Materiały źródłowe

• #1 Ureteral Cancer and Ureteral Urothelial Carcinoma | Saint John’s Cancer Institute – Santa Monica, CA

  https://www.saintjohnscancer.org/urology/conditions/ureteral-cancer/

  Upper tract urothelial carcinoma is a cancer that can occur anywhere from the inner linings of the kidney, down the ureter, in the bladder, and down the urethra. […] Between 5% and 10% of all urothelial cancers start in the ureter (or renal pelvis) and are diagnosed as upper tract urothelial carcinoma (UTUC). […] Ureteral cancer is uncommon and occurs mostly in older adults and in those who previously treated for bladder cancer. […] Ureteral cancer is closely related to bladder cancer. These are cancers that originate in the renal pelvis, calyx, or ureters that extend to the bladder and are referred to as descending tumors. 22-47% of the ureteral cancer cases will also develop bladder cancer at some time in the future. […] 20-25% of patients with carcinoma in the bladder will develop upper tract urothelial carcinoma.

• #1 EAU Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma – Uroweb

  https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/chapter/diagnosis

  The diagnosis of UTUC may be incidental or symptom related. The most common symptom is haematuria. Flank pain, due to clot or tumour tissue obstruction, can occur in 20-32% of cases. Pre-operative symptoms at diagnosis are associated with a worse prognosis. Systemic symptoms (including anorexia, weight loss, malaise, fatigue, fever, night sweats, and cough) in patients with UTUC should prompt evaluation for metastases associated with a worse prognosis. […] Computed tomography (CT) urography has the highest diagnostic accuracy of the available imaging techniques. A meta-analysis of 13 studies comprising 1,233 patients revealed a pooled sensitivity of CT urography for UTUC of 92% (CI: 0.85-0.96) and a pooled specificity of 95% (CI: 0.88-0.98). […] Magnetic resonance (MR) urography is indicated in patients who cannot undergo CT urography, usually when radiation or iodinated contrast media are contraindicated. The sensitivity of MR urography is 75% after contrast injection for tumours 2 cm. Computed tomography urography is more sensitive and specific for the diagnosis and staging of UTUC compared to MR urography.

• #1 Diagnosis of cancer of the renal pelvis or ureter | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/renal-pelvis-and-ureter/diagnosis

  Diagnosis is the process of finding out the cause of a health problem. Diagnosing cancer of the renal pelvis or ureter usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for cancer or other health problems. […] The following tests are usually used to rule out or diagnose cancer of the renal pelvis or ureter. Many of the same tests used to diagnose cancer are used to find out the stage (how far the cancer has spread). Your doctor may also order other tests to check your general health and to help plan your treatment. […] A urinalysis examines your urine. It finds and measures substances in a sample of urine, such as blood, bacteria and cells. It is often one of the first tests done to check for abnormalities in the urine and problems in the urinary tract.

• #1 Renal pelvis or ureter cancer: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000525.htm

  Cancer of the renal pelvis or ureter is cancer that forms in the renal pelvis (center of the kidney) or ureter (tube that carries urine from the kidney to the bladder). […] Cancer can grow in the urine collection system (renal pelvis and ureter), but it is uncommon. Renal pelvis and ureter cancers affect men more often than women. These cancers are more common in people older than 65. […] If tests are done: Urinalysis may show blood in the urine. A complete blood count (CBC) may show anemia. Urine cytology (microscopic examination of cells) may reveal cancer cells. […] These tests may reveal a tumor or show that the cancer has spread from the kidneys. […] The goal of treatment is to eliminate the cancer. […] Cancer that is only in the kidney or ureter may be cured with surgery. Cancer that has spread to other organs is usually not curable. […] Complications from this cancer may include: Kidney failure, Local spread of the tumor with increasing pain, Spread of the cancer to lung, liver, and bone. […] Contact your provider if you have any of the symptoms listed above.

• #1 Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10560346/

  The objective of this review is to outline contemporary approaches to diagnosis, workup, and risk stratification for patients with UTUC. […] Basic laboratory workup should include microscopic urinalysis to detect microscopic hematuria and rule out urinary tract infection, along with hemoglobin level and renal function panel. […] Cytology remains a reliable diagnostic method for UTUC, however voided urinary cytology has high false negative rates approaching 50-90%. […] Selective cytology of the affected upper tract has shown improved diagnostic accuracy compared to voided cytology, with meta-analysis demonstrating a sensitivity of 53.1% and specificity of 90%. […] Newer classification methods in cytologic grading (Paris System) were introduced in 2016 to improve diagnostic accuracy and focus more on high-grade diagnosis.

