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Because the ureter and renal pelvis make up the upper urinary tract, ureteral urothelial carcinoma is generally managed as part of upper tract urothelial carcinoma (UTUC).",[68,74,78,82,86],{"key":69,"title":70,"html":71,"icon":72,"updatedAt":73},"","Overview","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">The ureters are tubes that carry urine from the kidneys to the bladder.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Ureter cancer is relatively uncommon. Most tumors arise from urothelial cells lining the ureter and are therefore classified as urothelial carcinoma. Squamous cell carcinoma, adenocarcinoma, and other histologic types are much less common.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Cancers of the renal pelvis and ureter are commonly grouped together as upper tract urothelial carcinoma (UTUC) because they share many risk factors, pathologic features, and systemic treatment approaches.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Treatment depends not only on tumor location but also on grade, depth of invasion, whether the disease is multifocal, and whether lymph nodes or distant organs are involved.\u003C\u002Fspan>\u003C\u002Fp>","⚕️","2026-10-08",{"key":69,"title":75,"html":76,"icon":77,"updatedAt":73},"Causes and Risk Factors","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">The exact cause of ureter cancer is often unknown, but several risk factors are well established.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">These include:\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Smoking、Long-term occupational exposure to aromatic amines and other carcinogenic chemicals、Exposure to aristolochic acid、Certain chronic inflammatory or stone-related conditions of the upper urinary tract、A personal history of bladder cancer or other urothelial cancers、Lynch syndrome and other inherited cancer-predisposition conditions、Certain endemic kidney diseases associated with aristolochic acid exposure.Smoking is one of the most important modifiable risk factors.\u003C\u002Fspan>\u003C\u002Fp>","🧬",{"key":69,"title":79,"html":80,"icon":81,"updatedAt":73},"Signs and Symptoms","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Blood in the urine is the most common symptom of ureter cancer. It may be visible to the eye or detected only on a urine test.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Hematuria can come and go, so temporary disappearance of blood does not necessarily mean the underlying condition has resolved.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Other possible symptoms include:Flank or back pain、Renal colic、Hydronephrosis、Urinary discomfort、Fatigue、Loss of appetite、Unexplained weight loss.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Flank pain or hydronephrosis may occur when the tumor blocks the flow of urine.Some patients have no symptoms and are diagnosed incidentally on imaging.\u003C\u002Fspan>\u003C\u002Fp>","📋",{"key":69,"title":83,"html":84,"icon":85,"updatedAt":73},"Diagnosis","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Evaluation of suspected ureter cancer usually combines imaging, cystoscopy, urine cytology, and ureteroscopy when needed.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">CT urography is one of the most important imaging tests for UTUC. It can help identify the location and extent of the tumor, urinary obstruction, local invasion, lymph node involvement, and distant spread.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">MRI-based urinary tract imaging may be used when contrast-enhanced CT is not appropriate.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Urine cytology may detect abnormal urothelial cells and is particularly useful in higher-grade disease, although a negative result does not rule out cancer.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Cystoscopy is also commonly performed because patients with UTUC have an increased risk of synchronous or subsequent bladder cancer.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">When imaging and cytology do not provide enough information, ureteroscopy may be used to directly visualize the tumor and obtain a biopsy for pathologic diagnosis and grading.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch2 style=\"margin-top: 7px;margin-bottom: 7px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Risk Stratification\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh2>\u003Cp>\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Not every patient with UTUC needs immediate removal of the kidney and ureter.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Doctors estimate whether the disease is low or high risk based on factors such as tumor size and number, pathologic grade, imaging evidence of invasion, hydronephrosis, and urine cytology.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Low-risk tumors are generally localized, low grade, and lack clear invasive features. Kidney-sparing treatment may be preferred in these patients.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">High-grade tumors, invasive features on imaging, larger tumors, or multifocal disease generally require more intensive treatment.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Current EAU guidance recommends kidney-sparing management as the primary option for low-risk UTUC and radical nephroureterectomy for high-risk nonmetastatic disease.\u003C\u002Fspan>\u003C\u002Fp>","🩺",{"key":69,"title":87,"html":88,"icon":89,"updatedAt":73},"Treatment","\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">\u003Cstrong>Low-Risk UTUC\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For low-risk UTUC, preserving the kidney is now preferred whenever oncologically appropriate.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Treatment may include ureteroscopic removal or laser ablation of the tumor. Selected low-risk tumors in the distal ureter may also be treated with segmental ureterectomy.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Close surveillance is essential after endoscopic treatment. Current EAU guidance also recommends considering a second-look ureteroscopy within about eight weeks after initial endoscopic management.