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Ureteral Carcinoma

Ureter Carcinoma

Ureteral carcinoma is a type of malignancy involving the ureter. The condition is rare, and the vast majority of tumors are transitional cell carcinomas (TCC) of the ureter, classified under the wider category of urothelial tumors of the ureter.


Presentation

Ureteral carcinoma is a tumor that may be located in any part of the ureter. This malignancy is commonly referred to as urothelial tumor of the renal pelvis and ureter; the greatest majority of the neoplasms are of urothelial nature and isolated ureteral cancer is a rare medical occurrence with few pertaining literary documentations [1].

The predominant manifesting symptom of a primary ureteral carcinoma is gross hematuria, often with no other accompanying symptoms, either specific to a urinary tract pathology or constitutional [2]. The second most frequently reported complaint is a flank pain, observed in 1 in 5 patients diagnosed with a ureteral carcinoma [3]. Flank pain can be initially misdiagnosed as originating from an episode of renal colic due to ureterolithiasis, and in a case of ureteral carcinoma, the painful feeling is attributed to blood clots forming in the area. An equal percentage of patients also present with a palpable lumbar mass and less than 10% report dysuric symptoms, such as pain or burning upon urination and an increased frequency to urinate. Generalized manifestations such as weight loss and skeletal pain are rarely documented and are a sign of progressed malignant disease.

A ureteral carcinoma can also occur as a metastatic tumor, in which case most patients report no symptomatology and are diagnosed incidentally [4] [5]. The minority of patients who experience cancer-related symptomatology present with dysuric symptoms consistent with a renal colic due to obstruction (flank pain) or a urinary tract infection. Hematuria is also a symptom of a metastatic ureteral carcinoma and, in the uncommon case where the ureters are bilaterally affected, patients may present with anuria [6] [7].

