Section 11. Kidney and Urinary Tract Disorders

Chapter 151. Cancers of the Kidney and Urinary Tract

Topics: Introduction | Kidney Cancer | Cancers of the Renal Pelvis and Ureter | Bladder Cancer | Cancer of the Urethra

Cancers of the Renal Pelvis and Ureter

Cancer can occur in the cells lining the central collecting area of the kidney (the renal pelvis--called transitional cell carcinoma of the renal pelvis) and in the slender tubes that carry urine from the kidney to the bladder (ureters). Cancers of the renal pelvis and ureter are much less common than cancers of the rest of the kidney or bladder; they probably occur in fewer than 6,000 people in the United States each year.

Symptoms and Diagnosis

Blood in the urine is usually the first symptom. Crampy pain in the flank (the space between the ribs and hip) or lower abdomen may occur if the flow of urine is obstructed.

The diagnosis is made by intravenous urography or retrograde urography. Computed tomography (CT) can help a doctor distinguish a kidney stone from a cancer or blood clot and may help show how much the cancer has grown. Microscopic examination of a urine sample may show cancer cells. A flexible viewing tube--a ureteroscope or nephroscope--threaded up through the bladder or passed through the abdominal wall may be used to view, and occasionally even treat, small cancers.

Treatment and Prognosis

If the cancer has not spread beyond the area of the renal pelvis and ureter, the usual treatment is surgical removal of the entire kidney and ureter (nephroureterectomy) along with a small part of the bladder. However, in some situations--for example, when the kidneys are not functioning well or a person has only one kidney--the kidney is usually not removed, because the person would then become dependent on dialysis. Some cancers in the renal pelvis and ureter may be treated with a laser to destroy the cancer cells or with surgery that removes only the cancer itself while leaving the kidney, the noncancerous portion of the ureter, and the bladder in place. If the cancer has spread, chemotherapy is used.

A person may be cured if the cancer has not spread and if it can be completely removed surgically. A cystoscopy (insertion of a flexible viewing tube to examine the inside of the bladder) is performed periodically after surgery, because people who have had this type of cancer are at risk of developing bladder cancer.