General Information About Transitional Cell Cancer of the Renal Pelvis and Ureter

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 part of the kidney and the ureter connects the kidney to the bladder. There are 2 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. The kidneys clean the blood and produce urine to rid the body of waste. The urine collects in the middle of each kidney in a large cavity called the renal pelvis. Urine drains from each kidney through a long tube called the ureter, into the bladder, where it is stored until it is passed from the body through the urethra.

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 or the ureter or both.

Renal cell cancer is a more common type of kidney cancer. Refer to the PDQ summary on Renal Cell Cancer Treatment for more information.

Misuse of certain pain medicines can affect the risk of developing transitional cell cancer of the renal pelvis and ureter.

Risk factors include the following:

• Misusing certain pain medicines, including over-the-counter pain medicines, for a long time.
• Being exposed to certain dyes and chemicals used in making leather goods, textiles, plastics, and rubber.
• Smoking cigarettes.

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

These and other symptoms may be caused by transitional cell cancer of the renal pelvis and ureter. Other conditions may cause the same symptoms. There may be no symptoms in the early stages. Symptoms may appear as the tumor grows. A doctor should be consulted if any of the following problems occur:

• 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 detect (find) and diagnose transitional cell cancer of the renal pelvis and ureter.

The following tests and procedures may be used:

• Physical exam and 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 (a thin, lighted tube) is inserted through the urethra into the bladder, ureter, and renal pelvis. Tissue samples may be taken for biopsy.
• Urine cytology: Examination of urine under a microscope to check for abnormal cells. Cancer in the kidney, bladder, or ureter may shed cancer cells into the urine.
• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to check for cancer. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
• 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.

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

The prognosis (chance of recovery) 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.

Stages of Transitional Cell Cancer of the Renal Pelvis and Ureter

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

• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread within these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
• 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.
• Ureteroscopy: A procedure to look inside the ureter and renal pelvis to check for abnormal areas. A ureteroscope (a thin, lighted tube) is inserted through the urethra into the bladder, ureter, and renal pelvis. Tissue samples may be taken for biopsy.
• Surgery: Tissues removed during surgery to treat the transitional cell cancer will be examined by a pathologist.

The following stages are used for transitional cell cancer of the renal pelvis and/or ureter:Stage 0 (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 stage 0a and stage 0is, depending on the type of tumor:

• Stage 0a may look like tiny mushrooms growing from the lining. Stage 0a is also called noninvasive papillary carcinoma.
• Stage 0is is a flat tumor on the tissue lining the inside of the renal pelvis or ureter. Stage 0is is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and spread through the lining of the renal pelvis and/or ureter, into the layer of connective tissue.

Stage II

In stage II, cancer has spread through the layer of connective tissue to the muscle layer of the renal pelvis and/or ureter.

Stage III

In stage III, cancer has spread:

• to the layer of fat outside the renal pelvis and/or ureter; or
• into the wall of the kidney.

Stage IV

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

• A nearby organ.
• The layer of fat surrounding the kidney.
• One or more lymph nodes.
• Other parts of the body.

Transitional cell cancer of the renal pelvis and ureter is also described as localized, regional, or metastatic: 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 Transitional Cell Cancer of the Renal Pelvis and Ureter

Recurrent transitional cell cancer of the renal pelvis and ureter is cancer that 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.

Treatment Option Overview

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. Before starting treatment, patients may want to think about taking part in a clinical trial. 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.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

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.

Other types of treatment are being tested in clinical trials. These include the following: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 be called laser therapy 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 the effectiveness of chemotherapy or biologic therapy using drugs placed directly into the renal pelvis or the ureter.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Treatment Options for Transitional Cell Cancer of the Renal Pelvis and Ureter

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.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized transitional cell cancer of the renal pelvis and ureter.

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. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with regional transitional cell cancer of the renal pelvis and ureter.

Metastatic Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of metastatic transitional cell cancer of the renal pelvis and ureter is usually done in a clinical trial, which may include chemotherapy. Information about ongoing clinical trials is available from the NCI site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with metastatic transitional cell cancer of the renal pelvis and ureter.

Recurrent Transitional Cell Cancer of the Renal Pelvis and Ureter

Treatment of recurrent transitional cell cancer of the renal pelvis and ureter is usually done in a clinical trial, which may include chemotherapy. Information about ongoing clinical trials is available from the NCI Web site.

Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent transitional cell cancer of the renal pelvis and ureter.

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

Chat online

The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

Write to us

For more information from the NCI, please write to this address:

• NCI Public Inquiries Office
• Suite 3036A
• 6116 Executive Boulevard, MSC8322
• Bethesda, MD 20892-8322

Search the NCI Web site

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (09/20/2007)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.