Upper urinary tract cancer

Abstract

Urothelial cancers are the fourth most common cancer of which more than 95 % originate from the urothelium. The majority of these tumors arise within the bladder (90-95 %) while only 5-10 % occur in the upper urinary tract, i.e., renal pelvis and ureter (upper urinary tract urothelial cell carcinomas (UUTUCCs)). Tumors of the pyelocaliceal system are more common than ureteral tumors. Two thirds (60 %) of the UUTUCCs are invasive when diagnosed and 8-13 % of all patients present with concomitant bladder cancer. UUTUCC more commonly affects patients at approximately 80 years of age with a male to female ratio of 3:1 [ 1 ]. Patients with an invasive tumor (T2-4) have a signifi cantly lower 5-year disease-specifi c survival rate than patients with a superfi cial tumor (Ta and T1), 16.8 and 70.8 %, respectively [ 2 ]. Risk factors for UUTUCC include smoking, analgesics, chronic urinary tract infection, stone disease, and chemotherapeutic agents such as cyclophosphamide. There is also an increased risk for UUTUCC with patients who have been diagnosed with primary bladder cancer (10 %). Prognostic factors include stage, grade, lymph node invasion, lymphovascular invasion, tumor necrosis, and tumor architecture (infi ltrative) [ 3 ].