regional ureteric cancer

Regional ureteric cancer, also known as upper urinary tract urothelial cancer (UTUC), refers to a type of cancer that starts in the lining of the kidney or ureter [8]. It is a rare form of cancer, accounting for only 5-10% of all patients with urothelial carcinoma [12].

Regional ureteric cancer typically occurs when cancer cells from the renal pelvis or ureter grow into nearby tissue and destroy it, or when they spread to other parts of the urinary tract [6]. This type of cancer can be localised in the upper urinary tract, including the pyelocaliceal cavities and ureter.

Symptoms of regional ureteric cancer may include blood in the urine, back pain, cramps, and other urinary symptoms [5]. Treatment options for this type of cancer may include surgery, chemotherapy, or a combination of both [10].

It's worth noting that regional ureteric cancer is closely related to bladder cancer, as it can start in the renal pelvis, calyx, or ureters and extend to the bladder, referred to as descending tumors [14].

Common Signs and Symptoms of Regional Ureteric Cancer

Regional ureteric cancer, also known as upper urinary tract urothelial carcinoma, is a type of cancer that affects the ureters, which are tubes that connect the kidneys to the bladder. The symptoms of regional ureteric cancer can vary from person to person, but here are some common signs and symptoms:

• Blood in the urine: This is often the first symptom of regional ureteric cancer. The blood may make the urine look red, pink or cola-colored.
• Pain in the back: People with regional ureteric cancer may experience pain in their back that doesn't go away.
• Extreme tiredness: Fatigue is a common symptom of many types of cancer, including regional ureteric cancer.
• Discomfort or burning during urination: Some people may experience discomfort or burning sensations when they urinate.

Other Possible Symptoms

In addition to the above symptoms, some people with regional ureteric cancer may also experience:

• Dark urine: The urine may appear darker than usual due to the presence of blood.
• Urinary frequency and urgency: People with regional ureteric cancer may need to urinate more frequently or feel a sudden urge to urinate.
• Painful urination: Some people may experience pain or discomfort when they urinate.

Important Note

It's essential to note that these symptoms can also be caused by other conditions, and only a medical professional can diagnose regional ureteric cancer. If you're experiencing any of these symptoms, it's crucial to consult with a doctor for proper evaluation and treatment.

References:

• [1] Symptoms of upper urinary tract urothelial cancer.
• [3] •A cancer that begins in cells in the renal pelvis and ureter, which are part of the upper urinary tract
• [5] Signs and Symptoms of Ureteral and Renal Pelvic Cancer · Dark urine · Urinary frequency and urgency · Pain or burning sensations when urinating · Urinary hesitancy ...
• [6] Signs and Symptoms · Blood or blood clots in the urine · Cramps or back pain · Dark urine · Discomfort or burning during urination · Fatigue · Frequent or urgent ...
• [7] Symptoms of Renal Pelvis and Ureter Cancers​​ Blood in the urine is usually the first symptom. People may also have pain and burning during urination and an ...

Diagnostic Tests for Regional Ureteric Cancer

Regional ureteric cancer, also known as transitional cell cancer of the renal pelvis and ureter, requires a combination of medical history, physical examination, and diagnostic tests to diagnose. Here are some of the key diagnostic tests used:

• Imaging tests: These make pictures of the body and can help understand the size of the cancer. Imaging tests used for ureteral cancer may include:
  • Intravenous pyelogram (IVP)
  • Computerized tomography urogram (CT urogram)
  • Ultrasound
• Blood tests: Blood tests are done to check for any abnormalities in the blood that could indicate cancer.
• Urinalysis and urine cytology: A sample of urine is taken from the patient and evaluated for cancer cells. This test can help diagnose ureteral cancer early on.
• Cystourethroscopy: A direct visual inspection of the urethra and bladder is done to check for any abnormalities.

Accuracy of Diagnostic Tests

The accuracy of these diagnostic tests varies, but some are more effective than others in establishing a diagnosis. For example:

• Retrograde urography: This test is more than 75% accurate in establishing a diagnosis of urothelial cancer (Source: [8])
• Urinalysis and urine cytology: These tests can help diagnose ureteral cancer early on, but their accuracy may vary depending on the individual case.

Staging Classification

The Tumor-Node-Metastasis (TNM) staging classification is used to stage ureteral cancers. This system helps determine the extent of the disease and guide treatment decisions.

• Local cancer: Cancer has not spread beyond the kidney or ureter.
• Regional cancer: Cancer has progressed into the tissue surrounding the kidney and/or neighboring structures.

References

[8] Apr 7, 2023 — Overall, retrograde urography is more than 75% accurate in establishing a diagnosis of urothelial cancer. Left retrograde ureterogram (Source: [8]) [12] A combination of blood tests, urinalysis, ultrasound, and imaging scans help a physician make a diagnosis. ... and has not spread beyond the kidney or ureter. Regional cancer has progressed into the tissue surrounding the kidney and/or neighboring structures (Source: [12])

Treatment Options for Regional Ureteral Cancer

Regional treatment for transitional cell cancer of the renal pelvis and ureter involves placing chemotherapy or immunotherapy directly into the renal pelvis or the ureter to mainly affect cancer cells in those areas [2]. This approach is used to treat cancer that has spread to the regional lymph nodes.

Chemotherapy Options

The most commonly used chemotherapy agents for treating regional ureteral cancer are mitomycin and gemcitabine [9]. These drugs can be administered directly into the renal pelvis or the ureter through a catheter, allowing them to target cancer cells in that area. In some cases, systemic chemotherapy may also be recommended depending on the severity and recurrence of the disease.

Immunotherapy

Immunotherapy helps a person's immune system fight cancer [2]. This approach can be used in conjunction with chemotherapy or as a standalone treatment for regional ureteral cancer.

Targeted Therapy

Targeted therapy involves using medications that specifically target cancer cells, reducing harm to healthy cells. This approach is still being researched and developed for treating regional ureteral cancer.

References: [2] - Regional treatment for transitional cell cancer of renal pelvis and ureter is a method of placing the chemotherapy or immunotherapy drug directly into the renal pelvis or the ureter to mainly affect cancer cells in those areas. [9] - Most commonly used chemotherapy agents are mitomycin and gemcitabine.

The differential diagnosis for regional ureteric cancer involves considering various conditions that can cause similar symptoms and signs. According to the provided context, the key differential diagnosis issues for ureteral diseases include:

• Stones: This is the most common cause of ureteral obstruction and dilatation.
• Clot: Blood clots can also cause ureteral obstruction and dilatation.
• Gas bubbles: Gas bubbles in the urine can also cause ureteral dilatation.
• Tumor: Ureteric cancer or tumors of the renal pelvis are less common but should be considered in the differential diagnosis.

These conditions can often present with similar symptoms such as hematuria (blood in the urine), flank pain, and urinary obstruction. Therefore, a thorough evaluation is necessary to differentiate between these conditions and ureteric cancer.

Key points:

• Stones are the most common cause of ureteral obstruction and dilatation.
• Clot, gas bubbles, and tumor should also be considered in the differential diagnosis.
• A thorough evaluation is necessary to differentiate between these conditions and ureteric cancer.

[Citations]

• [4] - Stones > clot > gas bubbles > tumor
• [9] - Most ureteral diseases result in dilatation of some or all of the ureter.