Soft Tissue Mass
  • If hydronephrosis and hydroureter are present then careful examination of the transition point for a soft tissue mass should be carried out.[radiopaedia.org]
  • Computed Tomography (CT) showed an ill-defined soft tissue mass in the left ureter. A left retrograde pyelogram revealed a mass 4 cm from the ureterovesical junction, with ureter dilation proximal to it.[omicsonline.org]
  • tissue mass occupying the dilated renal pelvis (*). b) Axial image caudal to (a) demonstrates dilated proximal part of retrocavacal ureter (*).[latunisiemedicale.com]
  • Metastatic lesions show focal circumferential thickening of the ureter (involvement of transmural involvement of the ureteral wall) that may be associated with ill-defined extraluminal soft tissue (infiltration of the periureteric soft tissue) masses.[read.nxtbook.com]
Recurrent Urinary Tract Infection
  • Eighty days after transplantation complete obstruction of the proximal ureter was observed, complicated by recurrent urinary tract infections.[ncbi.nlm.nih.gov]
  • The other clinical features included recurrent urinary tract infections, microscopic or gross haematuria as in our reported case 7. Imagings are usually sufficient to make diagnosis of retrocaval ureter.[latunisiemedicale.com]
  • urinary tract infection ; urethral discharge and swelling". [4] Risk factors [ edit ] Tobacco smoking is associated with an increased risk of ureteral cancer. [5] Diagnosis [ edit ] Example of ureteral cancer Diagnosis may include a fluorescence in situ[en.wikipedia.org]
  • Regarding risk factors, tobacco smoking was referred by 66% of the patients and 33% had recurrent urinary tract infections or calculi. In one patient there was an hereditary nonpolyposis colorectal cancer syndrome associated (3%).[scielo.br]
Intravenous Administration
  • Seven patients were studied by an intravenous administration method. The RII results of three cases with primary or recurrent bladder cancer and three cases with ureteral cancer were confirmed histologically.[ncbi.nlm.nih.gov]
Painter
  • Dry Cleaners Painters Autoworkers Truck drivers Paper manufactures Metal workers Plumbers Hairdressers Tire and rubber workers Chemical workers Petroleum workers Often times a CT scan, usually a CT urogram is done.[saintjohnscancer.org]
Metal Worker
  • Dry Cleaners Painters Autoworkers Truck drivers Paper manufactures Metal workers Plumbers Hairdressers Tire and rubber workers Chemical workers Petroleum workers Often times a CT scan, usually a CT urogram is done.[saintjohnscancer.org]
Abdominal Pain
  • Two of the three patients had abdominal pain, while the other patient had no upper urinary tract symptoms. All patients had excretory urograms that showed delayed or no excretion of contrast medium on the side of obstruction.[jamanetwork.com]
  • The edema of her right lower limb and right lower quadrant abdominal pain were palliated. On September 2009, computed tomography scan of pelvis showed no obvious abnormalities.[ncbi.nlm.nih.gov]
  • Symptoms resulting from local tumor extension include hematuria, abdominal pain, and a flank mass.[clinicalgate.com]
Left Flank Pain
  • The clinical symptom was just left flank pain. Imageology examination showed the hydronephrosis and occupied lesions. Compared with other cases, this one is maybe in an early stage of the tumour.[wjso.biomedcentral.com]
Hematuria
  • Gross hematuria was present in all the patients. Three cases had multicentric tumor sites. Three tumors were located in the distal ureter. Four cases showed a non functioning kidney at IVP.[ncbi.nlm.nih.gov]
  • Hematuria is also a symptom of a metastatic ureteral carcinoma and, in the uncommon case where the ureters are bilaterally affected, patients may present with anuria.[symptoma.com]
  • The clinical signs were hematuria and flank pain. Urine cytology and IVU were diagnostic in a limited number of cases. Retrograde pyelography was very helpful. CT showed to be the image modality of choice for diagnosis and preoperative staging.[ncbi.nlm.nih.gov]
  • The patient had recurrent pyelonephritis, hematuria and renal colic. Urography shows no function on right side. Abdominal ultrasound revealed marked right hydronephrosis. Antegrade ureterography through nephrostomy revealed a RCU.[ncbi.nlm.nih.gov]
  • We report a solitary metachronous metastatic RCC in the contralateral ureter 14 months after right radical nephrectomy for Fuhrman grade 2 pT3a clear cell disease after the patient re-presented with gross hematuria.[ncbi.nlm.nih.gov]
Flank Pain
  • The second most frequently reported complaint is a flank pain, observed in 1 in 5 patients diagnosed with a ureteral carcinoma.[symptoma.com]
  • He presented with bilateral flank pain accompanied by nausea, vomiting and oliguria. Bilateral hydronephrosis with upper ureteral filling defects was found on antegrade pyelogram.[ncbi.nlm.nih.gov]
  • The clinical signs were hematuria and flank pain. Urine cytology and IVU were diagnostic in a limited number of cases. Retrograde pyelography was very helpful. CT showed to be the image modality of choice for diagnosis and preoperative staging.[ncbi.nlm.nih.gov]
  • We report a 70-year-old woman who presented with left-sided flank pain. The clinical impression and diagnosis following renal ultrasound was of a calculus in the distal left ureter.[bjuinternational.com]
  • Clinical presentation is relatively non-specific, most frequently consisting of hematuria and/or flank pain due to obstructive hydronephrosis. Clots may cause renal colic and mimic ureterolithiasis.[radiopaedia.org]
Bilateral Flank Pain
  • He presented with bilateral flank pain accompanied by nausea, vomiting and oliguria. Bilateral hydronephrosis with upper ureteral filling defects was found on antegrade pyelogram.[ncbi.nlm.nih.gov]
  • Case Report A 70 year-old Saudi male patient, with past history of bronchial asthma, presented to the Emergency Room (ER) with a history of bilateral flank pain for 2 weeks.[omicsonline.org]
Oliguria
  • He presented with bilateral flank pain accompanied by nausea, vomiting and oliguria. Bilateral hydronephrosis with upper ureteral filling defects was found on antegrade pyelogram.[ncbi.nlm.nih.gov]
Adnexal Mass
  • A right complex adnexal mass and right hydroureter and hydronephrosis in an atrophic nonfunctioning right kidney was found during evaluation for the back pain.[ncbi.nlm.nih.gov]

Workup

The complete workup involved in diagnosing a ureteral carcinoma consists of blood laboratory testing, imaging modalities and histopathologic assessment of the lesion.

