Article: Transitional Cell Cancer (Kidney/Ureter) Treatment

General Information About Transitional Cell Cancer of the Renal Pelvis and Ureter

Transitional cell cancer of the renal pelvis and ureter is a disease in which malignant (cancer) cells form in the renal pelvis and ureter.

The renal pelvis is part of the kidney and the ureter connects the kidney to the bladder. There are 2 kidneys, one on each side of the backbone, above the waist. The kidneys of an adult are about 5 inches long and 3 inches wide and are shaped like a kidney bean. The kidneys clean the blood and produce urine to rid the body of waste. The urine collects in the middle of each kidney in a large cavity called the renal pelvis. Urine drains from each kidney through a long tube called the ureter, into the bladder, where it is stored until it is passed from the body through the urethra.

The renal pelvis and ureters are lined with transitional cells. These cells can change shape and stretch without breaking apart. Transitional cell cancer starts in these cells. Transitional cell cancer can form in the renal pelvis or the ureter or both.

Renal cell cancer is a more common type of kidney cancer. Refer to the PDQ summary on Renal Cell Cancer Treatment for more information.

Misuse of certain pain medicines can affect the risk of developing transitional cell cancer of the renal pelvis and ureter.

Risk factors include the following:

  • Misusing certain pain medicines, including over-the-counter pain medicines, for a long time.
  • Being exposed to certain dyes and chemicals used in making leather goods, textiles, plastics, and rubber.
  • Smoking cigarettes.

Possible signs of transitional cell cancer of the renal pelvis and ureter include blood in the urine and back pain.

These and other symptoms may be caused by transitional cell cancer of the renal pelvis and ureter or by other conditions. There may be no symptoms in the early stages. Symptoms may appear as the tumor grows. A doctor should be consulted if any of the following problems occur:

  • Blood in the urine.
  • A pain in the back that doesn't go away.
  • Extreme tiredness.
  • Weight loss with no known reason.
  • Painful or frequent urination.

Tests that examine the abdomen and kidneys are used to detect (find) and diagnose transitional cell cancer of the renal pelvis and ureter.

The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
  • Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria.
  • Ureteroscopy: A procedure to look inside the ureter and renal pelvis to check for abnormal areas. A ureteroscope (a thin, lighted tube) is inserted through the urethra into the bladder, ureter, and renal pelvis. Tissue samples may be taken for biopsy.
  • Urine cytology: Examination of urine under a microscope to check for abnormal cells. Cancer in the kidney, bladder, or ureter may shed cancer cells into the urine.
  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to check for cancer. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. An ultrasound of the abdomen may be done to help diagnose cancer of the renal pelvis and ureter.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the stage and grade of the tumor.

The treatment options depend on the following:

  • The stage and grade of the tumor.
  • Where the tumor is.
  • Whether the patient's other kidney is healthy.
  • Whether the cancer has recurred.

Most transitional cell cancer of the renal pelvis and ureter can be cured if found early.

Stages of Transitional Cell Cancer of the Renal Pelvis and Ureter

After transitional cell cancer of the renal pelvis and ureter has been diagnosed, tests are done to find out if cancer cells have spread within the renal pelvis and ureter or to other parts of the body.

The process used to find out if cancer has spread within the renal pelvis and ureter or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread within these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Ureteroscopy: A procedure to look inside the ureter and renal pelvis to check for abnormal areas. A ureteroscope (a thin, lighted tube) is inserted through the urethra into the bladder, ureter, and renal pelvis. Tissue samples may be taken for biopsy.
  • Surgery: Tissues removed during surgery to treat the transitional cell cancer will be examined by a pathologist.

The following stages are used for transitional cell cancer of the renal pelvis and/or ureter:

Stage 0 (Carcinoma in Situ)

In stage 0, the cancer is found in or on tissue lining the inside of the renal pelvis or ureter only. Stage 0 is divided into stage 0a and stage 0is, depending on the type of tumor:

  • Stage 0a may look like tiny mushrooms growing from the lining. Stage 0a is also called noninvasive papillary carcinoma.
  • Stage 0is is a flat tumor on the tissue lining the inside of the renal pelvis or ureter. Stage 0is is also called carcinoma in situ.

