RENAL PELVIS AND URETER TUMORS
They consist of 5 to 10% of renal tumors. It is more common in men, at and over 65 years and it may be bilateral in 2 to 4% of the cases.
As well as it has not any exact cause;
Smoking – long use of some analgesic drugs such as phenacetin – long use of a drugs called cyclophosphamide which is used for chemotherapy – chronic urinary tract infection- stones not treated for a long period – diseases that cause obstruction in urinary tract –Balkan nephropathy are among causes.
90% of them is originated from transitional cells which spread the inner layer of urinary tract like bladder tumors (TCC: transitional cell carcinoma). Squamous epithelium cell cancer (ca) is 10% of the cases and the cause is stones in general. There is adenocarcinoma less then 1% and stone and infection accompany to it.
At the diagnosis 30% of renal pelvis tumors are high grade and 65% of them were located on renal pelvis.
70% of ureter tumors are detected on distal ureter. While patients with bladder tumor have a risk of tumor development on upper urinary system is: 2 to 4%, Patients with renal pelvis and ureter tumor have a risk of bladder tumor development is 30 to 75%.
Metastasis are most common on: Lymph glands – Lung- Liver and Bones.
Staging and grading are most important criteria to determine the prognosis. Multifocality is seen in high grade tumors and indicates bad prognosis.
CLINICAL PICTURE AND DIAGNOSIS
Nonspecific findings for the tumor type such as PAINLESS MACROSCOPIC HEMATURIA WITH 80%, Abdominal Pain- Weight loss – Nausea/Vomiting- Anemia.
All painless hematuria cases should be approached by a concern that there is an underlying tumoral event unless otherwise is proven.
Ultrasonography (US) and/or Urography (IVP) should be performed first. US: It may show a mass within the renal pelvis or images on enlargement on the upper side due to a mass in the ureter may be taken. IVP: It may show a filling defect and non functioning in the kidney.
COMPUTED TOMOGRAPHY (CT) :
It may show both renal pelvis and mass in the ureter as well as it is a test that should be preferred to show metastasis on surrounding tissues.
URETEROSCOPY is a test that may be applied to see the inner side of the ureter clearer for bleedings without undetected reason.
Furthermore : Retrograde pyelography – cytology and cystoscopy may be done.
To : No tumor detected
Tx : Primary tumor can not be determined
Tis : Carcinoma in-situ
T1 : Papillary non-invasive carcinoma
T2 : Tumor metastatic to the muscle
T3 : Peripelvic or periurethral soft tissue or renal parenchyma involvement
T4 : Adjacent organs involvement
N : Regional lymph nodes
No : No significant lymph node could be detected by clinical evaluation.
N1 : Metastasis < 2cm in the lymph node.
N2 : Metastasis between 2 and 5 cm in the lymph node or metastasis <5 cm on multiple lymph nodes.
N3 : Metastasis >5 cm in the lymph node.
M: Distant metastasis
Mo : No distant metastasis
M1 : Distant metastasis
Nephroureterectomy (removal of the kidney + ureter + the area where the ureter enters from the bladder) is an ideal therapy. This procedure may be performed with open surgery as well as Laparoscopic surgery.
Conservative approaches (Endoscopic resection – tumor excision and end to end anastomosis to the ureter or neocystostomy i.e.) may be tried for low grade and stage tumors.
Chemotherapy and/or Radiotherapy may be tried for metastatic cases.