Laboratory testing aims at the evaluation of the general patient status as well as kidney function. A complete blood count and biochemical profile are performed, alongside prothrombin time, international normalized ratio and activated partial thromboplastin time tests, in order to eliminate potential abnormalities in the coagulation process. Urinalysis is a basic initial test since it allows for the confirmation of hematuria and helps to rule out a simple urinary tract infection that could account for the same symptoms elicited by a ureteral carcinoma. As far as imaging is concerned, excretory urography has been presently replaced to a large extent by computerized tomography (CT). A CT urogram that focuses extensively on the excretory stage of urination can illustrate tumors of the ureters, primarily those that are larger than 5 mm in size. CT scans also aid in determining the extent to which a malignancy has spread peripelvically or periureterally, although it contributes very little to the staging process of a transitional cell carcinoma.

Cytology evinces a satisfactory accuracy rate in diagnosing high-grade ureteral carcinomas and more aggressive disease, whereas, in the case of low-grade malignant lesions, the analysis renders cancer-negative results in most of the samples [8]. Low-grade neoplastic lesions are better detected with the use of fluorescence in situ hybridization (FISH) [9] [10]. Ureteroscopy is usually also employed in order to directly visualize a ureteral carcinoma [11].

Treatment

  • CONCLUSION: The conservative treatment of patients presenting with superficial ureteral lesions seems to be a good alternative to radical surgery.[ncbi.nlm.nih.gov]
  • Percutaneous perfusion of mitomycin C appears to be one of the effective and safe treatments for the carcinoma in situ of the upper urinary tract.[ncbi.nlm.nih.gov]
  • Since ureteral carcinoma in situ at the time of cystectomy for bladder cancer has had little influence on the course of these patients, conservative treatment is probably indicated when the lesion is encountered.[ncbi.nlm.nih.gov]
  • However, it represents a feasible and effective alternative for the treatment of LG-UC in distal ureter, as long as the oncological and reconstructive principles are respected.[elsevier.es]
  • Positive cytology and upper tract carcinoma recurrence were not significantly associated with ureteral margin status, clinical or pathological bladder tumor stage or prior bacillus Calmette Guerin treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Being grade and stage closely related to prognosis, the diagnostic delay must be reduced.[ncbi.nlm.nih.gov]
  • Evaluation of these cases shows that grades III and IV lesions have a poorer prognosis than grades I and II and that staging in ureteral tumors is a difficult task and unreliable for predicting survival.[ncbi.nlm.nih.gov]
  • Prognosis appears to be determined by the bladder tumor.[ncbi.nlm.nih.gov]
  • The prognosis of patients with papillomas or grades 1 to 3, stages Pa to P1 ureteral tumors was excellent and a conservative approach is recommended for these patients.[ncbi.nlm.nih.gov]
  • Prognosis depends on the stage of the tumor (see staging of TTCs of the ureter ) and histological grade (see grading of TCCs ) has little influence 3 . Metastases are most frequently to liver, bone, and lung 4 . Promoted articles (advertising)[radiopaedia.org]

Etiology

  • Frequency, etiology, clinical, diagnostic findings and surgical therapy as well have all been taken into account, based on the literature. Histopathologic aspects, grade and stage, are considered too.[ncbi.nlm.nih.gov]
  • Critical evaluation of environmental exposure agents suspected in the etiology of Balkan endemic nephropathy. Int J Occup Environ Health. 2006;12(4):369–76. PubMed 6. Grollman AP, Shibutani S, Moriya M, et al.[springermedizin.at]
  • Duplicated kidney is the most common congenital anomaly of urinary tract occurring in about 0.8% of general population. 1 It has certain associated anomalies and complications, but ureteral cancer in duplicated kidney is rarely reported. 2 , 3 Although no etiologic[academic.oup.com]
  • Globally, the incidence rate of RCC is the highest in North America and Scandinavia and the lowest is in Asia and South America. 12 Etiology Cigarette smoking and obesity are two well-established risk factors for RCC, and each may increase the risk of[clinicalgate.com]

