ureteric orifice cancer

Ureteric Orifice Cancer: An Overview

Ureteric orifice cancer, also known as ureteral cancer, is a rare type of cancer that affects the ureters, which are the tubes that connect the kidneys to the bladder. This condition is closely related to bladder cancer and can have similar symptoms.

Definition and Incidence Ureteric orifice cancer is defined as a malignant neoplasm of the ureteric orifice [2]. It is uncommon and occurs mostly in older adults, with some cases linked to previous treatment for bladder cancer. According to various sources, 22-47% of ureteral cancers are related to bladder cancer [3].

Symptoms and Diagnosis The symptoms of ureteric orifice cancer may include bleeding or trouble with urination [6]. Tests that examine the urethra and bladder are used to diagnose this condition.

Stages and Treatment Options The stages of ureter cancer are determined by the size of the malignancy and whether or not the cancer cells have spread past the ureter or renal pelvis. Treatment options for ureteral cancer include surgery, chemotherapy, immunotherapy, and targeted therapy [15]. The choice of treatment depends on various factors, including the size and location of the cancer, how aggressive the cells are, and individual patient preferences.

Relationship with Other Cancers Ureteric orifice cancer is closely related to bladder cancer and can have similar symptoms. It is also associated with upper urinary tract urothelial cancer (UTUC), which affects the renal pelvis and ureters [14].

Prevalence and Statistics According to integrated disease information, approximately 4,010 Americans will be diagnosed with cancer of the ureter/other urinary organs in 2022 [12]. This highlights the relatively rare nature of this condition.

References:

[1] Cited by 9 - Urothelial carcinoma (UCa) is the ninth most common malignancy worldwide and has a higher incidence in the Western world. [2] Definition. Evidence of a malignant neoplasm of the ureteric orifice. [from NCI]. [3] Ureteral cancer is uncommon and occurs mostly in older adults and in those who previously treated for bladder cancer. [6] Signs of urethral cancer include bleeding or trouble with urination. [12] Approximately 4,010 Americans will be diagnosed with cancer of the ureter/other urinary organs in 2022. [14] Upper urinary tract urothelial cancer (UTUC) is cancer that starts in the upper urinary tract. This is made up of the ureters and an area of the kidneys called the renal pelvis. [15] Treatment options for ureteral cancer include surgery, chemotherapy, immunotherapy and targeted therapy.

Common signs and symptoms of ureteric orifice cancer include:

• Blood in urine: This is the most common symptom, as mentioned in [5] (visible blood in the urine) and [9] (blood in your urine).
• Pain: Pain can occur in the lower back, abdomen, or groin area, depending on the location of the tumor. This is mentioned in [7] (pelvic or bony pain, lower-extremity edema, or flank pain).
• Urinary tract infections: These can be caused by a block

To diagnose cancer of the ureteral orifice, several diagnostic tests and procedures can be employed. Here are some of them:

• Urine tests/urinalysis: This checks for blood and other substances in your urine that may indicate the presence of cancer [13].
• Cystoscopy: A thin tube with a lens is inserted through the urethra into the bladder, allowing the urologist to examine the area for abnormalities. This exam can be done in the doctor's office or hospital [13].
• Ureteroscopy: This procedure involves inserting a small scope through the urethra and bladder into the ureters to visually inspect the area for tumors or other abnormalities [7, 3].
• Imaging tests: These may include intravenous pyelogram (IVP), computerized tomography urogram (CTU), and magnetic resonance imaging (MRI) to help visualize the tumor and assess its size and location [10, 5].
• Biopsy: A tissue sample is taken from the affected area for further examination under a microscope. This is usually done during cystoscopy or ureteroscopy [8, 14].

It's worth noting that the choice of diagnostic test may depend on various factors, such as the patient's overall health, the suspected location and size of the tumor, and the doctor's experience and expertise.

References:

[3] Principles of RNU include complete excision of ipsilateral upper tract urothelium, including the intramural portion of the ureter and ureteral orifice with negative margins, and avoidance of urinary spillage, such as by early low ligation of the ureter, to minimize the risk of seeding urothelial cancer outside the urinary tract.

[5] Imaging in the Diagnosis, Staging, and Follow-Up of Cancer of the Urinary Tract.

[7] Doctors may use the following tests and procedures to diagnose urothelial carcinoma: Urine tests/urinalysis. This checks for blood and other substances in your urine that may indicate the presence of cancer.

[8] No wire is passed prior to ureteroscopy and the ureteral orifice is ideally entered without the use of dilation.

[10] Imaging tests make pictures of the body. They may help your healthcare team better understand the size of the cancer.

[13] Doctors may use the following tests and procedures to diagnose urothelial carcinoma: Urine tests/urinalysis. This checks for blood and other substances in your urine that may indicate the presence of cancer.

[14] (f) The papillary tumor in the dilated right ureteral orifice after the first resection procedure (at 9 s in Video S2).

Based on the provided context, it appears that surgery is the primary treatment for cancer of the ureteric orifice, rather than drug treatment.

• According to search result 6, tumors involving the ureteral orifice were treated with wide, deep resection, including the entire orifice area.
• Search result 3 mentions that resection of the distal ureter and its orifice is performed because there is a considerable risk of tumour recurrence in this area and in the bladder.

However, chemotherapy can be used as a second-line treatment for patients whose cancer has progressed. According to search result 2, chemotherapy is sometimes used when the cancer has spread or come back.

• Search result 7 mentions that systemic treatments, including chemotherapy, are used in the first-line setting for distant metastases.
• Search result 4 mentions that URANUS trial aims to explore the feasibility of treatment options based on real-world data, but it does not specifically mention drug treatment for ureteric orifice cancer.

It's worth noting that targeted therapy and immunotherapy may also be used as treatment options for ureteral cancer, including ureteric orifice cancer. According to search result 11, these treatments are considered in addition to surgery.

• Search result 11 mentions that treatment options for ureteral cancer include surgery, chemotherapy, immunotherapy, and targeted therapy.
• However, it does not specifically mention drug treatment as a primary option for ureteric orifice cancer.

In summary, while there is some mention of chemotherapy and other treatments being used in the context of ureteral cancer, it appears that surgery is still the primary treatment for cancer of the ureteric orifice.

The differential diagnosis for ureteral orifice cancer includes various conditions that can mimic or be associated with this type of cancer.

• Bladder tumors: The resection of the ureteral orifice has oncological and functional consequences, such as development of upper tract urothelial carcinoma (UTUC), vesicoureteral reflux or ureteral stenosis [10].
• Squamous cell carcinoma of the bladder: This type of cancer can involve the ureteral orifice and may be considered in the differential diagnosis.
• Adenocarcinoma of the bladder: Another type of bladder cancer that can be associated with the ureteral orifice.
• Benign conditions: Such as benign tumors, stones, or other obstructions that can cause symptoms similar to those of ureteral orifice cancer.

It's essential to note that a complete work-up is required for all cases of haematuria (blood in the urine) to evaluate for potential bladder cancer and rule out these differential diagnoses [9].

In addition, the imaging appearance of ureteral orifice cancer can be diagnostic, but multiple urothelial cancers should also be considered in the differential diagnosis. The disease progression can result from reflux of urine from the bladder or as a result of topical treatment of a ureteral cancer [15].