Upper Tract Urothelial Cancer (UTUC): General Overview

 Upper Tract Urothelial Cancer (UTUC)

Fig. CECT in Coronal Plane during Angiographic phase demonstrates enhancing tumor in the  infundibulum to the upper calcyeal system

Urothelial cancers are localized either in:

1. Bladder & Urethra

2. Upper urinary tract ( Pelvicalyceal system and ureters)

Epidemiology:

UTUC account for 5 -10 % of Urothelial cancers

Pelvicalyceal tumors are twice more common as ureteral tumors

Bladder cancer > pelvicalyceal cancers > Ureteral cancer

17 % of cases have concurrent bladder cancers

41 % have prior history of bladder cancers

Peak incidence in 70 - 90 years

Pathology:

1. Transitional cell carcinoma (TCC): Same as the Bladder cancer

2. Squamous cell carcinoma associated with chronic inflammatory diseases and infections from utolithiasis

2/3rd tumor in UTUC are invasive at diagnosis due to absence of "muscularis propria" layer in the upper tract. 

9 % present with metastasis

Risk Factors:

1. Occupations exposure (dyes)

2. Aristolochic acid (herb used in China and Taiwan)

3. Smoking exposure / Alcohol

4. Lynch Syndrome / Hereditary non polyposis colorectal cancer (HNPCC)

- Most common hereditary Cancer Syndromes

- High risk of developing colorectal caners and other types of cancers, including Urothelial cancers

Imaging:

Modality of Choice is MDCT (> 90 % sensitivity & specificity)

MR Urography has a potential role, but the diagnostic confidence is poor compared to CT Urography

Findings: Urothelial thickening / hyper enhancement

              : Presence of nodule or mass

Management:

1. Kidney sparing surgery for low risk disease ( unifocal / < 2 cm size / low grade cytology / low grade URS biopsy / non-invasive on CT scan

2. Radical Nephroureterectomy and excision of bladder cuff for high risk disease

Prepared by Dr. Sharad Maheshwari

01.04.2023

Updated: 

References:

1. https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Upper-Urinary-Tract-Urothelial-Carcinoma-2023.pdf

2. https://journals.sagepub.com/doi/pdf/10.1177/039463201402700406

3. https://www.pathologyoutlines.com/topic/bladderurothelialinvasivegen.html

4. https://www.cancer.net/cancer-types/lynch-syndrome

5. https://www.ncbi.nlm.nih.gov/books/NBK304331/

6. https://pubmed.ncbi.nlm.nih.gov/23801402/

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766367/

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954076/