• #1 EAU Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma – Uroweb

  https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/chapter/diagnosis

  Voided cytology may indicate high-grade UTUC when bladder cystoscopy is normal, and in the absence of CIS in the bladder and prostatic urethra. Voided urine cytology is less sensitive for UTUC than selectively obtained cytology from the affected upper tract. In a recent study, barbotage cytology detected up to 91% of cancers. […] Flexible ureteroscopy (URS) is used if it is necessary to confirm the diagnosis of UTUC by visualising the ureter, renal pelvis and collecting system and to perform a biopsy of suspicious lesions. It is also essential for meticulous tumour mapping before considering kidney-sparing options for UTUC. […] The diagnosis and staging of UTUC is best achieved with computed tomography urography and URS. Selective urinary cytology has high sensitivity in high-grade tumours, including carcinoma in situ. Urethrocystoscopy can detect concomitant BC.

• #1 EAU Guidelines on Non-muscle-invasive Bladder Cancer – Uroweb

  https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer/chapter/diagnosis

  A focused patient history is mandatory. […] Haematuria is the most common finding in NMIBC. Visible haematuria was found to be associated with higher stage at diagnosis disease compared to nonvisible haematuria. […] A focused urological examination is mandatory although it does not reveal NMIBC. […] Computed tomography (CT) urography is used to detect papillary tumours in the urinary tract, indicated by filling defects and/or hydronephrosis. […] Intravenous urography (IVU) is an alternative if CT is not available, but CT urography provides more information particularly in muscle-invasive tumours of the bladder and in UTUCs (including status of lymph nodes and neighbouring organs). […] The necessity to perform a baseline CT urography once a bladder tumour has been detected is questionable due to the low incidence of significant findings which can be obtained.

• #1 Urothelial Tumors of the Renal Pelvis and Ureters Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/452449-workup

  Laboratory studies that should be ordered include the following: Urinalysis To confirm hematuria and to rule out a coexistent urinary tract infection […] Excretory urography, commonly referred to as intravenous pyelography (IVP), has traditionally been used to evaluate the upper urothelial tract, but has been primarily replaced with multidetector computed tomography (CT). Approximately 50-75% of patients with urothelial tumors of the renal pelvis and ureters have a radiolucent filling defect that is characteristically irregular and in continuity with the wall of the collecting system. Approximately 10-30% of such tumors cause obstruction or non-visualization of the collecting system. […] CT scanning has limited value in staging UTUC because stage Ta or superficial lesions cannot be differentiated from T2 or invasive lesions. However, CT scanning is helpful in demonstrating peripelvic or periureteral tumor extension, thereby assisting with staging of aggressive disease. Hydronephrosis and obstruction are associated with a higher degree of invasiveness.

• #1 Diagnosis of cancer of the renal pelvis or ureter | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/renal-pelvis-and-ureter/diagnosis

  Retrograde pyelography is a test that makes images of the urinary system, including the kidneys and ureters. A dye is injected directly into the urinary system through a tube placed into the ureter using a cystoscopy. This procedure is sometimes used to find out what is blocking the flow of urine. It can also help diagnose cancer in the ureters or kidneys. […] A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A CT scan of the abdomen and pelvis is used to check the urinary system for any tumours or blockages. It is also used to check if cancer has spread to lymph nodes, the liver or other organs and tissue around the renal pelvis and ureter. […] Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. An MRI may be used to check if cancer has spread to organs or areas outside the urinary tract.

• #1 Transitional cell carcinoma (ureter) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/transitional-cell-carcinoma-ureter?lang=us

  Transitional cell carcinoma (TCC) of the ureter, also called urothelial cell carcinoma (UCC) of the ureter, is uncommon compared to similar tumors elsewhere along the urinary tract but is nonetheless the most common primary tumor of the ureter. […] Clinical presentation is relatively non-specific, most frequently consisting of hematuria and/or flank pain due to obstructive hydronephrosis. Clots may cause renal colic and mimic ureterolithiasis. […] Ultrasound has little role to play in the diagnosis of transitional cell carcinoma of the ureter, although it may suggest the diagnosis by diagnosing hydronephrosis. […] Conventional CT with or without contrast medium often struggles to diagnose a small ureteral transitional cell carcinoma, as all that may be visible is focal soft tissue thickening of the ureter.

