Ureteral cancer is a rare malignancy that occurs in the ureters—the thin, muscular tubes that carry urine from the kidneys to the bladder. Most ureteral cancers are transitional cell carcinomas, the same type found in the bladder and renal pelvis. Because symptoms may be vague or mimic other urinary conditions, diagnosis is often delayed until the disease has progressed.
Symptoms of Ureteral Cancer
Early symptoms are often subtle and may be mistaken for kidney stones, infections, or other benign urologic issues. Common symptoms include:
- Blood in the urine (hematuria), visible or microscopic
- Flank or abdominal pain, often one-sided
- Frequent urinary tract infections
- Painful or difficult urination
- Unexplained weight loss or fatigue (in advanced cases)
Causes and Risk Factors
The precise cause of ureteral cancer is not always known, but several factors increase the risk:
- Tobacco Use: Smoking is the most significant risk factor
- History of Bladder or Kidney Cancer: Particularly transitional cell carcinoma
- Prolonged Exposure to Certain Chemicals: Including aromatic amines used in dye, rubber, and leather industries
- Chronic Inflammation: Long-term kidney infections or urinary tract irritation
- Hereditary Conditions: Such as Lynch syndrome, which increases risk for upper urinary tract cancers
Diagnosis
A thorough evaluation is essential to differentiate ureteral cancer from other urologic conditions. Common diagnostic tools include:
- Urinalysis and Urine Cytology: To detect blood and abnormal cells in urine
- Imaging Studies: CT urography, MRI, or retrograde pyelography to visualize the ureters and identify masses
- Ureteroscopy with Biopsy: Allows direct visualization of the ureter and tissue sampling
- Cystoscopy: To evaluate for concurrent bladder cancer
Treatment Options
Treatment depends on the cancer’s location, size, grade, and stage, as well as the patient’s overall health.
- Nephroureterectomy: Surgical removal of the affected kidney and ureter, often recommended for high-grade or invasive tumors
- Segmental Ureterectomy: Removal of only the cancerous portion of the ureter, preserving kidney function when possible
- Endoscopic Resection: A minimally invasive approach for small, low-grade tumors
- Intracavitary Therapy: Instillation of chemotherapy agents directly into the ureter or renal pelvis
- Systemic Chemotherapy or Immunotherapy: May be used before or after surgery, or for metastatic disease
Next Steps
Ureteral cancer requires expert evaluation and prompt treatment to prevent spread to other parts of the urinary tract or distant organs. If you’ve experienced unexplained hematuria or flank pain, especially with a history of smoking or prior bladder cancer, consult a urologic oncologist for appropriate diagnostic testing and a personalized treatment plan. Early intervention improves outcomes and may allow for kidney-sparing approaches.