Upper Tract Urothelial Cancer

Urothelial cancer refers to a cancer of the lining of the urinary system. While the majority of urothelial cancers (approximately 90-95%) arise in the bladder, upper tract urothelial cancers (UTUCs) correspond to a subset of urothelial cancers that arise in the lining of the kidney (called the renal pelvis) or the ureter (the long, thin tube that connects that kidney to the bladder). As the lining of the bladder, kidney and ureter are the same, there are many similarities and some differences between UTUCs and bladder cancers. For instance, both bladder cancers and UTUCs can present with hematuria (blood in the urine). However, UTUCs can block the ureter or kidney, causing swelling (known as hydronephrosis) and infections, and they can even affect kidney function in some patients.

Similar to bladder cancers, UTUCs can develop as low- or high-grade tumors. In general, low-grade tumors are not invasive and very rarely spread from the kidney or ureter. However, they often recur and management involves treating visible tumors and trying to preserve the urinary tract – as these tumors are more likely to recur in the urinary system than they are to spread. High-grade tumors have an aggressive appearance under a microscope and are assumed invasive in the kidney or ureter. In the bladder, a thick bladder muscle (called the detrusor) acts as a barrier to confine invasive cancers but in the kidney and ureter, this muscle does not exist. High-grade UTUC has the potential to spread from the kidney or ureter and is most often treated with surgical removal of the kidney and ureter – an operation called radical nephrouretectomy. High-grade UTUC can be aggressive and an expert may recommend systemic therapy (for example, chemotherapy) before or after surgery to reduce the risk of recurrence elsewhere in the body. An expert pathologist is often enlisted to determine low- and high-grade urothelial cancers, as this distinction can dramatically impact management choices.

Advances in Upper Tract Urothelial Cancer

Phillip M. Pierorazio, M.D., Associate Professor of Urology and Oncology at the Johns Hopkins University School of Medicine and member of the Greenberg Bladder Cancer Institute, presents important information about advances in upper tract urothelial cancer. (JHGBCI Virtual Grand Rounds, recorded 12/15/2020)

At the Greenberg Bladder Cancer Institute, we have a specialized multidisciplinary medical and scientific team working on new therapies and approaches for UTUC. We individualize a treatment plan for each patient based on cancer characteristics, and their other medical issues that may impact tolerance to treatment, that can include standard as well as cutting edge experimental approaches. As there are characteristics of UTUC that appear different than bladder urothelial cancer, we continue to work to understand how these diseases differ and to investigate novel therapies to improve the lives of patients with UTUC, and all patients with urothelial cancers.

Upper Tract Urothelial Cancer

Upper tract urothelial cancer (UTUC) is a subset of urothelial cancer that is found in the renal pelvis of the ureter. At Johns Hopkins, we have a team of specialist in the Greenberg Bladder Cancer Institute who work together to treat and manage patients with this disease. Watch this short video to learn more about UTUCs.