• #1 Ureteral cancer | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/ureteral-cancer?content_id=CON-20314003

  Imaging tests make pictures of the body. They may help your healthcare team better understand the size of the cancer. Imaging tests also can look for signs that cancer may have spread beyond the ureter. Imaging tests used for ureteral cancer may include: Intravenous pyelogram, Computerized tomography urogram, also called CT urogram, Magnetic resonance urogram, also called MR urogram, Positron emission tomography scan, also called PET scan. […] You may undergo a urinalysis to analyze your urine. A urine cytology test may be used to look for concerning cells in a urine sample. […] During a procedure called ureteroscopy, a healthcare professional inserts a thin, lighted tube equipped with a camera into the urethra. The device is passed through the bladder and into the ureters. […] Ureteroscopy makes it possible for a healthcare professional to inspect the ureters. If necessary, a biopsy is taken during the procedure. A biopsy is a procedure to remove a sample of tissue for testing in a lab.

• #1 Urothelial Tumors of the Renal Pelvis and Ureters Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/452449-workup

  Since the advent of rigid and flexible ureteroscopes, ureteropyeloscopy is used increasingly for the diagnosis of upper tract urothelial tumors. Biopsy forceps or cytology brushings can be used to collect tissue. This procedure yields an accuracy of 86% in diagnosing renal pelvis tumors and 90% in diagnosing ureteral tumors. […] Huang et al concluded that percutaneous biopsy is safe and effective for diagnosis of upper tract urothelial lesions that are not amenable to endoscopic biopsy. In their study of 26 upper tract lesions in 24 patients, percutaneous biopsy provided tissue diagnosis in 85% of cases.

• #1 Diagnosis of cancer of the renal pelvis or ureter | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/renal-pelvis-and-ureter/diagnosis

  Urine cytology studies the cells in a urine sample or washings of the urinary tract (collected during a ureteroscopy or cystoscopy when rinsing parts of the urinary tract with salt water). Urine cytology can be used to look for abnormal cells, including cancer cells. […] A ureteroscopy uses a thin tube with a light and lens on the end (called a ureteroscope) to look inside the ureters and renal pelvis. It is used to look for any tumours or abnormal areas. Biopsy samples may be taken during a ureteroscopy. A ureteroscopy is done when there is blood or abnormal cells in the urine. […] During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from a pathologist will show whether or not cancer cells are found in the sample. Small tumours and biopsy samples from the renal pelvis or ureter may be removed during a ureteroscopy or surgery.

• #1 Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/non-metastatic-upper-tract-urothelial-carcinoma

  Universal histologic testing of UTUC with additional studies, such as immunohistochemical (IHC) or microsatellite instability (MSI), should be performed to identify patients with high probability of Lynch-related cancers whom clinicians should refer for genetic counseling and germline testing. (Strong Recommendation; Evidence Level: Grade B) […] At the time of identified UTUC, clinicians should perform a standardized assessment documenting clinically meaningful endoscopic (focality, location, appearance, size) and radiographic (invasion, obstruction, and lymphadenopathy) features to facilitate clinical staging and risk assessment. (Strong Recommendation; Evidence Level: Grade B) […] Following standardized assessment, clinicians should risk-stratify patients as low- or high risk for invasive disease (pT2 or greater) based on obtained endoscopic, cytologic, pathologic, and radiographic findings. Further stratification into favorable and unfavorable risk groups should then be based on standard identified features (Table 5). (Strong Recommendation; Evidence Level: Grade B)

• #1 Ureteral Cancer and Ureteral Urothelial Carcinoma | Saint John’s Cancer Institute – Santa Monica, CA

  https://www.saintjohnscancer.org/urology/conditions/ureteral-cancer/

  A CT scan may reveal the presence of cancer, visible as a blockage. […] A simple urine sample called a urine cytology is often helpful to provide a complete diagnosis. The sample is examined by a pathologist who can determine if cancerous cells are present and are coming from the urinary system. […] There are two types of treatment for upper tract urothelial carcinomas: […] The tumor location and grade will indicate the type of treatment needed. […] Aggressive cancers may involve removal of the kidney and the ureter, and sometimes the bladder. […] If the cancer has spread or appears invasive beyond the ureter, or kidney, then we may recommend chemotherapy, sometimes before and after surgery. […] Stage 0, or stage TA or TIS is a tumor that is just involving the mucosa, the lining on the top.