Epidemiology

  • Epidemiology of transitional cell carcinomas of the renal pelvis are similar to those of the rest of the urinary tract: please refer to TCCs of urinary tract for further details.[radiopaedia.org]
  • Epidemiological aspects of Balkan endemic nephropathy in a typical focus in Yugoslavia. IARC Sci Publ. 1991;115:5–10. PubMed 34. Bukvic D, Jankovic S, Markovic -Denic Lj.[springermedizin.at]
  • Kidney Epidemiology Kidney cancer comprises approximately 3% of new cancer cases and 3% of cancer deaths in the United States each year. 1, 5 In 2010 there were approximately 58,240 new cases of kidney and renal pelvis cancer diagnosed in the United States[clinicalgate.com]
Sex distribution
Age distribution

Pathophysiology

  • Conclusion: The pathogenesis and pathophysiology of PTTM remains obscure with no effective management available.[karger.com]

Prevention

  • Simultaneously, we used laser to cut the suspicious mucosa around the tumour and then indwelled double-J stent to prevent ureteral obstruction.[wjso.biomedcentral.com]
  • […] strategies Discussion of the benefits and limitations of genetic testing Genetic testing, if appropriate Opportunity to participate in research studies focused on cancer risk and prevention Make an Appointment Please call Laura Gross, BA (Program Manager[hospitals.jefferson.edu]
  • The drugs kill cancer cells, preventing them from dividing and spreading further. Read more Meet our doctors Everything we do is focused on designing better care for our patients.[genesiscare.co.uk]
  • Radioactive implants may be considered to help prevent metastases. A patient with an early diagnosis and comprehensive therapy may achieve a long-term relative survival . Conflict of interest : There are no conflicts of interest in this study.[bjuinternational.com]

References

Article

  1. Ito Y, Kikuchi E, Tanaka N, et al. Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma. J Urol. 2011;185:1621–1626.
  2. Jang H, Yuk SM, Kim JO, Han DS. A rare case of primary malignant small cell carcinoma combined with urothelial cell carcinoma in the ureter. World J Surg Oncol. 2013; 11: 181.
  3. Xiong X, Jia L, Wang J. Primary adenocarcinoma of the renal pelvis, ureter and the urinary bladder: A case report and review of the literature. Oncol Lett. 2016 Mar; 11(3): 1811–1814.
  4. Cohen WM, Freed SZ, Hasson J. Metastatic cancer to the ureter: a review of the literature and case presentations. J Urol. 1974;112:188–189.
  5. Winalski CS, Lipman JC, Tumeh SS. Ureteral neoplasms. Radiographics. 1990;10:271–283.
  6. Richie JP, Withers G, Ehrlich RM. Ureteral obstruction secondary to metastatic tumors. Surg Gynecol Obstet. 1979;148:355–357.
  7. Puech JL, Song MY, Joffre F, et al. Ureteral metastases- computed tomographic findings. Eur J Radiol. 1987;7:103–106.
  8. Brien JC, Shariat SF, Herman MP, Ng CK, Scherr DS, Scoll B. Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol. 2010 Jul. 184(1):69-73.
  9. Luo B, Li W, Deng CH, Zheng FF, Sun XZ, Wang DH. Utility of fluorescence in situ hybridization in the diagnosis of upper urinary tract urothelial carcinoma. Cancer Genet Cytogenet. 2009 Mar. 189(2):93-7.
  10. Mian C, Mazzoleni G, Vikoler S, Martini T, Knuchel-Clark R, Zaak D. Fluorescence in situ hybridisation in the diagnosis of upper urinary tract tumours. Eur Urol. 2010 Aug. 58(2):288-92.
  11. Sarosdy MF, Kahn PR, Ziffer MD, Love WR, Barkin J, Abara EO. Use of a multitarget fluorescence in situ hybridization assay to diagnose bladder cancer in patients with hematuria. J Urol. 2006 Jul. 176(1):44-7.

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Last updated: 2018-06-22 05:52