscopy and urinary cytology

Experience gained from the management of bladder TCC suggests that both neoadjuvant chemotherapy and regional lymphadenectomy should both have a role in the management of upper-tract TCC