Ureteral cancer

Overview

Ureteral cancer is a growth of cells that starts in the ureters. The ureters are tubes that connect the kidneys to the bladder. The ureters are part of the urinary tract. They carry urine produced by the kidneys to the bladder.

Ureteral cancer is not common. When it happens, it occurs most often in older adults and in people who have had bladder cancer.

Ureteral cancer is closely related to bladder cancer. The cells that line the ureters are the same type of cells that line the inside of the bladder. People diagnosed with ureteral cancer have an increased risk of bladder cancer. So people with ureteral cancer are usually tested for signs of bladder cancer.

Treatment for ureteral cancer typically involves surgery. In certain situations, chemotherapy, immunotherapy or targeted therapy may be recommended.

Symptoms

Signs and symptoms of ureteral cancer include:

• Blood in the urine, which may make the urine look red, pink or cola colored.
• Back pain.
• Pain when urinating.
• Losing weight without trying.
• Feeling very tired.

When to see a doctor

Make an appointment with a doctor or other healthcare professional if you have any persistent symptoms that worry you.

Causes

It's not clear what causes ureteral cancer. Ureteral cancer starts as a growth of cells in a ureter. The ureters are tubes that connect the kidneys to the bladder.

Ureteral cancer happens when cells in a ureter develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time.

In cancer cells, the DNA changes give other instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Risk factors

Factors that can increase the risk of ureteral cancer include:

• Increasing age. The risk of ureteral cancer goes up with age. Most people diagnosed with this cancer are in their 70s and 80s.
• Previous bladder or kidney cancer. People who have been diagnosed with bladder cancer or kidney cancer have a higher risk of ureteral cancer.
• Smoking tobacco. Smoking tobacco raises the risk of ureteral cancer. It also raises the risk of other urinary tract cancers, including kidney cancer and bladder cancer.
• Exposure to certain chemicals. Working with certain chemicals is linked to an increased risk of ureteral cancer.
• Family history of cancer. If you have a strong family history of cancer, discuss it with your healthcare professional. Together you may decide whether to consider genetic testing for inherited cancer syndromes such as Lynch syndrome. Lynch syndrome raises the risk of colon cancer and other cancers, including ureteral cancer.

Prevention

Although there's no sure way to prevent ureteral cancer, you can take steps to help reduce your risk. For instance:

Don't smoke

If you don't smoke, don't start. If you smoke, talk with your healthcare professional about a plan to help you stop. Support groups, medicines and other methods may help you quit.

Take caution around chemicals

If you work with chemicals, follow all safety instructions to avoid harmful exposure.

Choose a variety of fruits and vegetables

Eat many different kinds of colorful fruits and vegetables. The antioxidants in fruits and vegetables may help reduce the risk of certain cancers.

Diagnosis

To diagnose ureteral cancer, a healthcare professional might start by asking about your symptoms and examining your body. You might have a procedure to see inside your urinary tract to look for signs of cancer. Other tests and procedures include urine tests and imaging tests.

Physical exam

A healthcare professional may do a physical exam to better understand your condition. The healthcare professional also may ask questions about your symptoms.

Imaging tests

Imaging tests make pictures of the body. They may help your healthcare team better understand the size of the cancer. Imaging tests also can look for signs that cancer may have spread beyond the ureter. Imaging tests used for ureteral cancer may include:

• Intravenous pyelogram.
• Computerized tomography urogram, also called CT urogram.
• Magnetic resonance urogram, also called MR urogram.
• Positron emission tomography scan, also called PET scan.

Your healthcare team chooses which imaging tests you need based on your situation. Information from these procedures is used to assign a stage to cancer. The stage tells your healthcare team about the extent of the cancer and about your prognosis.

Urine tests

You may undergo a urinalysis to analyze your urine. A urine cytology test may be used to look for concerning cells in a urine sample.

Use of a thin, lighted tube to view the ureters

During a procedure called ureteroscopy, a healthcare professional inserts a thin, lighted tube equipped with a camera into the urethra. The device is passed through the bladder and into the ureters.