• #1 Ureteral Cancer and Ureteral Urothelial Carcinoma | Saint John’s Cancer Institute – Santa Monica, CA

  https://www.saintjohnscancer.org/urology/conditions/ureteral-cancer/

  Stage 1 occurs in 25% of patients. […] Stage 2 involves muscle-invasive upper tract urothelial carcinoma. […] Stage 3 cancers occur in 24% of patients. […] Stage 4 upper tract urothelial carcinoma can involve surrounding organs. […] 35% are low grade or non-aggressive tumors while 65% are high-grade or aggressive.

• #1 Transitional Cell Cancer (Kidney/Ureter) Treatment – NCI

  https://www.cancer.gov/types/kidney/patient/transitional-cell-treatment-pdq

  Ureteroscopy is a procedure to look inside the ureter and renal pelvis to check for abnormal areas. […] Urine cytology is a laboratory test in which a sample of urine is checked under a microscope for abnormal cells. […] CT scan (CAT scan) uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body from different angles. […] MRI (magnetic resonance imaging) uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the pelvis. […] Biopsy is the removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. […] The process used to find out if the cancer has spread within the renal pelvis and ureter or to other parts of the body is called staging. […] The results of the diagnostic and staging tests will also help you and your doctor plan treatment. […] Most transitional cell cancer of the renal pelvis and ureter can be cured if found early.

• #1 Urothelial Cancer: Diagnostic Evaluation | MedPage Today

  https://www.medpagetoday.com/medical-journeys/urothelial-cancer/102694

  Upper tract urothelial cancers, particularly those that are high grade, may also cause a positive urine cytology associated with the shedding of cancer cells into the urine. […] Visualization and biopsy is typically necessary to confirm the diagnosis. […] The role of many urine-based molecular tests in the diagnosis of bladder cancer is still evolving and thus their use is not routine for this indication. […] The most common of these urine-based molecular tests is the FISH test, also referred to as UroVysion.

• #1 EAU Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma – Uroweb

  https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/chapter/diagnosis

  Perform a urethrocystoscopy to rule out bladder tumour. Perform voided urinary cytology in any case of suspicion of upper tract tumour. Perform computed tomography (CT) or MRI if CT is contraindicated, with urography for diagnosis and staging of all upper tract tumours. Use diagnostic ureteroscopy if imaging and voided urine cytology are not sufficient for the diagnosis and/or risk-stratification of patients suspected to have upper urinary tract urothelial carcinomas. Test for FGFR 2/3 alterations at initial diagnosis in the metastatic setting.

• #1 Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10560346/

  A recent comprehensive systemic review and meta-analysis was performed utilizing 23 studies (almost 3,600 patients) to evaluate the accuracy of ureteroscopic biopsies in predicting the stage and grade of UTUC. […] These data demonstrate that invasion of the subepithelial connective tissue in the ureteroscopy specimen has a strong correlation with pathologic stage, however biopsy of the subepithelium is one of the main challenges of ureteroscopic biopsy. […] Various pre-operative serum and urine-based biomarkers have been investigated to help predict the prognosis of UTUC, however none of the investigated markers have been validated yet to support their introduction into routine clinical decision-making. […] The predictive ability of the EAU risk stratification system to identify pT2/N+ stage patients at radical nephroureterectomy was recently evaluated and compared to a new preoperative risk model utilizing over 1,200 patients in a multi-institutional retrospective cohort. […] These preoperative nomograms can be used to select patients more optimally for preoperative systemic chemotherapy and facilitate clinical trial enrollmentalthough some caution should be used as none have benefited from external validation.

