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Ureteral cancer is a rare type of cancer in which abnormal cells develop on the inner lining of the ureter (tubes that connect the kidneys to the bladder). Ureter is part of the urinary tract system, which transports urine from the kidneys to the bladder.
Ureteral cancer and bladder cancer are closely linked as the cells that line the lining of the bladder also line the ureters. Therefore, bladder cancer risk is significantly increased in people with ureteral cancer. Ureteral cancer commonly affects older adults or people who had been diagnosed with bladder cancer.
Treatment options for ureteral cancers are surgery, chemotherapy and immunotherapy.
Symptoms
Ureteral cancer signs and symptoms include:
- Painful urination
- Blood in the urine
- Unexplained weight loss
- Fatigue or weakness
- Lower back pain
If you are experiencing any persistent sign and symptoms, please consult a specialist for proper diagnosis.
Causes
The exact cause of ureteral cancer is unknown. When cells on the inner lining of the ureter experience changes (mutations) in their DNA, ureteral cancer develops. The instructions that inform a cell what to do are encoded in its DNA. The modifications instruct the cells to quickly multiply and to survive through their typical life cycle. The mass of ureteral cancer is growing abnormal cells that could block the ureter or it could spread to the other part of the body.
Risk factors
Ureteral cancer risk factors include the following:
- Age: Older adults at the age of 70 to 80 years old have higher risk to develop the disease.
- History of cancer: Ureteral cancer risk is higher in people who have been diagnose with bladder or kidney cancer.
- Family history: Family history of hereditary nonpolyposis colorectal cancer (HNPCC) or also known as Lynch syndrome are at higher risk to develop ureteral cancer.
- Smoking: Could cause a higher risk to develop ureteral cancer or kidney and bladder cancer.
Diagnosis
The following tests and procedures are used to diagnose ureteral cancer:
- Physical examination: The doctor will perform a physical assessment to evaluate the signs and symptoms.
- Imaging tests: Is recommended by the specialist to determine the severity of ureteral cancer by intravenous pyelograms and computed tomography (CT) urography. If you are unable to get computed tomography (CT) imaging, in some circumstances a magnetic resonance urogram may be used.
- Urine tests: This test is to check for any abnormalities at the urine. A urine sample can be examined using a urine cytology test to look for abnormal cells.
- Ureteroscopy: The specialist will insert a thin, lighted tube equipped with a camera into the urethra, which will allow the specialist to inspect the ureters, and if needed, to remove a small tissue sample for biopsy. The pathologist will analyze the tissue sample for any signs of cancer.
- Cystoscopy: Examination of the bladder using scope or an imaging test to visualize the inner part of the bladder, to check for any signs of bladder cancer. Ureteral cancer patients have a significant chance of developing bladder cancer.
Treatment
Surgery is frequently used to treat ureteral cancer. Ureter cancer treatment options will depend on the extent and location of the cancer, the aggressiveness of the cancer cells, and the personal preferences and goals of the patient.
Surgery
Surgical removal of ureteral cancer is recommended to treat the disease. At an early stage of ureteral cancer, surgical removal of a portion of the ureter may be recommended. However, if the cancer had become advanced or progress then “nephroureterectomy” is recommended. This is the removal of the affected kidney, ureter and part of the bladder.
Chemotherapy
This is drugs used in cancer treatment to kill the cancer cells. It can be used to reduce the size of the tumor before surgery so that it may be removed more easily. This method could also be utilized to continue eliminating any cancer cells that remained even after the surgery. Chemotherapy may be used to manage the signs and symptoms of advanced ureteral carcinoma.
Immunotherapy
Immunotherapy is a type of cancer treatment that relies on the function of the patient’s immune system. Typically, the immune system keeps monitoring and destroy all of the foreign substances, such as cancer cells. However, it cannot detect cancer cells. Immunotherapy helps to boost the effectiveness of the immune system to detect and fight against the cancer. In advanced ureteral cancer that has not responded to previous therapies, immunotherapy may be an alternative.
Follow up examination:
The specialist will plan a schedule for a follow-up examination after the initial treatment to check for any recurrence of the cancer cells. Since ureteral cancer have a higher risk of bladder cancer, these follow-up exams will also screen for any symptoms of bladder cancer. However, the patient should anticipate seeing the doctor on a few months basis for the first year, and less regularly after that.
