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What is upper tract urothelial cancer?

Upper tract urothelial cancer (sometimes called transitional cell carcinoma) is a cancer that occurs in either the inner lining of the tube that connects the kidney to the bladder (the ureter) or within the inner lining of the kidney.  

The lining of the bladder, kidney and ureter are the same, so there are some similarities between upper tract urothelial cancer and bladder cancer

Upper tract urothelial cancer is not common with about 470 Australians diagnosed each year. It is three times more likely to be diagnoses in men than women and is more common in people over the age of 70 years.  



Upper tract urothelial cancer symptoms

Upper tract urothelial cancer can be difficult to diagnose in its early stages and you may have no symptoms if the cancer is slow growing.  

Symptoms that some people may experience include:  

  • blood in the urine (haematuria) — you may or may not be able to see this  

  • pain on one side of the back caused by a blockage in the kidney or ureter  

  • weight loss

  • urinary tract infections.



Causes of upper tract urothelial cancer

The cause of UTUC is not known in most cases. However, there are several risk factors:  

  • smoking tobacco

  • a history of long-term inflammation of the ureter or kidney

  • exposure to certain chemicals over time, such as those used to make plastics, textiles, rubber, paint and dyes  

  • exposure to arsenic  

  • prior chemotherapy or radiation therapy for another cancer  

  • long-term use of large quantities of painkillers

  • family history of bladder cancer

  • having Lynch syndrome (an inherited syndrome) or Balkan nephropathy (caused by exposure to toxins in the diet of people living in the Balkan region).



Diagnosis of upper tract urothelial cancer

If your doctor thinks you may have UTUC they will take your medical history, perform a physical examination and arrange for you to have a number of tests.  

If the results of these tests suggest that you may have UTUC, your doctor will refer you to a specialist called a urologist, who will arrange further tests. These may include: 

Urine test

For this test you will be asked to collect a urine sample with er at your doctor’s surgery or at home, which will be checked for blood and bacteria. You may also need to collect urine samples over three days to be checked for cancer cells – this is called urine cytology.  

Blood tests

Blood tests to measure your white blood cells, red blood cells and platelets, and to check your kidney and liver function.  

Ultrasound

This can uses soundwaves to create pictures of the inside of your body. You will be asked to lie down and a gel will be spread over the affected part of your body and then a small device (transducer) is moved over the area. The ultrasound takes about 15 minutes and is painless.  

CT scan

Special machines are used to scan and create pictures of the inside of your body. You may have an injection of dye into your veins before the scan which makes the pictures clearer.  During the scan you will lie on a table which moves in and out of the scanner.  A CT scan takes about 10-30 minutes.  

MRI

An MRI scan produces detailed cross-sectional pictures of your body and can show the extent of any tumours.  You will lie on a table which slides into a large metal tube that is open at both ends. An MRI scan takes about 30-90 minutes.  

PET scan

In a positron emission tomography (PET) scan, a small amount of radioactive glucose is injected into the body. When scanned, cancer cells will appear brighter. 

Cystoscopy and ureteroscopy

A cystoscopy involves looking in the bladder while a ureteroscopy involves looking up into the ureter to the kidney. A cystoscopy is usually performed under local anaesthetic whereas a ureteroscopy is generally performed under general anaesthetic.  



Treatment for upper tract urothelial cancer

Discussions with your health professionals will help you decide on the best treatment for your cancer depending on the type of cancer you have and its exact location; the grade and stage of your cancer; your age, fitness and general health; the health and function of your other kidney (if it is the kidney that is affected) and your preferences.  

The main treatments for UTUC include surgery, chemotherapy and sometimes radiation therapy. These can be given alone or in combination. This is called multi-modality treatment. 

Surgery

Surgery is the most effective treatment for UTUC. Surgery may be performed as either keyhole surgery or open surgery. The extent of the surgery depends on the location and stage of the tumour. Your surgeon will discuss the type of operation you may need. 

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. Your treatment will depend on your situation and stage of the tumour. Chemotherapy may be used before or after you have surgery.  

Sometimes after surgery to remove the kidney and ureter (nephroureterectomy) a single dose of chemotherapy “wash” is put into the bladder. This is usually a drug called mitomycin and is given via the catheter that is left for one to two weeks after the surgery. Doing this can reduce the chance of the cancer recurring in the bladder.  

Immunotherapy

If your cancer has spread and is now known as advanced or metastatic upper urothelial cancer you may be offered immunotherapy. Immunotherapy uses the body’s own immune system to fight cancer. A new group of immunotherapy drugs called checkpoint inhibitors are available that work by helping the immune system to recognise and attack the cancer. 

Radiation therapy (radiotherapy)

Radiation therapy (also known as radiotherapy) uses high energy x-rays to destroy cancer cells. Radiation therapy, however, is less commonly used for UTUC. Your doctor will discuss your options with you. 

Palliative care

In some cases of upper tract urothelial cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer without trying to cure the disease. 

As well as slowing the spread the cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies. 

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Physiotherapist/occupational therapist- help with physical and practical problems such as restoring movement and mobility after treatment.
  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.
  • Dietitian- recommends an eating plan to follow while you are in treatment and recovery.
  • Pathologist- examines cells and tissues under a microscope
  • Urologist- specialises in the treatment of diseases of the urinary system (male and female) and the male reproductive system.


Screening for upper tract urothelial cancer

There is currently no national screening program for UTUC available in Australia.  



Preventing upper tract urothelial cancer

As the causes of UTUC is not known in most cases it is not possible to prevent the disease. However, quitting smoking, limiting exposure to certain chemicals and not taking large quantities of painkillers can help reduce your risk of developing UTUC. 



Prognosis for upper tract urothelial cancer

Prognosis refers to the expected outcome of a disease. It is not possible for any doctor to predict the exact course of the disease. An individual's prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis. This information will also help your doctor to advise on the best treatment options.  



Sources

Understanding Upper Tract Ureothelial Cancer. Cancer Council Australia © 2021. Last medical review of the source fact sheet: February 2021. 

Australian Institute of Health and Welfare (AIHW). Cancer in Australia 2019. Cancer series no.119. Cat. no. CAN 123. AIHW, Canberra, 2019. 

This web-based resource was made possible by the Cancer Australia Supporting people with cancer Grant initiative, funded by the Australian Government.