Transitional cell cancer of the renal pelvis and ureter is a disease in which malignant (cancer) cells form in the renal pelvis and ureter.

The renal pelvis is the top part of the ureter. The ureter is a long tube that connects the kidney to the bladder. There are two kidneys, one on each side of the backbone, above the waist. The kidneys of an adult are about 5 inches long and 3 inches wide and are shaped like a kidney bean. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine collects in the middle of each kidney in the renal pelvis. Urine passes from the renal pelvis through the ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.

The renal pelvis and ureters are lined with transitional cells. These cells can change shape and stretch without breaking apart. Transitional cell cancer starts in these cells.

Transitional cell cancer can form in the renal pelvis, the ureter, or both.

Renal cell cancer is a more common type of kidney cancer.

A personal history of bladder cancer and smoking can affect the risk of transitional cell cancer of the renal pelvis and ureter.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for transitional cell cancer of the renal pelvis and ureter include the following:

• Having a personal history of bladder cancer.
• Smoking cigarettes.
• Taking a lot of certain pain medicines, such as phenacetin.
• Being exposed to certain dyes and chemicals used in making leather goods, textiles, plastics, and rubber.

Signs and symptoms of transitional cell cancer of the renal pelvis and ureter include blood in the urine and back pain.

These and other signs and symptoms may be caused by transitional cell cancer of the renal pelvis and ureter or by other conditions. There may be no signs or symptoms in the early stages. Signs and symptoms may appear as the tumor grows. Check with your doctor if you have any of the following:

• Blood in the urine.
• A pain in the back that doesn't go away.
• Extreme tiredness.
• Weight loss with no known reason.
• Painful or frequent urination.

Tests that examine the abdomen and kidneys are used to diagnose transitional cell cancer of the renal pelvis and ureter.

The following tests and procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria.
• Ureteroscopy: A procedure to look inside the ureter and renal pelvis to check for abnormal areas. A ureteroscope is a thin, tube-like instrument with a light and a lens for viewing. The ureteroscope is inserted through the urethra into the bladder, ureter, and renal pelvis. A tool may be inserted through the ureteroscope to take tissue samples to be checked under a microscope for signs of disease.

• Urine cytology: A laboratory test in which a sample of urine is checked under a microscope for abnormal cells. Cancer in the kidney, bladder, or ureter may shed cancer cells into the urine.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. An ultrasound of the abdomen may be done to help diagnose cancer of the renal pelvis and ureter.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the pelvis. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. This may be done during a ureteroscopy or surgery.

KEY POINTS

• After transitional cell cancer of the renal pelvis and ureter has been diagnosed, tests are done to find out if cancer cells have spread within the renal pelvis and ureter or to other parts of the body.
• There are three ways that cancer spreads in the body.
• Cancer may spread from where it began to other parts of the body.
• The following stages are used for transitional cell cancer of the renal pelvis and/or ureter:
  • Stage 0 (Noninvasive Papillary Carcinoma and Carcinoma in Situ)
  • Stage I
  • Stage II
  • Stage III
  • Stage IV
• Transitional cell cancer of the renal pelvis and ureter is also described as localized, regional, metastatic, or recurrent:
  • Localized
  • Regional
  • Metastatic
  • Recurrent

After transitional cell cancer of the renal pelvis and ureter has been diagnosed, tests are done to find out if cancer cells have spread within the renal pelvis and ureter or to other parts of the body.

The process used to find out if cancer has spread within the renal pelvis and ureter or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The doctor will use results of the diagnostic tests to help find out the stage of the disease.

The following tests and procedures may also be used in the staging process:

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if transitional cell cancer of the ureter spreads to the lung, the cancer cells in the lung are actually ureter cancer cells. The disease is metastatic cancer of the ureter, not lung cancer.

The following stages are used for transitional cell cancer of the renal pelvis and/or ureter:

Stage 0 (Noninvasive Papillary Carcinoma and Carcinoma in Situ)

In stage 0, abnormal cells are found in tissue lining the inside of the renal pelvis or ureter. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stages 0a and 0is, depending on the type of tumor:

• Stage 0a is also called noninvasive papillary carcinoma, which may look like long, thin growths that grow out from the tissue lining the inside of the renal pelvis or ureter.
• Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the renal pelvis or ureter.

Stage I

In stage I, cancer has formed and has spread from the tissue lining the inside of the renal pelvis or ureter to the connective tissue layer.