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 style=\"margin-top: 7px;margin-bottom: 7px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>High-Risk UTUC\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp style=\"margin: 7px 0;\">\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For high-risk UTUC without distant metastases, radical nephroureterectomy remains the standard treatment.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">The procedure generally removes the affected kidney, the entire ureter, and a small cuff of bladder tissue around the ureteral opening.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Open, laparoscopic, and robot-assisted approaches may all be used depending on the clinical situation. For selected high-risk patients, template-based regional lymph node dissection may also be considered.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Selected high-risk tumors confined to the distal ureter may sometimes be managed with distal ureterectomy to preserve kidney function.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 style=\"margin-top: 7px;margin-bottom: 7px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">\u003Cstrong>Perioperative Systemic Therapy\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fstrong>\u003Cstrong>\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">\u003C\u002Fspan>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp style=\"margin: 7px 0;\">\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Perioperative systemic treatment may be considered for selected patients with high-risk UTUC.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Cisplatin-based chemotherapy before surgery can be considered in some patients. One reason is that kidney function may decline after nephroureterectomy, making cisplatin treatment more difficult afterward.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">After radical nephroureterectomy, current EAU guidance recommends adjuvant platinum-based chemotherapy for eligible patients with pathologic stage pT2–T4 and\u002For lymph node-positive disease.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Adjuvant immunotherapy may also be considered in selected high-risk patients who are not candidates for or decline platinum-based chemotherapy, depending on biomarker status, treatment history, and local approvals.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 style=\"margin-top: 7px;margin-bottom: 7px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Ch3 style=\"margin-top: 7px;margin-bottom: 7px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">\u003Cstrong>Postoperative Bladder Instillation\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fstrong>\u003Cstrong>\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">\u003C\u002Fspan>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp style=\"margin: 7px 0;\">\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Bladder recurrence is an important issue after treatment for UTUC.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For patients without a previous history of bladder cancer, current EAU guidance recommends a single postoperative intravesical chemotherapy instillation after radical nephroureterectomy to reduce the risk of subsequent bladder tumors.\u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 style=\"margin-top: 7px;margin-bottom: 7px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>\u003Cbr\u002F>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Ch3 style=\"margin-top: 7px;margin-bottom: 7px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">\u003Cstrong>Locally Advanced or Metastatic Ureteral Cancer\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fstrong>\u003Cstrong>\u003Cspan style=\"font-size: 15px; color: rgb(15, 17, 21); background-color: rgb(255, 255, 255);\">\u003C\u002Fspan>\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp style=\"margin: 7px 0;\">\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">The statement that chemotherapy and radiation are generally ineffective is no longer accurate.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Advanced ureteral urothelial cancer is treated using systemic strategies similar to those used for advanced urothelial bladder cancer.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Enfortumab vedotin plus pembrolizumab is now an important first-line treatment for advanced or metastatic urothelial carcinoma. About one-quarter of patients in the EV-302 trial had UTUC, and the benefit was seen regardless of primary tumor location.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">When this combination is not appropriate or available, platinum-based chemotherapy remains an important option. Cisplatin-based combination chemotherapy may be used in eligible patients, while gemcitabine plus carboplatin can be considered when cisplatin is not suitable.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Patients whose cancer does not progress after first-line platinum chemotherapy may be candidates for maintenance avelumab.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Ch3 style=\"margin-top: 7px;margin-bottom: 7px;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>Molecular Testing and Targeted Therapy\u003C\u002Fstrong>\u003C\u002Fspan>\u003C\u002Fh3>\u003Cp style=\"margin: 7px 0;\">\u003Cbr\u002F>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">Molecular testing should be considered early in advanced or metastatic UTUC.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">FGFR2 and FGFR3 alterations are particularly relevant, and FGFR3 alterations are relatively common in upper tract disease.\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">\u003Cbr\u002F>\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"margin: 7px 0;\">\u003Cspan style=\"font-size: 15px;\">For selected previously treated patients with susceptible FGFR2\u002F3 alterations, the FGFR inhibitor erdafitinib may be an option. Current EAU guidance recommends considering early FGFR testing in advanced or metastatic UTUC.\u003C\u002Fspan>\u003C\u002Fp>","💊",{"author":69,"reviewedBy":69,"lastReviewed":69,"datePublished":69,"citations":91,"disclaimer":69},[],false,1792294354503]