• #1 Negative pathology of ureteral carcinoma significantly delaying the diagnosis of the primary tumor of osteoblastic metastases: A case report and review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5038518/

  Ureteral urothelial carcinoma (UC) is a rare malignant tumor. The most common clinical manifestations of ureteral UC are hematuria, increased urinary frequency, dysuria and pain. The diagnosis of ureteral UC is made via radiography, endoscopy and pathology. […] The present study reports the case of a 66-year-old man presenting with osteoblastic metastases, in which the primary tumor was finally diagnosed as a ureteral UC. However, the lack of pathological evidence significantly delayed the diagnosis of the primary tumor (6 months), even though the results of radiographic examination, and the type and mode of bone metastases significantly suggested a ureteral UC. […] The case reveals that a suitable screening test should be recommended for patients at high risk due to the possibility of a negative pathology result for ureteral UC. Additionally, a more efficient diagnostic method is required. Moreover, the possibility of new diagnostic criterion that do not rely on the pathology of primary foci in ureteral UC should be considered in future.

• #1 Negative pathology of ureteral carcinoma significantly delaying the diagnosis of the primary tumor of osteoblastic metastases: A case report and review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5038518/

  The present study describes a delayed diagnosis of ureteral UC due to the lack of pathological evidence. […] Currently, imaging and endoscopy, combined with pathological examination, are the main diagnostic approaches for UC. […] Hence, the difficulty in achieving pathological evidence (as reported in the present study) will delay the diagnosis, no matter which diagnostic method the patient received or how efficient this was. […] Considering the possibility of asymptomatic ureteral UC and negative pathology, a suitable screening test should be recommended for high-risk patients. Additionally, a more efficient diagnostic method is required. Moreover, the possibility of new diagnostic criteria that do not rely on the pathology of primary foci in ureteral UC should be considered due to the difficulty in achieving pathological evidence in certain patients.

• #1 Urothelial Tumors of the Renal Pelvis and Ureters Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/452449-guidelines

  Guidelines on the diagnosis and treatment of urothelial tumors of the renal pelvis and ureters have been published by the following organizations: National Comprehensive Cancer Network (NCCN), European Association of Urology (EAU). […] The NCCN guidelines recommend including the following tests in the workup of suspected renal pelvic and ureteral tumors: Cystoscopy, CT or MR urography, Renal ultrasound or CT without contrast with retrograde pyelography for patients who cannot receive iodinated or gadolinium-based contrast agents, Ureteroscopy with biopsy and/or selective washings, Kidney function tests, Chest x-ray to help evaluate for possible metastasis and assess for comorbidities, Urine cytology to help identify carcinoma cells. […] Additional imaging studies, such as renal or bone scanning, may be indicated by the test results or presence of specific symptoms. Evaluation for Lynch syndrome should be considered for those at high risk.

• #1 Ureteral cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-cancer/diagnosis-treatment/drc-20360722

  In the lab, tests can look for signs of cancer. Other tests might look for changes in the DNA inside the cancer cells. Results from these tests may help your healthcare team make a treatment plan. […] People diagnosed with ureteral cancer have a high risk of bladder cancer. Bladder cancer may occur at the same time as the ureteral cancer or grow soon after treatment. Imaging tests may be used to examine the bladder and look for signs of cancer. In a procedure called a cystoscopy, a healthcare professional may use a scope to see inside the bladder. […] After your treatment, your healthcare team may create a schedule of follow-up exams. During these exams, the team checks for signs that your cancer has returned. The team also looks for signs of bladder cancer, since people diagnosed with ureteral cancer have an increased risk of bladder cancer.

• #1 Ureteral cancer | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/ureteral-cancer?content_id=CON-20314003

  In the lab, tests can look for signs of cancer. Other tests might look for changes in the DNA inside the cancer cells. Results from these tests may help your healthcare team make a treatment plan. […] People diagnosed with ureteral cancer have a high risk of bladder cancer. Bladder cancer may occur at the same time as the ureteral cancer or grow soon after treatment. Imaging tests may be used to examine the bladder and look for signs of cancer. In a procedure called a cystoscopy, a healthcare professional may use a scope to see inside the bladder.