Stage II

In stage II, cancer has spread to the muscle layer of the renal pelvis or ureter.

Stage III

In stage III, cancer has spread:

• from the muscle layer of the renal pelvis to fat around the renal pelvis or to tissue in the kidney; or
• from the muscle layer of the ureter to fat around the ureter.

Stage IV

In stage IV, cancer has spread to at least one of the following:

• a nearby organ.
• the layer of fat around the kidney.
• lymph nodes.
• other parts of the body, such as the lung, liver, or bone.

Transitional cell cancer of the renal pelvis and ureter is also described as localized, regional, metastatic, or recurrent:

Localized

The cancer is found only in the kidney.

Regional

The cancer has spread to tissues around the kidney and to nearby lymph nodes and blood vessels in the pelvis.

Metastatic

The cancer has spread to other parts of the body.

Recurrent

The cancer has recurred (come back) after it has been treated. The cancer may come back in the renal pelvis, ureter, or other parts of the body, such as the lung, liver, or bone.

Treatment Option Overview

KEY POINTS

• There are different types of treatment for patients with transitional cell cancer of the renal pelvis and ureter.
• One type of standard treatment is used:
  • Surgery
• New types of treatment are being tested in clinical trials.
  • Fulguration
  • Segmental resection of the renal pelvis
  • Laser surgery
  • Regional chemotherapy and regional biologic therapy
• Treatment for transitional cell cancer of the renal pelvis and ureter may cause side effects.
• Patients may want to think about taking part in a clinical trial.
• Patients can enter clinical trials before, during, or after starting their cancer treatment.
• Follow-up tests may be needed.

There are different types of treatment for patients with transitional cell cancer of the renal pelvis and ureter.

Different types of treatments are available for patients with transitional cell cancer of the renal pelvis and ureter. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

One type of standard treatment is used:

Surgery

One of the following surgical procedures may be used to treat transitional cell cancer of the renal pelvis and ureter:

• Nephroureterectomy: Surgery to remove the entire kidney, the ureter, and the bladder cuff (tissue that connects the ureter to the bladder).
• Segmental resection of the ureter: A surgical procedure to remove the part of the ureter that contains cancer and some of the healthy tissue around it. The ends of the ureter are then reattached. This treatment is used when the cancer is superficial and in the lower third of the ureter only, near the bladder.

Fulguration

Fulguration is a surgical procedure that destroys tissue using an electric current. A tool with a small wire loop on the end is used to remove the cancer or to burn away the tumor with electricity.

Segmental resection of the renal pelvis

This is a surgical procedure to remove localized cancer from the renal pelvis without removing the entire kidney. Segmental resection may be done to save kidney function when the other kidney is damaged or has already been removed.

Laser surgery

A laser beam (narrow beam of intense light) is used as a knife to remove the cancer. A laser beam can also be used to kill the cancer cells. This procedure may also be called or laser fulguration.

Regional chemotherapy and regional biologic therapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. Biologic therapy is a treatment that uses the patient's immune system to fight cancer; substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. Regional treatment means the anticancer drugs or biologic substances are placed directly into an organ or a body cavity such as the abdomen, so the drugs will affect cancer cells in that area. Clinical trials are studying chemotherapy or biologic therapy using drugs placed directly into the renal pelvis or the ureter.

Treatment for transitional cell cancer of the renal pelvis and ureter may cause side effects.

For information about side effects caused by treatment for cancer, see our Side Effects page.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment of Localized Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of localized transitional cell cancer of the renal pelvis and ureter may include the following:

• Surgery (nephroureterectomy or segmental resection of ureter).
• A clinical trial of fulguration.
• A clinical trial of laser surgery.
• A clinical trial of segmental resection of the renal pelvis.
• A clinical trial of regional chemotherapy.
• A clinical trial of regional biologic therapy.

Treatment of Regional Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of regional transitional cell cancer of the renal pelvis and ureter is usually done in a clinical trial.

Treatment of Metastatic or Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of metastatic or recurrent transitional cell cancer of the renal pelvis and ureter is usually done in a clinical trial, which may include chemotherapy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis depends on the stage and grade of the tumor.

The treatment options depend on the following:

• The stage and grade of the tumor.
• Where the tumor is.
• Whether the patient's other kidney is healthy.
• Whether the cancer has recurred.

Most transitional cell cancer of the renal pelvis and ureter can be cured if found early.