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Tumors of the renal pelvis and ureter: causes and pathogenesis
Last reviewed: 17.10.2021
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The cause of tumors of the kidney and ureter
An increase in the risk of morbidity in persons in contact with oil products, plastic and plastics was noted.
Chronic urinary infection, trauma and concrements can increase the predisposition to the development of transitional cell tumors and adenocarcinoma of the upper urinary tract.
Cyclophosphamide increases the likelihood of developing urothelial cancer. The reason for this is the negative effect of its metabolite - acrolein. As a rule, tumors caused by this effect have a high degree of differentiation. In addition, in the appearance of cancer of the pelvis and ureter, heredity can play a role. There is a correlation of this type of tumors with Lynch II syndrome, which includes the early appearance of colon tumors and extraintestinal tumors.
Pathophysiology of tumors of the renal and ureteral pelvis
Types of tumors of the upper urinary tract
The most common histological type of tumors of the upper urinary tract is transitional cell carcinoma. Which is found in 90% of cases. Its development strongly correlates with smoking.
Squamous cell tumors account for 1-7% of urothelial tumors. Squamous cell carcinoma is often associated with the presence of secondary pyelonephritis on the background of nephrolithiasis. This histological variant of the tumor often has a moderate and low degree of differentiation. And is characterized by early spread of the tumor process.
Adenocarcinoma is less than 1% of tumors of this localization. Often in patients with this histological variant of the tumor there are concrements causing a prolonged obstruction of the upper urinary tract.
Inverted papilloma infrequent neoplasm of the upper urinary tract, which is considered benign. However, its malignancy is possible.
Growth and metastasis of tumors of the renal and ureteral pelvis
Transitional-cellular tumors of the upper urinary tract spread strictly in the caudal direction. For example, there is a high incidence of recurrences in the ureteral stalk in patients subjected to nephrectomy, ureterectomy for cancer of the pelvis. On the contrary, recurrence to the zones located proximal to ureteral lesions is practically not met. In 30-75% of patients with urothelial tumors of the upper urinary tract during the development of the disease, tumors of the bladder occur.
Transitional-cellular tumors of the pelvis and ureter are characterized by lymphogenous and hematogenous dissemination of the tumor process. Depending on the localization of the primary tumor, para-aortic, paracaval, general iliac and pelvic lymph nodes from the neoplasm can be affected. Hematogenous metastases most often affect the lungs, liver and bones.
The frequency of transitional-cellular cancer of different parts of the upper urinary tract:
- renal pelvis - 58%;
- ureter - 35% (73% of tumors are localized in its distal part);
- renal pelvis and ureter - 7%;
- bilateral defeat - 2-5%.