Ureteroscopy makes it possible for a healthcare professional to inspect the ureters. If necessary, a biopsy is taken during the procedure. A biopsy is a procedure to remove a sample of tissue for testing in a lab.

In the lab, tests can look for signs of cancer. Other tests might look for changes in the DNA inside the cancer cells. Results from these tests may help your healthcare team make a treatment plan.

Tests for bladder cancer

People diagnosed with ureteral cancer have a high risk of bladder cancer. Bladder cancer may occur at the same time as the ureteral cancer or grow soon after treatment. Imaging tests may be used to examine the bladder and look for signs of cancer. In a procedure called a cystoscopy, a healthcare professional may use a scope to see inside the bladder.

Treatment

Treatment options for ureteral cancer include surgery, chemotherapy, immunotherapy and targeted therapy. Treatment depends on many factors. These factors include the size and location of the cancer, how aggressive the cells are, and your own goals and preferences.

Surgery

Surgery is often recommended to remove ureteral cancer. The kind of surgery used for your ureteral cancer will depend on your cancer.

For a small ureteral cancer that hasn't spread beyond the ureter, surgery may remove only a portion of the ureter.

For a ureteral cancer that grows larger or spreads beyond the ureter, it may be necessary to remove more. The surgeon may remove the affected ureter, its associated kidney and part of the bladder. This procedure is sometimes referred to as a nephroureterectomy.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Chemotherapy is sometimes used before surgery to shrink the cancer. This can make it easier to remove during surgery. Chemotherapy may be used after surgery to kill any cancer cells that may remain.

For advanced ureteral cancer, chemotherapy may be used to control symptoms of the cancer.

Immunotherapy

Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Immunotherapy might be an option for treating advanced ureteral cancer that spreads to nearby lymph nodes or other parts of the body. It is sometimes used in combination with targeted therapies.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Your cancer cells may be tested to see if targeted therapy is likely to be effective.

Targeted therapy may be used for treating advanced ureteral cancer.

Follow-up examinations

After your treatment, your healthcare team may create a schedule of follow-up exams. During these exams, the team checks for signs that your cancer has returned. The team also looks for signs of bladder cancer, since people diagnosed with ureteral cancer have an increased risk of bladder cancer.

The tests you have and the schedule of exams depend on your situation. Most people see their care teams every few months for the first year. After that, visits may be less frequent.

Preparing for an appointment

If you have any symptoms that worry you, make an appointment with a doctor or other healthcare professional.

If you're diagnosed with ureteral cancer, you'll likely be referred to a urologist or oncologist. A urologist is a doctor who specializes in conditions that affect the urinary system. An oncologist is a doctor who specializes in treating cancer.

Here's some information to help you get ready for your appointment.

What you can do

• Note symptoms you're experiencing. If you have had symptoms of illness or are just not feeling well, write down those details before your appointment. Your healthcare professional also may want to know when you first noticed these symptoms and whether they've changed over time.
• Make a list of your medicines. Include any prescription medicines you take and any medicines you take that don't need a prescription. Also note all vitamins, supplements and herbal remedies.
• Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who is with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Questions to ask your healthcare professional at your initial appointment include:

• What may be causing my symptoms or condition?
• Are there any other possible causes?
• What kinds of tests do I need?
• What do you recommend for next steps in determining my diagnosis and treatment?
• Are there any restrictions that I need to follow in the meantime?

Questions to consider if you are referred to a specialist include:

• Do I have ureteral cancer?
• What are the goals of treatment in my case?
• What treatment do you recommend?
• Do I need to start treatment right away?
• I have these other health conditions. How can I best treat them together?
• What are the possible side effects of treatment?
• If the first treatment isn't successful, what can we try next?
• What is the outlook for my condition?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare team is likely to ask you questions, such as:

• What are your symptoms, if any?
• When did your symptoms begin?
• How have your symptoms changed over time?
• Have you been diagnosed or treated for any other medical conditions?
• What medicines are you taking?