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Cancer can occur in the cells lining the central collecting area of the kidney (the renal pelvis—usually a type called transitional cell carcinoma of the renal pelvis) and in the slender tubes that carry urine from the kidney to the bladder (ureters). Cancers of the renal pelvis and ureter are much less common than cancers of the rest of the kidney or bladder. They probably occur in fewer than 6,000 people in the United States each year.
Symptoms
Blood in the urine is usually the first symptom. Crampy pain in the flank (the space between the ribs and hip) or lower abdomen may occur if the flow of urine is obstructed (for example, because a blood clot blocks the ureter).
Diagnosis
The cancer is usually detected by using computed tomography (CT). CT can help doctors distinguish other noncancerous (benign) kidney and ureteral problems such as stones or blood clots. Microscopic examination of a urine sample may reveal cancer cells. A flexible viewing tube—a ureteroscope—threaded up through the bladder may be used to view, and occasionally even treat, small cancers.
Prognosis
If the cancer has not spread and if it can be completely removed surgically, cure is likely. However, if the cancer has spread into the wall of the renal pelvis or ureter or to distant sites, cure is unlikely.
Treatment
If the cancer has not spread beyond the area of the renal pelvis and ureter, the usual treatment is surgical removal of the entire kidney and ureter(nephroureterectomy) along with a small part of the bladder. However, in some situations—for example, when the kidneys are not functioning well or a person has only one kidney—the kidney is usually not removed, because the person would then become dependent on dialysis. Some cancers in the renal pelvis and ureter may be treated with a laser to destroy the cancer cells or with surgery that removes only the cancer itself while leaving the kidney, the noncancerous portion of the ureter, and the bladder in place. If the cancer has spread, chemotherapy is also used.
A cystoscopy (insertion of a flexible viewing tube to examine the inside of the bladder) is done periodically after surgery, indefinitely, because people who have had this type of cancer are at risk of developing bladder cancer.
Last full review/revision December 2007 by David A. Swanson, MD
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