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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].

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]
  • She had previously been treated five times by her local general practitioner for recurrent urinary tract infections. The only relevant finding on clinical examination was that of an ill-defined left flank mass with pain on palpation.[liebertpub.com]
  • 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]
Hyperthermia
  • CASE REPORT: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years and had received treatment for urinary infections a number of times.[scielo.br]
  • One such therapy includes chemo-hyperthermia, which may be an effective treatment but requires additional study and is not currently available in the U.S. 158 Patients with higher-risk features, such as persistent high-grade T1 disease on repeat resection[auanet.org]
Amyloidosis
  • ’s disease and tuberculosis. 4 Localized amyloidosis is much less common than systemic amyloidosis and occurs in about 10-20% of amyloidosis cases. 3,5 This condition can occur in the lungs, trachea, larynx, tongue, skin, nervous system, gastrointestinal[appliedradiology.com]
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]
  • A 79-year-old woman visited her home doctor with the chief complaint of right lower abdominal pain. Abdominal computed tomographic scan (CT) disclosed a tumor measuring about 5 cm in diameter at the right lower quadrant of the abdomen.[ncbi.nlm.nih.gov]
  • If papillary urothelial carcinoma spreads, it can cause other signs and symptoms, including: loss of appetite swelling in feet pelvic pain abdominal pain tiredness jaundice fever weight loss Bladder cancer overview Bladder cancer can affect any part of[medicalnewstoday.com]
  • At about 12 months after surgery, the patient had symptoms of frequent urination, urgency, dysuria, and abdominal pain.[dovepress.com]
Left Flank Pain
  • This is the case report of a 69‑year‑old male patient who presented with left flank pain and gross hematuria. Following diagnosis of ureteral carcinoma, nephroureterectomy was performed.[spandidos-publications.com]
  • Case Presentation A 39-year-old, HIV-negative woman presented with a 1-year history of worsening left flank pain, intermittent visible hematuria, and a fullness in the left flank.[liebertpub.com]
  • 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.[ncbi.nlm.nih.gov]
Myalgia
  • The patient tolerated adjuvant chemotherapy and radiation therapy well, with no significant side effects or adverse reactions, except for intermittent nausea, vomiting and generalized myalgia.[wjso.biomedcentral.com]
  • Side effects and complications of intravesical BCG The following side effects and complications can be seen after intravesical instillation of BCG: Flu-like symptoms: fever, malaise, fatigue, myalgias, arthralgias.[cancertherapyadvisor.com]
Arthritis
  • […] primary or secondary disease. 1 Primary amyloidosis is associated with immune dyscrasias, such as multiple myeloma and Waldenström’s macroglobulinemia, 2,3 while secondary amyloidosis is associated with chronic inflammatory conditions, such as rheumatoid arthritis[appliedradiology.com]
Hematuria
  • 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]
  • 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]
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]
  • 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]
  • The patient is a 70 year-old man who presented with bilateral flank pain. Laboratory investigations showed high serum creatinine. There was left hydronephrosis on ultrasonography.[omicsonline.org]
Macroscopic Hematuria
  • However, on urinalysis, there was macroscopic hematuria and 40–50 white blood cells per high-power field.[spandidos-publications.com]
  • The vast majority of patients with bladder cancer present with microscopic or macroscopic hematuria (85%). Intermittent painless gross hematuria is the most common presentation.[cancertherapyadvisor.com]
  • Rhéaume-Lanoie J, Lepanto L, Fradet V et al: Diagnostic performance of ultrasound for macroscopic hematuria in the era of multidetector computed tomography urography. Can Assoc Radiol J 2014; 65: 253.[auanet.org]
Pelvic Pain
  • If papillary urothelial carcinoma spreads, it can cause other signs and symptoms, including: loss of appetite swelling in feet pelvic pain abdominal pain tiredness jaundice fever weight loss Bladder cancer overview Bladder cancer can affect any part of[medicalnewstoday.com]
  • Patients present with abnormal vaginal bleeding and can have pelvic pain from local spread of disease or inflammation (, 3 ).[pubs.rsna.org]
  • Diabetes mellitus Apex 3.3 Partial cystectomy TCC, G2, with squamous and glandular differentiation osteochondrosarcoma pT2 min N/A 38 (51) F/75 Hematuria, pelvic pain von Recklinghausen disease Left trigone 11 Cystectomy High grade TCC with glandular[onlinelibrary.wiley.com]
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]
  • The patient is a 70 year-old man who presented with bilateral flank pain. Laboratory investigations showed high serum creatinine. There was left hydronephrosis on ultrasonography.[omicsonline.org]

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].

Pyuria
  • CASE REPORT: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years and had received treatment for urinary infections a number of times.[scielo.br]
Left Shift of WBC
  • Because of clinical findings of fever, a left shift of WBCs, and elevation of C-reactive protein level, the condition of one of our patients ( Fig. 6 ) was diagnosed as a urinary tract infection.[ajronline.org]

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]
  • 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]
  • Radiographic features of the other imaging modalities may be nonspecific, but it is important for clinicians and radiologists to be cognizant of this disease so proper management and treatment may be provided.[appliedradiology.com]

Prognosis

  • Being grade and stage closely related to prognosis, the diagnostic delay must be reduced.[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]
  • […] urothelial carcinoma is not synonymous with WHO 1973 grade 1 Epidemiology Incidence: 5 per 100,000 individuals per year Mean age 70 years 75% male Sites Commonly on posterior bladder wall Lateral wall close to ureteral orifices is another common site Etiology[pathologyoutlines.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]
  • Further prospective studies and standardized diagnostic criteria are needed to clarify the epidemiology, diagnostic tools and most effective treatment protocol for SCC of the ureter.[wjso.biomedcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Conclusion: The pathogenesis and pathophysiology of PTTM remains obscure with no effective management available.[karger.com]
  • Pathophysiology Types of upper urinary tract tumors Transitional cell carcinoma (TCC) is the most common histology observed, accounting for greater than 95% of upper urinary tract urothelial tumors. TCCs are strongly associated with smoking.[emedicine.medscape.com]
  • Pathophysiology Ta and Tis have distinct molecular pathways and clinical course. Two distinct molecular pathways of oncogenesis and tumor progression are recognized in urothelial carcinoma of the bladder (Ta).[cancertherapyadvisor.com]

Prevention

  • Simultaneously, we used laser to cut the suspicious mucosa around the tumour and then indwelled double-J stent to prevent ureteral obstruction.[ncbi.nlm.nih.gov]
  • […] 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]
  • Causes, Risk Factors, and Prevention Learn about the risk factors for bladder cancer and what you might be able to do to help lower your risk. Early Detection, Diagnosis, and Staging Know the signs and symptoms of bladder cancer.[cancer.org]

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: 2019-07-11 21:21