Conditions like prostate cancer, bladder cancer, and testicular cancer are quite common, but they're not the only ones that can affect your urological health. Although extremely rare, upper tract urothelial carcinoma (UTUC) is a type of cancer that isn't talked about often. It only affects roughly two people per 100,000, but it does exist, and a diagnosis is just as scary as any other cancer diagnosis. If you or a loved one has recently been diagnosed with UTUC, you probably want to learn more about it. To help, we've put together a comprehensive guide on what you need to know about upper tract urothelial cancer.
What is Upper Urinary Tract Urothelial Carcinoma?
Urinary tract urothelial carcinoma is a type of cancer that affects the urothelial cells lining the urinary system. These cells can be found from the lining of the kidneys to the bladder. Upper urinary tract urothelial cancer corresponds specifically to the lining of the kidneys and ureters, the long, thin tubes that connect the kidney to the bladder. It's sometimes called transitional cell carcinoma.
UTUC accounts for a smaller percentage of diagnoses compared to urothelial cancer cells in the bladder, which make up about 90% to 95% of all urothelial cancers. It's a rare mutation affecting kidney function and overall health and requires swift treatment to avoid metastatic spread. UTUC can be categorized into two main subtypes, often determined based on the characteristics of the tumor.
Low-Grade UTUC
Low-grade UTUC typically grows more slowly and is less likely to invade deeper tissues or spread to other parts of the body. However, even with the best treatment, low-grade tumors tend to recur, and removing or treating them can make preserving the urinary tract difficult.
Low-grade tumors often present with symptoms such as blood in the urine (hematuria) but may be less aggressive. Treatment for low-grade UTUC often involves minimally invasive procedures such as ureteroscopic surgery or laser ablation, aiming to remove or destroy the tumor while preserving kidney function.
High-Grade UTUC
In contrast, high-grade UTUC involves tumors that have much more aggressive behavior. High-grade tumors are more likely to invade the muscular wall of the ureter or renal pelvis and have a higher potential for metastasis, spreading to other organs. Once cancer has spread, it becomes more difficult to treat and can result in less favorable outcomes. Symptoms tend to be more severe, and treatment for UTUC presenting with high-grade tumors needs to be more aggressive. Even when treated, high-grade UTUC has a high recurrence rate.
Signs and Symptoms of UTUC
Unfortunately, symptoms for urothelial cancer can be difficult to spot, as they may not present until the cancer has grown. Some symptoms may also present as minor urologic conditions that don't usually warrant cause for concern. If you do experience symptoms, you may notice:
- Hematuria (blood in urine)
- Pain on one side of the body
- Urinary tract infections
- Weight loss
- Loss of appetite
- Night sweats
What Causes Upper Tract Urothelial Cancer?
As with many types of cancer, there's still a long way to go in understanding upper tract urothelial cancer. Although the direct cause is unknown, UTUC typically occurs in people later in life. The average age of diagnosis is about 73, but that doesn't mean it cannot affect younger individuals. Several factors can increase your risk of developing urologic cancers such as UTUC. Some of them include:
- Smoking
- Long-term use of high-dose painkillers
- Recurrent urinary tract infections
- Chronic inflammation or irritation of the urinary tract (e.g., kidney stones)
- Lynch Syndrome
- Balkan nephropathy
- Exposure to arsenic
- Exposure to certain chemicals, such as those used in the textile, rubber, leather, and chemical industries (e.g., aromatic amines and polycyclic aromatic hydrocarbons)
- Prior chemotherapy
- Prior radiation therapy
- Family health history of UTUC or bladder cancer
How is UTUC Diagnosed?
Diagnosing upper tract urothelial carcinoma involves a variety of diagnostic tools to detect and characterize the disease accurately. Some of the common diagnostic tools include the following:
- Urinalysis — Urinalysis involves testing a urine sample for signs of abnormal cells, blood, and other substances that might indicate the presence of cancer.
- Blood Testing — Blood tests can be done to assess kidney function and see whether the cancer is advanced enough to cause damage.
- Cystoscopy — This involves inserting a cystoscope (a thin tube with a camera) through the urethra to examine the bladder and urethra visually. While primarily used to inspect the lower urinary tract, cystoscopy can help identify tumors in the bladder or urethra that might coexist with UTUC.
- Ultrasound — An ultrasound uses sound waves to create images of the kidneys and urinary tract. It can help detect masses or abnormalities in the upper urinary tract.
- MRI — Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to provide detailed images of the urinary tract. It is particularly useful for evaluating the tumor's size and the state of surrounding structures.
- PET Scan — Positron emission tomography (PET) scans involve injecting a small amount of radioactive glucose into the body. Cancer cells absorb more of this substance and appear as bright spots on the scan, helping to detect metastatic disease.
- CT Scan — This involves taking a series of X-ray images after injecting a contrast dye, which provides detailed images of the kidneys, ureters, and bladder.
Your doctor will likely use one or more diagnostic tools to try and understand your unique circumstances and find the best treatment for your cancer.
Treatment Options for Upper Tract Urothelial Carcinoma
Treatment for upper tract urothelial cancer will depend on the severity, grade, and location of the cancer. Low-grade UTUC is usually minimally invasive, while treatment for high-grade UTUC requires more aggressive approaches. Your doctor will discuss your options with you to find the best way to destroy cancer cells and keep you feeling your best. Some options include:
Surgery
Treatment for upper urinary tract urothelial carcinoma can involve a few different surgical options. Typically, surgery is the most effective option, but the extent and type will depend on the location of the tumors and stage. Some options for surgery include:
- Ureteroscopy — This is a minimally invasive procedure that uses a small scope to access the urinary tract, find the tumor, and remove or destroy it on the spot. It's typically only effective with low-grade UTUC.
- Ureterectomy — This involves removing part or all of the affected ureter while preserving the kidney. It can be an option for localized UTUC where the kidney function remains intact.
- Nephroureterectomy — This is the surgical removal of the affected kidney, ureter, and a portion of the bladder cuff. It's the standard treatment for high-grade UTUC or when the cancer is too extensive for more minimally invasive options. This procedure is often necessary to ensure complete removal of the tumor and reduce the risk of recurrence.
- Distal Resection — This is the surgical removal of the bottom part of the ureter that connects to the bladder. It's only performed when the tumor is localized but is preferable because it saves the kidney and ureter.
Immunotherapy
This treatment option focuses on using your own immune system to fight cancer. It includes taking certain medications or drugs called checkpoint inhibitors to help the immune system recognize and attack the cancer cells.
Chemotherapy
This involves the use of drugs to kill cancer cells or stop them from growing. Chemotherapy may be administered before surgery to shrink tumors or after surgery to eliminate any remaining cancer cells. It's particularly useful for high-grade UTUC or metastatic spread.
Radiotherapy
Radiation therapy uses high-energy rays to target and kill cancer cells. Although it's less common, it can be used as a primary treatment in patients who aren't candidates for surgery or in combination with other treatments to manage symptoms and control tumor growth.
An upper tract urothelial cancer diagnosis can be difficult to receive, but it's important to take a proactive approach to treatment and try to maintain a positive mindset. Regardless of whether you receive a urologic cancer diagnosis or are suffering from another urologic condition, Byram Healthcare provides high-quality, supportive urologic products to help you manage your symptoms. Contact us today to learn more.
