Ureteral/Renal Pelvis Cancer


Cancer of the ureter or renal pelvis typically originates in the lining or urothelium. Greater than 90% of these tumors are urothelial (transitional cell) carcinomas similar to what is typically found in bladder cancer due to the fact that the lining of these different structures have a similar embyologic origin.

Patients who have tumors of the ureter or renal pelvis can have bladder tumors in up to 40-50%. However, patients who have bladder tumors less commonly have tumors of the ureters or renal pelvis.

Risk Factors

  • Environmental carcinogens
  • Balkan Endemic Nephropathy
  • Lynch Syndrome
  • arsenic exposure
  • Pphenacetin use
  • Chinese Herb Nephropathy


  • Urothelial (Transitional Cell) Carcinoma- >90%
  • Squamous Cell Carcinoma approximately- 8%
  • Adenocarcinoma-Rare

Staging (TNM)

Primary Tumor (T):

  • TX-primary tumor cannot be assessed
  • T0-No evidence of primary tumor
  • Ta-papillary non-invasive tumor
  • T1-tumor invades the subepithelial connective tissue
  • T2-Tumor invades the muscularis
  • T3-Renal Pelvis Only—Tumor invades beyond the muscularis into peri-pelvic fat or the renal parenchyma. Ureter Only—Tumor invades beyond the muscularis into peri-ureteric fat.
  • T4-Tumor invades adjacent organs or through the kidney into the perinephric fat.

Regional Lymph Nodes (N):

  • Nx-Lymph nodes cannot be assessed
  • N0-no lymph node metastasis
  • N1-Metastasis in single lymph node 2cm or less in greatest dimension.
  • N2-Metastasis in single lymph node >2cm but not >5cm in greatest dimension, or multiple lymph nodes, none >5cm in greatest dimension.
  • N3-Metastasis in a lymph node >5cm in greatest dimension.

Distant Metastasis (M):

  • M0-No distant metastasis
  • M1-Distant metastasis


  • General labs (i.e. electrolytes, blood count, kidney function)
  • Cystourethroscopy and ureteroscopy (i.e. scoping of the entire urinary tract). Biopsy or brush biopsy can be performed at the time of scoping. Urine can also be obtained directly from the upper tract via scopes which can be sent for urine cytology to look for tumor cells in the urine.
  • Urine tests: urinalysis, urine culture and sensitivity, and urine cytology to look for tumor cells in the urine. At times, other urine biomarkers may be used.
  • Imaging of the upper and lower urinary tract: CT scan, MRI, IVP, retrograde pyelography (i.e. imaging performed at the time of scoping of the urinary tract)

Treatment Options

  • Management depends upon the stage of the lesion and the location of the lesion, but typically requires some form of surgical management.
  • Small, solitary, low stage lesions can be treated with limited resection or ablation (i.e. segmental ureterectomy, laser ablation, or fulguration) after appropriate tissue sampling of the lesion.
  • More advanced lesions require more aggressive surgical management (i.e. Nephroureterectomy commonly with a regional lymph node dissection which can be performed in an open, laparoscopic, or robotic-assisted laparoscopic fashion). Some patients may require neoadjuvant therapy (i.e. treatment before surgery) or adjuvant therapy (i.e. treatment immediately after surgery) with chemotherapy and/or radiation depending on clinical disease features.
  • Metastatic lesions are typically treated with up-front chemotherapy

Recommended Follow-up

  • Patients are typically followed with upper tract imaging (i.e. CT, MRI, IVP, retrograde pyelography) to evaluate the remaining portions of upper tract urothelium both for the affected kidney and the opposite kidney.
  • The lower urinary tract will need to be monitored with cystourethroscoping (i.e. scoping)
  • Urine cytology will need to be sent regularly to look for tumor cells in the urine. At times other urine biomarkers may be used as well.