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Kidney Cancer: Renal Pelvis and Ureter

Kidney Cancer
Kidney cancer is characterized by the formation of malignant cells forming in the renal pelvis and ureter.

Cancer that starts in the kidneys is called kidney cancer, renal pelvis cancer, or renal cell cancer. 

  • Kidneys are bean-shaped organs located behind the liver and stomach, one on each side. The major function of kidneys is to filter blood and produce urine.
  • The renal pelvis is the kidney's central region. It collects urine and lets it flow into the ureter (tube-like structures that connect to the bladder).

What Are the Symptoms of Kidney Cancer?

The listed symptoms may not be present in all people with kidney or renal pelvic cancer. Other factors can cause these symptoms. Consult your doctor to get a proper diagnosis.

Symptoms of kidney cancer may include:

  • Any lump or swelling in the abdomen region
  • Painful or frequent urge to urinate
  • Blood in the urine
  • Lower back or pain in the side, which does not go away
  • Fever
  • Extreme tiredness
  • Loss of appetite
  • Unusual weight loss
  • A general feeling of illness
  • Feels like something is blocking the bowels

What Are the Risk Factors of Kidney Cancer?

The following are the risk factors for kidney cancer:

Staging of Kidney Cancer

The TNM staging system by the American Joint Committee on Cancer (AJCC) is the most standard staging system to describe the extent of cancer's spread.

  • T: Indicates the size of the tumor.
  • N: Indicates the spread of cancer cells to the nearby lymph nodes.
  • M: Indicates cancer has spread to distant organs.
Table 1. Stages of kidney cancer and their characteristics
Stage Stage grouping Stage description
I T1, N0 and M0
  • The tumor size is 7 cm or smaller across and is present only in the kidney (T1).
  • There is no spread to lymph nodes (N0) or distant organs (M0).
II T2, N0 and M0
  • The size of the tumor is larger than 7 cm across and is present only in the kidney (T2).
  • There is no spread to lymph nodes (N0) or distant organs (M0).
II T3, N0 and M0
  • The tumor is growing into the major vein or tissue around the kidney but is not into the adrenal gland (T3) or beyond Gerota’s fascia.
  • There is no spread to lymph nodes (N0) or distant organs (M0).
Or
III T1 to T3, N1 and M0
  • The tumor can be of any size and outside the kidney but not beyond Gerota’s fascia.
  • Cancer cells have spread to nearby lymph nodes but not to distant organs.
IV T4, any N, and M0
  • The tumor is growing beyond Gerota’s fascia and into the adrenal gland.
  • May have spread to the nearby lymph nodes.
  • Has not spread to nearby lymph nodes or distant organs.
Or
IV Any T, any N, and M1
  • The tumor can be any size and might have grown outside the kidney.
  • May have spread to nearby lymph nodes.
  • Has spread to distant lymph nodes or organs.

How to Diagnose Kidney Cancer

The doctor employs the following to diagnose kidney cancer:

  • Physical and general examination: The doctor will analyze the symptoms and conduct a physical examination. If they suspect any tumor, they may order a few more tests for a definitive diagnosis.
  • Urinalysis: Checks the color and content of the urine, such as sugars, protein, blood, and bacteria.
  • Ureteroscopy: Identifies abnormalities in the ureter and pelvis. Uses a ureteroscope (a tube-like filament that contains light and a lens).
  • Urine cytology: Identifies any abnormal cells in the urine sample. Cancer in the kidney, bladder, or ureter may shed cancer cells in the urine.
  • Ultrasound: Uses sound waves to produce clear images of the internal tissues of the kidneys and abdomen.
  • MRI: Investigates narrowing and blockage in the blood vessels leading to the kidneys.
  • Biopsy: When doctors suspect that kidney cancer has spread to other sites, they may perform a biopsy of the metastatic site rather than the kidney. A pathologist examines biopsy samples that have been sent to a lab for tissue or cell examination under a microscope for signs of malignancy.

How to Treat Kidney Cancer: Renal Pelvis and Ureter

Surgery is the standard treatment used for kidney cancer.

  • Nephroureterectomy: Surgical removal of the entire kidney, ureter, and bladder cuff.
  • Segmental resection of the ureter: A section of the ureter, containing cancer cells, is removed, along with some of the healthy tissue surrounding it. Then, the ends are attached. Used for superficial cancer.

Other new treatment options include:

  • Fulguration: A surgical procedure where the cancer cells are destroyed using an electric current.
  • Segmental resection of the renal pelvis: Removal of localized cancerous cells and a part of the renal pelvis to maintain kidney function.
  • Laser surgery: Laser beams are used to destroy cancer cells.
  • Chemotherapy: Uses powerful medications to kill fast-growing cancer cells and stop them from growing. The chemotherapy drugs are administered orally or intravenously.
  • Biological therapy: The body’s immune system is used to fight against cancer.

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References
Image Source: iStock image

Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/kidney/patient/transitional-cell-treatment-pdq#_22

Kidney Cancer. https://www.cdc.gov/cancer/kidney/index.htm

Understanding Kidney Cancer. https://www.webmd.com/cancer/understanding-kidney-cancer