Ureteral cancer is an uncommon form of cancer that typically occurs when cancerous cells grow on the inner lining of your ureters, which are the tubes that connect your kidneys to your bladder.
Your ureters form an essential part of your urinary system. The system is responsible for removing waste from your body via urine. It is made up of your kidneys, which send waste and fluid filtered out from your blood (urine), down through your ureters, into your bladder. The urine is eventually released via your urethra.
Relationship with Bladder Cancer
Ureteral cancer often occurs in older adults and patients who have previously been diagnosed with bladder cancer. It shares many similarities with bladder cancer as the cells that line the ureters are the same type of cells found on the bladder’s inner lining. If you have been diagnosed with ureteral cancer, there is a higher chance that you will subsequently develop bladder cancer, and your doctor will recommend you be tested for that too.
Symptoms
There are several symptoms of ureteral cancer. They include blood in your urine and pain when you urinate. Patients also often experience back pain and fatigue. In some cases, patients have noted an increase in nighttime urination and pain during or after sex. Another symptom is if you start experiencing unexplained weight loss.
If you have any symptoms that could be linked to ureteral cancer, it is vital that you immediately speak to your doctor or a healthcare professional.
How is Ureteral Cancer Diagnosed?
Your doctor will begin any diagnosis by discussing with you your symptoms before giving you a physical exam. If they suspect that you may have ureteral cancer, they will send you for imaging tests. These typically involve CT scans and MRIs that produce detailed views of your urinary tract that allow your doctor to assess the extent of your cancer. They may also test your urine for signs of any abnormal cells.
Your doctor may also recommend an invasive procedure called a ureteroscopy. The procedure passes a thin tube with a camera called a ureteroscope up through your bladder and allows the doctor to examine your ureters. If necessary, they may remove a small piece of tissue to test for cancerous cells.
Causes
The causes of ureteral cancer remain unclear. Like many cancers, ureteral cancer occurs when the DNA of the cells on the inner lining of the ureters starts mutating. The mutation typically makes the cells reproduce rapidly and live beyond their normal life cycle. When this happens, it creates a mass of cells that can cause a blockage in the ureter or spread to other parts of the body.
Risk Factors
The risk of ureteral cancer increases as you age. The cancer is typically diagnosed in people in their 70s and 80s and more commonly in men.
There is also a greater chance of being diagnosed with ureteral cancer if you have previously been diagnosed with bladder or kidney cancer. This is because the mutated cancer cells may have spread.
Smokers are also typically at higher risk of developing ureteral cancer, as is common with other urinary tract cancers such as kidney and bladder cancer. Work that involves exposure to certain dyes and chemicals in the production of plastics, textiles, rubber, and leather goods can increase your risk.
If you have a family history of cancer and especially urinary tract cancers, it may be advisable to speak to your doctor about ureteral cancer. Many patients who have an inherited cancer syndrome called Lynch Syndrome will also have a much higher chance of developing ureteral cancer.
Treatment
Ureteral cancer is typically treated with surgery, although your doctor may recommend chemotherapy or immunotherapy in certain situations. Treatment options can vary between patients and are often based on your age and the cancer’s size and location.
- Surgery: The type of surgery will depend on how advanced the cancer has become. For early-stage cancer, your surgeon may only remove a portion of the affected ureter. However, in more advanced cases, they may be forced to remove the entire ureter. If it has spread upwards and/or downwards, your surgeon may also remove the connected kidney and/or part of the bladder. In some cases, your surgeon may recommend electrosurgery, where an electric current is used to remove the affected cells. A similar treatment is laser therapy. In this treatment, the surgeon will use a laser beam via a ureteroscope to destroy the cancer cells.
- Chemotherapy: The use of chemotherapy is typically pre-surgery and to shrink any tumor. It may also be used post-surgery to kill off any remaining cancer cells.
- Immunotherapy: Immunotherapy is often used when your ureteral cancer hasn’t responded to other treatments. The purpose of the treatment is to help your immune system to recognize and attack the cancer cells.
After any treatment, you should expect to have follow-up exams with your doctor approximately once every three months for the first year. The primary purpose of these check-ups will be to check that the cancer hasn’t returned and make sure you don’t have any signs of bladder cancer.
References
- The Urinary Tract & How It Works | NIDDK
- Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®)–Patient Version – National Cancer Institute
- Symptoms of cancer of the renal pelvis or ureter
- Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®)–Patient Version – National Cancer Institute
- Renal pelvis or ureter cancer: MedlinePlus Medical Encyclopedia
- Ureter and renal pelvis cancers
- Treatments for cancer of the renal pelvis or ureter