Each kidney has a large cavity called the renal pelvis, which fills with urine. Urine then drains from each kidney through a tube called the ureter, into the bladder, and out of the body through the urethra. Transitional cells (urothelial cells) line these organs. Cancer of the ureter (ureteral cancer) usually occurs in transitional cells, so it falls under the broader category of transitional cell cancer (urothelial cancer). Treatment for cancer of the ureter has a high success rate when detected early.

  • Expertise and experience. Cancer of the ureter is rare, and Mayo Clinic specialists have the experience and expertise you need to detect, accurately diagnose and treat this type of cancer.
  • Advanced technology. Mayo Clinic experts developed diagnostic methods to more accurately detect urothelial cancer and pioneered the use of endoscopic procedures for diagnosis. Mayo surgeons are experts in performing minimally invasive surgical techniques that preserve urinary organs and function.
  • Comprehensive cancer center. Mayo Clinic Cancer Center meets strict standards for a National Cancer Institute comprehensive cancer center, recognizing scientific excellence and a multispecialty approach focused on cancer prevention, diagnosis and treatment.

Mayo Clinic in Rochester, Minn., and Mayo Clinic in Scottsdale, Ariz., are ranked among the Best Hospitals for cancer by U.S. News & World Report. Mayo Clinic in Jacksonville, Fla., is ranked high performing for cancer by U.S. News & World Report.

In the early stages, cancer of the ureter often has no warning signs or symptoms. The first warning sign may be blood in the urine (hematuria). Other symptoms can include pain in the space between the ribs and hip (flank), extreme tiredness, weight loss for no reason, or pain or frequent urination. Because these symptoms can also result from more common conditions, expertise in diagnosing cancer of the ureter is vital.

Examples of risk factors for cancer of the ureter include misuse of pain medication for a long time, tobacco use, long-term industrial chemical exposure, or chronic or repeated urinary infections or inflammation.

Learn about bladder cancer.

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Early, accurate diagnosis of cancer of the ureter is essential for effective treatment. Your doctor will first perform a physical exam, and then use other tests to screen for and diagnose cancer of the ureter. These may include:

  • Urine tests. Urinalysis checks for the color and contents of urine. Urine cytology checks for abnormal cells.
  • Computerized tomography urogram (CTU). An intravenous pyelogram (IVP) uses CT to create a 3-D image of the lower urinary tract.
  • Ureteroscopy. A ureteroscope is a specialized, miniature telescope that is carefully guided through the ureter, allowing your doctor to visually inspect the ureter wall. Through the ureteroscope, the doctor can remove a small tissue sample for lab analysis (biopsy).
  • Additional tests. For people who can't have a CTU for various reasons, magnetic resonance urography (MRU) may be used as an alternative imaging technique. Infrequently, your doctor may use a test called fluorescence in situ hybridization (FISH) to check for chromosomal abnormalities.

Successful treatment of cancer of the ureter is shaped by many factors, including the size, location and stage of the cancer. Mayo Clinic's experienced team of oncologists, radiation oncologists and urologists will review options with you to define a treatment approach that best meets your needs. Treatment may include one or a combination of the following options.

Surgery

Surgery is the most common treatment for cancer of the ureter. Mayo Clinic surgeons are highly experienced at minimally invasive methods and surgical techniques that preserve urinary organs and function, and use these approaches whenever possible. Minimally invasive methods include:

  • Minimally invasive (laparoscopic) surgery, using instruments inserted through small keyhole incisions in the abdominal wall
  • Robotic surgery, an alternative to traditional laparoscopic surgery
  • Natural orifice surgery, a type of laparoscopic surgery done through the vagina or penis

Surgery for cancer of the ureter can range from removing cancer from the ureter wall to removing part of the ureter (partial ureterectomy), to removing a kidney and the affected ureter.

For advanced and invasive cancer of the ureter and renal pelvic cancer, surgeons most often remove the ureter, the attached kidney and a portion of the upper bladder in a procedure known as a nephroureterectomy (NE-fro-u-REE-ter-EC-to-mee). Depending on the cancer's stage, nearby lymph nodes and other tissues also are removed and tested to determine whether the cancer has spread.

Chemotherapy

Your treatment team may recommend chemotherapy before or after surgery, and in some instances in combination with radiation therapy, to ensure all cancer is gone. For advanced cancer that has spread beyond the ureter, your doctor may recommend chemotherapy without surgery to keep the cancer under control.

Radiation therapy

Radiation therapy uses high-energy radiation to kill cancer cells. In rare instances, or when surgery is not an option, radiation therapy may be appropriate. Your doctor may use it along with chemotherapy.

Mayo Clinic researchers are investigating:

  • Urine-based marker tests for detecting urothelial cancer of the ureter, bladder and kidneys. Urine-based marker tests are generally noninvasive and potentially reliable for detecting low-grade urothelial cancer. The tests identify key urine indicators that suggest cancer recurrence.
  • Drugs for treating advanced urothelial cancer.
  • Experimental treatments for urothelial cancer.
  • New tissue-based markers for detecting and managing urothelial cancer.

Publications

See a list of publications by Mayo doctors on urothelial cancer on PubMed, a service of the National Library of Medicine.

Jun. 27, 2013