• #2 Ureteral cancer – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-cancer/symptoms-causes/syc-20360721

  Ureteral cancer is a growth of cells that starts in the ureters. The ureters are tubes that connect the kidneys to the bladder. The ureters are part of the urinary tract. They carry urine produced by the kidneys to the bladder. […] Ureteral cancer is closely related to bladder cancer. The cells that line the ureters are the same type of cells that line the inside of the bladder. People diagnosed with ureteral cancer have an increased risk of bladder cancer. So people with ureteral cancer are usually tested for signs of bladder cancer. […] Treatment for ureteral cancer typically involves surgery. In certain situations, chemotherapy, immunotherapy or targeted therapy may be recommended. […] It’s not clear what causes ureteral cancer. Ureteral cancer starts as a growth of cells in a ureter. The ureters are tubes that connect the kidneys to the bladder.

• #2 Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma – Zganjar – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/116230/html

  The most common symptom of UTUC is gross or microscopic hematuria, which is present in 75-80% of cases. […] Cytology remains a reliable diagnostic method for UTUC, however voided urinary cytology has high false negative rates approaching 50-90%. […] Selective cytology of the affected upper tract has shown improved diagnostic accuracy compared to voided cytology. […] Given the current limitations with non-invasive means for diagnosis of UTUC, the role of alternative urinary biomarkers has been an active area of investigation. […] Computerized tomographic urography (CTU) is the dominant imaging modality for evaluating the upper urinary tract. […] Cystourethroscopy remains an integral initial part of UTUC evaluation to rule out concomitant bladder cancer. […] The use of ureteroscopy with biopsy is currently the primary method for diagnosing UTUC if the imaging and cytology are not sufficient for the diagnosis and/or risk-stratification of the tumor.

• #2 UroPartners – Ureter/Renal Pelvis Cancer

  https://uropartners.com/Conditions/Ureter%20Renal%20Pelvis%20Cancer

  What is upper urinary tract cancer? It is a disease in which cancer cells are found in the tissues lining the collection reservoir (urothelial cells) of the kidneys – the renal pelvis – and/or in the ureters that connect the kidneys to the bladder. […] How is upper urinary tract cancer diagnosed? Investigating for cancer starts with a complete medical history and physical examination, during which your urologist will feel your abdomen, flank, and back for any lumps or masses. […] If your doctor suspects a malignancy or still cannot locate the source of your bleeding, he/she will probably order various imaging tests, starting with a computerized tomography (CT) scan with pyelography. […] If the urologist still does not have a complete picture, he or she may order a direct visual inspection of your upper urinary tract.

• #2 Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10560346/

  The objective of this review is to outline contemporary approaches to diagnosis, workup, and risk stratification for patients with UTUC. […] Basic laboratory workup should include microscopic urinalysis to detect microscopic hematuria and rule out urinary tract infection, along with hemoglobin level and renal function panel. […] Cytology remains a reliable diagnostic method for UTUC, however voided urinary cytology has high false negative rates approaching 50-90%. […] Selective cytology of the affected upper tract has shown improved diagnostic accuracy compared to voided cytology, with meta-analysis demonstrating a sensitivity of 53.1% and specificity of 90%. […] Newer classification methods in cytologic grading (Paris System) were introduced in 2016 to improve diagnostic accuracy and focus more on high-grade diagnosis.

• #2 Urothelial Tumors of the Renal Pelvis and Ureters Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/452449-workup

  Cytopathology of voided urine samples yields low sensitivity, especially for low-grade tumors, which results in normal cytology results in up to 80% of cases. The sensitivity of cytopathology increases for higher-grade tumors, which tend to shed more tumor cells. Cytology yields an accuracy of 83% in patients with high-grade disease. […] Each of the following should be obtained in a suspected case of UTUC: Cystoscopy To rule out bladder tumor, Urinary cytology, CT urography. […] Retrograde urography allows better visualization of the collecting system than excretory urography by increasing the distention of the urinary collecting system. Retrograde pyelography is preferable in patients with azotemia and/or contrast allergy. Overall, retrograde urography is more than 75% accurate in establishing a diagnosis of urothelial cancer.

