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Carcinoma of the renal pelvis & ureter

Carcinoma of the renal pelvis & ureter. Introduction. • rare, accounts for 4% of all urothelial cancers • frequently multifocal • papillary transitional cell cancer 85% (others include squamous cell, adenocarcinoma) • male: female = 3:1 • bladder: pelvis: ureter = 100:10:1.

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Carcinoma of the renal pelvis & ureter

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  1. Carcinoma of the renal pelvis & ureter

  2. Introduction • rare, accounts for 4% of all urothelial cancers • frequently multifocal • papillary transitional cell cancer 85% (others include squamous cell, adenocarcinoma) • male: female = 3:1 • bladder: pelvis: ureter = 100:10:1

  3. Predisposing factors • chemical exposure (industrial dyes and solvents) • smoking • analgesic abuse (acetaminophen, ASA and phenacetin) • Balkan nephropathy

  4. Symptoms and signs • gross painless hematuria (70-90% of patients) • microscopic hematuria found incidentally • flank pain • tenderness over kidney • flank mass caused by either tumour or associated hydronephrosis (10-20% of patients)

  5. Diagnosis • made by noting a radiolucent filling defect on IVP • cystoscopy

  6. • differential diagnosis of filling defect • transitional cell carcinoma (differentiate via cytology and CT scan) • uric acid stone (differentiate via cytology and CT scan) • blood clot • papillary necrosis • fungus ball • gas bubble from gas producing organisms

  7. Treatment • radical ureteronephrectomy with cuff of bladder • distal ureterectomy for distal ureteral tumours • overall 5 yr. survival following ureteronephrectomy is 84%

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