Renal Pelvis and Urethra

Renal Pelvis and Ureter

Epidemiology

  • 30% to 50% have metachronous or synchronous bladder cancer.

Risk Factors

  • Gene abnormalities
    • Ras p21 protein
    • P53, p21, p27, pRB
  • Chemical Exposure
    • Aromatic amines, aniline dyes, nitrites, nitrates
    • Tobacco
    • Analgesic abuse (phenacetin)
    • Plastics, coal, tar and aasphalt
    • Cyclophosphamide administration
    • Coffee, tea and sweeteners have NOT been shown to act as idependent risk factos
  • Chronic irritation
    • Schistosoma haematobius  SCCA or TCC
    • Indwelling catheters  SCCA
    • Pelvic RT  SCCA

Pathology

  • Like bladder tumor, 90% of upper tract tumors are TCC
  • SCCA account for most of the remaining 5% to 8%
  • Adenocarcinoma and sarcomas are rare < 1%

Presentation

  • Gross hematuria is the presenting symptom in 75% to 95%.

Treatment

Surgery

  • Nephroureterectomy with removal of the bladder cuff is the standard surgery
    • Low-grade 9-15% local failure rate with surgery
    • High-grade 30-50% local failure rate with surgery
    • Partial ureterectomy is acceptable in selected patients

Primary Radiation

  • Not considered to be standard treatment
  • EBRT of 50 to 60 Gy to gross residual disease have shown few long term disease control.
  • Combined Chemotherapy and radiation therapy may be reasonable based on Bladder data
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