Stage I

In stage I, cancer has spread through the cells lining the renal pelvis and/or ureter, into the layer of connective tissue.

Stage II

In stage II, cancer has spread through the layer of connective tissue to the muscle layer of the renal pelvis and/or ureter.

Stage III

In stage III, cancer has spread:

  • to the layer of fat outside the renal pelvis and/or ureter; or
  • into the wall of the kidney.

Stage IV

In stage IV, cancer has spread to at least one of the following:

  • A nearby organ.
  • The layer of fat surrounding the kidney.
  • One or more lymph nodes.
  • Other parts of the body.

Transitional cell cancer of the renal pelvis and ureter is also described as localized, regional, or metastatic:

Localized

The cancer is found only in the kidney.

Regional

The cancer has spread to tissues around the kidney and to nearby lymph nodes and blood vessels in the pelvis.

Metastatic

The cancer has spread to other parts of the body.

Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter

Recurrent transitional cell cancer of the renal pelvis and ureter is cancer that has recurred (come back) after it has been treated. The cancer may come back in the renal pelvis, ureter, or other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with transitional cell cancer of the renal pelvis and ureter.

Different types of treatments are available for patients with transitional cell cancer of the renal pelvis and ureter. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

One type of standard treatment is used:

Surgery

One of the following surgical procedures may be used to treat transitional cell cancer of the renal pelvis and ureter:

  • Nephroureterectomy: Surgery to remove the entire kidney, the ureter, and the bladder cuff (tissue that connects the ureter to the bladder).
  • Segmental resection of the ureter: A surgical procedure to remove the part of the ureter that contains cancer and some of the healthy tissue around it. The ends of the ureter are then reattached. This treatment is used when the cancer is superficial and in the lower third of the ureter only, near the bladder.

Other types of treatment are being tested in clinical trials. These include the following:

Fulguration

Fulguration is a surgical procedure that destroys tissue using an electric current. A tool with a small wire loop on the end is used to remove the cancer or to burn away the tumor with electricity.

Segmental resection of the renal pelvis

This is a surgical procedure to remove localized cancer from the renal pelvis without removing the entire kidney. Segmental resection may be done to save kidney function when the other kidney is damaged or has already been removed.

Laser surgery

A laser beam (narrow beam of intense light) is used as a knife to remove the cancer. A laser beam can also be used to kill the cancer cells. This procedure may be called laser therapy or laser fulguration.

Regional chemotherapy and regional biologic therapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Biologic therapy is a treatment that uses the patient's immune system to fight cancer; substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. Regional treatment means the anticancer drugs or biologic substances are placed directly into an organ or a body cavity such as the abdomen, so the drugs will affect cancer cells in that area. Clinical trials are studying the effectiveness of chemotherapy or biologic therapy using drugs placed directly into the renal pelvis or the ureter.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Treatment Options for Transitional Cell Cancer of the Renal Pelvis and Ureter

Localized Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of localized transitional cell cancer of the renal pelvis and ureter may include the following:

  • Surgery (nephroureterectomy or segmental resection of ureter).
  • A clinical trial of fulguration.
  • A clinical trial of laser surgery.
  • A clinical trial of segmental resection of the renal pelvis.
  • A clinical trial of regional chemotherapy.
  • A clinical trial of regional biologic therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Regional Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of regional transitional cell cancer of the renal pelvis and ureter is usually done in a clinical trial. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of metastatic transitional cell cancer of the renal pelvis and ureter is usually done in a clinical trial, which may include chemotherapy. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of recurrent transitional cell cancer of the renal pelvis and ureter is usually done in a clinical trial, which may include chemotherapy. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.

Changes to This Summary (02/18/2004)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

This summary was completely reformatted and some content was added.

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About PDQ

PDQ is a comprehensive cancer database available on Cancer.gov.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at Cancer.gov, the NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

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PDQ also contains information on clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at Cancer.gov. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


Source: National Cancer Institute
Cache Date: December 10, 2004