One-third to one-half of the patients who present with upper tract carcinoma are at risk for developing a bladder cancer, thus the need for continued cystoscopic surveillance in patients who have had treatment for an upper tract transitional cell carcinoma.
Predisposing Conditions and Prevention
As with transitional cell carcinomas of the bladder, smoking and exposure to solvents and dyes are associated with an increased risk of uppertract transitional cell carcinomas. Other predisposing conditions are analgesic abuse and Balkan nephropathy.
The standard therapy for transitional cell carcinoma of the renal pelvis and/or ureter has been a nephroureterectomy. Ureteroscopy is being studied and may be effective for tumors that are small in size and small in number. After biopsy, they may be ablated with laser. Surveillance, however, may be required with periodic ureteroscopy. Nephroscopic resection through a percutaneous nephrostomy tract is also being studied and may be indicated in those patients in whom a kidney-sparing procedure is desirable.
In some patients with renal pelvic and/or ureteral tumors, the rate of recurrence may be diminished by irrigating with an immunoagent such as BCG.
Radiotherapy and chemotherapy appear to have limited roles in the treatment of localized transitional cell carcinoma of the upper tract.