Ureteral Cancer – Diagnosis and Treatment
Diagnosis
Examining Symptoms and the Body
A health professional begins by collecting information about a person’s symptoms, focusing on issues like blood in the urine (hematuria), pain, or other urinary changes.
They then perform a physical examination to find any abnormal signs that could indicate ureteral cancer or other urologic problems.
Imaging to See Inside the Body
Imaging tests play a central role in understanding suspected cancers of the ureter, such as urothelial carcinoma or upper tract urothelial cancer. These tests help determine the location, size, and spread of the tumor.
Some common imaging tests are:
| Imaging Test | Purpose |
|---|---|
| Intravenous pyelogram | X-ray with contrast to show urinary tract |
| CT (Computed Tomography) urogram | Detailed body images, helps see tumors and spread |
| MR (Magnetic Resonance) urogram | Uses magnets for detailed pictures, safe for some who can’t have a CT scan |
| PET (Positron Emission Tomography) scan | Detects cancer spread using a special dye |
Doctors use imaging results to understand if the cancer has spread outside the ureter and to guide treatment planning.
Laboratory Testing of Urine
Doctors often order urine tests to check for cancer signs. A simple urinalysis may detect blood or abnormal substances.
In urine cytology, a sample is examined under a microscope to find unusual cells, which may suggest urothelial carcinoma or ureteral cancer.
Inspecting the Ureters with a Thin Scope
For a closer look inside the urinary tract, a doctor performs a procedure called ureteroscopy. This uses a slender, lighted tube with a camera that travels through the urethra and bladder to reach the ureter.
Ureteroscopy lets the doctor directly observe tumors, blockages, or swelling.
If the doctor sees something abnormal, they may take a biopsy. The laboratory then checks tissue samples for cancer cells and, in some cases, tests for specific genetic changes.
Screening the Bladder for Cancer
Because people with ureteral tumors face a higher risk of developing bladder cancer, doctors recommend checking the bladder regularly. Imaging tests often scan the bladder for abnormalities.
A doctor may also perform cystoscopy. In cystoscopy, a thin scope passes through the urethra into the bladder to allow direct viewing, making it easier to spot any signs of cancer early.
Treatment
Surgical Procedures
Surgeons usually begin treatment of ureteral cancer with surgery. The type of operation depends on how much cancer is present and where it is located.
For early or small tumors, surgeons may remove only the affected part of the ureter, which is known as a segmental ureterectomy. When the cancer is larger or has spread, surgeons may need to perform more extensive surgery.
This often means removing the whole ureter, the connected kidney, and sometimes part of the bladder. Surgeons call the full removal of the ureter and kidney a nephroureterectomy.
Other surgeries, such as radical cystectomy or simple ureterectomy, may be considered depending on individual cases.
Surgical Choices Table
| Surgery Type | What is Removed | When Used |
|---|---|---|
| Segmental ureterectomy | Part of the ureter | Small, early tumors |
| Nephroureterectomy | Entire ureter and kidney | Large or spread-out cancers |
| Radical cystectomy | Bladder (Sometimes needed) | If cancer affects or threatens bladder |
| Ureterectomy | Ureter (part or full) | Based on tumor location |
Cancer Drug Treatment
Doctors often use chemotherapy alongside surgery, either before or after an operation. When doctors give chemotherapy before surgery (neoadjuvant chemotherapy), it aims to shrink tumors, which might make surgery safer and more effective.
Chemotherapy after surgery (adjuvant chemotherapy) helps destroy any remaining cancer cells. For those whose cancer has spread or cannot be removed by surgery, doctors sometimes use chemotherapy to help control symptoms and slow cancer’s growth.
In some cases, doctors administer chemotherapy drugs directly into the bladder (intravesical chemotherapy).
Common Chemotherapy Points
- Given via IV or tablets.
- May cause side effects like nausea, tiredness, hair loss.
- Used by itself or with other treatments.
Medicines that Help the Immune System
Immunotherapy helps the body’s own immune system fight cancer cells. These medicines work by allowing immune cells to find and destroy cancer.
Doctors may use immunotherapy if cancer has returned, spread to other organs, or cannot be removed by surgery. Sometimes doctors give it together with other drugs, such as targeted medicines.
Targeted Medicines
Targeted therapy uses medicines designed to find and block specific molecules in cancer cells. By stopping these molecules, the drugs can help kill cancer cells or stop them from growing.
Doctors are more likely to use targeted therapy for advanced or aggressive cancers, or cancers with certain genetic features. They may check the tumor’s genes or proteins to see if targeted drugs will work well.
Ongoing Monitoring
After treatment, patients attend regular follow-up visits. Your healthcare provider recommends these visits to monitor for cancer recurrence or the development of new cancers, like bladder cancer.
The follow-up plan depends on how aggressive the cancer was and what treatments were given. Most people have frequent check-ups in the first year (every few months), and then less often later.
During these visits, the care team may use scans, urine tests, or other exams to look for any signs of cancer coming back. Keeping up with these appointments helps catch problems early and supports long-term recovery.
Getting Ready for Your Visit
Steps You Can Take Before Your Appointment
Being well prepared can help people make the most of their healthcare visit. Consider these actions before seeing a specialist:
- Keep Track of Symptoms: Write down any health changes or symptoms. Include details such as when they started and how they have changed.
- List Medications and Supplements: Make a complete list of everything taken regularly. This includes prescription drugs, over-the-counter medicine, vitamins, and herbal products.
- Bring Support: Bringing a family member or friend is helpful. They can help remember information, ask questions, and provide comfort.
- Prepare Questions: Write down any questions in advance to cover all important points during the visit.
Here are some sample questions that may be useful:
| Concern | Suggested Question |
|---|---|
| Possible Causes | What could be causing my symptoms? |
| Testing | What types of tests might I need? |
| Treatment Options | What are the recommended treatments? |
| Next Steps | What is the next step in my care? |
| Activity Restrictions | Are there activities I should avoid right now? |
| Managing Other Health Conditions | How can my other health problems affect treatment? |
| Future Care | If the first option does not work, what comes next? |
| Side Effects | What side effects should I expect? |
| Timing | Is it important to start treatment soon? |
Patients should not hesitate to ask any additional questions. Written notes or using a notepad app during the appointment can be very helpful.
Questions Your Healthcare Provider May Ask
Providers will likely want to get a clear picture of your personal health. Expect questions such as:
- What symptoms are you having?
- When did you first notice these symptoms?
- Have your symptoms changed since they began?
- Do you have a history of other health conditions?
- What medications or supplements are you currently taking?
If you answer as accurately as possible, you help make the appointment more effective.
