Tumors of the renal pelvis and ureter

Urothelial tumors of the pelvis of the kidney and ureter are relatively rare. Tumor tumors account for 10% of all kidney neoplasms and 5% for all urothelial tumors. Tumors of the ureter are met 4 times less frequently by neoplasms of the renal pelvis.

Epidemiology

Most often, the disease affects men with a ratio of sick men and women 3: 1. More often, neoplasms of this group develop in Caucasians compared with the Negroid (ratio 2: 1).

They note an increase in the incidence of cancer of the pelvis and ureter 100-200 times in persons suffering from Balkan nephropathy with degenerative interstitial nephritis of unclear etiology, most often found in the Balkans.

Tumors of the upper urinary tract associated with this disease are usually highly differentiated, multiple and bilateral.

[1], [2], [3], [4], [5]

Causes of the tumors of the renal pelvis and ureter

Tobacco smoking is a risk factor that increases the risk of developing transitional-cellular cancer of the upper urinary tract 3 times. About 70% of the sick men and 40% of women are smokers.

Consumption of more than seven cups of coffee per day is associated with an increased likelihood of developing the disease. Analgesics also increase the risk of incidence of urothelial cancers. There is an independent synergistic relationship between tumors of the upper urinary tract and papillary necrosis. Prolonged use of analgesics induces nephropathy, which is associated with a high incidence of urothelial cancer, reaching 70%. In turn, the pathognomonic sign of the use of analgesics - capillarosclerosis - is found in 15% of patients with tumors of the pelvis and ureter.

[6], [7], [8], [9], [10]

Forms

Classification of TNM

T - primary tumor.

• Tis - Carcinoma in situ.
• Ta - superficial / papillary tumor.
• T1 - invasion of the own muscular plate of the mucous membrane.
• T2 - invasion of the muscular layer of the organ wall.
• T3 - invasion of peripelvic / periureteral tissue or parenchyma of the kidney.
• T4 - involvement of neighboring organs.

N - regional lymph nodes.

• N0 - no metastasis to the regional lymph nodes.
• N1 - metastasis in one lymph node less than 2 cm in the largest dimension.
• N2 is a metastasis of 2-5 cm in the largest measurement in one lymph node or metastases in several lymph nodes of less than 5 cm in the largest dimension.
• N3 - metastasis in one lymph node more than 5 cm in the largest dimension.

M - distant metastases.

• M0 - no distant metastases.
• Ml - distant metastases.

[11],

Treatment of the tumors of the renal pelvis and ureter

Operative treatment of tumors of the pelvis of the kidney and ureter is indicated for localized and locally advanced tumors of the upper urinary tract. The standard approach to this category of neoplasms is nephroresterectomy.

An open nephrureterectomy is performed by transperitoneal access, removing the kidney, ureter and part of the bladder surrounding the mouth. Regional lymphodissection with tumors of the upper urinary tract can adequately assess the category N, and also has a potential curative effect in patients with  lymph node metastases.

Forecast

Five-year overall survival of patients with cancer of the upper urinary tract in the stages of Tis, Ta, T1 is 91%, T2 - 43%. At stages T3 - 4 and / or N1-2 - 23%, in stages N3 / M1 - 0%. With tumors G1-2, the type of surgery does not affect survival. However, the effectiveness of the organ-preserving treatment of low-grade urothelial cancer is inferior to nephrureterectomy.

[12], [13], [14], [15]