Upper Tract Urothelial Carcinoma (UTUC)

Kidney

Understanding Upper Tract Urothelial Carcinoma (UTUC)

UTUC is a rare form of cancer affecting the lining of the kidney (renal pelvis) and ureter. It constitutes 5-10% of all urothelial cancers, primarily affecting individuals aged 70-90, with a higher prevalence in men. The condition is often linked to risk factors like smoking, genetic predisposition, and exposure to certain chemicals.

Diagnosis and Symptoms

Risk Factors

Smoking

Like bladder cancer, smoking significantly increases your risk of developing UTUC or bladder cancer.

Previous Urothelial Cancers

17% of UTUC can be bladder involvement as well

Exposure

If you are exposed to Aromatic compounds at work or take Aristolochic acid, which is a form of traditional Chinese medicine, you can be at a higher risk of developing UTUC.

If you think you may be presenting symptoms of UTUC, schedule a consult as soon as possible.

Staging and Prognosis

Diagnosing UTUC can be challenging as imaging studies are not conclusive. Ideally, you require a sample of the lesion(histopathology), radiology and a direct vision of the lesion.
Staging is critical for determining treatment and survival rates. Advanced stages (T3-T4) are associated with lower survival rates, with 5-year survival dropping below 50% for T2 and even lower for T4.
Prognostic factors include age, kidney function, tumour grade, and recurrence risk.
Regularly assessing the bladder after treating UTUC is crucial.

Treatment Options

Radical Nephroureterectomy (RNU) involves Removing the kidney, ureter, and bladder cuff. It is often considered the gold standard for high-risk UTUC.
Nephron-sparing surgery (NSS) includes segmental ureterectomy or endoscopic approaches, which preserve kidney function while targeting localized tumors.
Adjuvant Chemotherapy: Recommended for high-risk cases to improve survival rates.
Emerging Therapies: Techniques like one-dose mitomycin C have shown promise in reducing recurrence.

Why Early Diagnosis Matters

Early detection allows for more treatment options, such as nephron-sparing techniques, reducing the risk of complications while preserving kidney function. Regular check-ups, especially for individuals with a history of bladder cancer or high-risk factors, can lead to early detection and better outcomes for UTUC.

If you think you may be presenting symptoms of UTUC, schedule a consult as soon as possible.