• #2 Upper urinary tract urothelial cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/upper-urinary-tract-urothelial-cancer-UTUC

  Upper urinary tract urothelial cancer (UTUC) is cancer that starts in the upper urinary tract. This is made up of the ureters and an area of the kidneys called the renal pelvis. […] If you have symptoms, you usually start by seeing your GP. They will examine you and arrange for you to have some tests. They may test your pee (urine). They may also do blood tests to check: your general health, the number of cells in your blood (full blood count), how well your kidneys and liver are working. […] The urologist or a specialist nurse will ask you about your symptoms and your general health. They will also examine you and arrange some of the following tests: Blood tests help your doctors check how well your kidneys and liver are working. They also show the number of blood cells in your blood. This is called a full blood count.

• #2 Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10560346/

  Given the current limitations with non-invasive means for diagnosis of UTUC, the role of alternative urinary biomarkers has been an active area of investigation. […] Computerized tomographic urography (CTU) is the dominant imaging modality for evaluating the upper urinary tract. […] It has been shown to be highly accurate for diagnosing UTUC, with sensitivity of 92% and specificity of 95% according to a recent meta-analysis of 13 studies involving 1,233 patients. […] Cystourethroscopy remains an integral initial part of UTUC evaluation to rule out concomitant bladder cancer. […] The use of ureteroscopy with biopsy is currently the primary method for diagnosing UTUC if the imaging and cytology are not sufficient for the diagnosis and/or risk-stratification of the tumor. […] While there have been improvements in the visualization of UTUC, the endoscopic yield of biopsies remains a key factor in the reliability of risk stratification for UTUC.

• #2 Diagnosis of cancer of the renal pelvis or ureter | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/renal-pelvis-and-ureter/diagnosis

  Retrograde pyelography is a test that makes images of the urinary system, including the kidneys and ureters. A dye is injected directly into the urinary system through a tube placed into the ureter using a cystoscopy. This procedure is sometimes used to find out what is blocking the flow of urine. It can also help diagnose cancer in the ureters or kidneys. […] A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A CT scan of the abdomen and pelvis is used to check the urinary system for any tumours or blockages. It is also used to check if cancer has spread to lymph nodes, the liver or other organs and tissue around the renal pelvis and ureter. […] Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. An MRI may be used to check if cancer has spread to organs or areas outside the urinary tract.

• #2 Ureteral cancer_ diagnosis

  https://en.yz-proton.com/plan/131.html

  Excretive urography is one of the basic examination methods for diagnosing renal pelvis or ureteral cancer. […] Retrograde upper urinary tract imaging is a method of examination in which a catheter is inserted into the ureter and renal pelvis through cystoscopy, and contrast agent is injected to enhance the imaging of the upper urinary tract. […] CT examination: CT scanning has high resolution, and after plain and enhanced scanning, it can clearly display the location, size, density infiltration range, and relationship between surrounding organs of the lesion. […] The typical CT manifestations of renal pelvis and ureteral cancer are: soft tissue tumors found in the renal pelvis or ureter, which may be accompanied by hydronephrosis in the pelvis or ureter, as well as infiltration and regional lymph node metastasis around the kidney or ureter;

• #2 Diagnosis of cancer of the renal pelvis or ureter | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/renal-pelvis-and-ureter/diagnosis

  An ultrasound uses high-frequency sound waves to make images of parts of the body. It may be used to check if cancer has spread to other organs or areas in the pelvis and abdomen. An ultrasound can also be used to check the health of the kidneys. […] A bone scan uses bone-seeking radioactive materials called radiopharmaceuticals and a computer to create a picture of the bones. It is used to check if cancer has spread to bone. It is usually only done if you have symptoms such as bone pain or if the level of ALP in the blood is high.

• #2 Urothelial Cancer: Diagnostic Evaluation | MedPage Today

  https://www.medpagetoday.com/medical-journeys/urothelial-cancer/102694

  Urine cytology has little diagnostic value when a patient presents with microscopic hematuria, especially given that the yield for low-grade cancer is low. […] For patients with microscopic hematuria, AUA recommends personalizing the diagnostic evaluation according to patient risk and involving shared decision-making. […] For patients who present with gross hematuria, upfront urine cytology is often pursued as part of the evaluation, in addition to cystoscopy and imaging. […] Several imaging findings on CT urography for hematuria strongly suggest the presence of malignancy within the bladder. […] These factors will ultimately influence treatment selection, since the majority of NMIBCs can be managed conservatively with intravesical instillations of chemotherapy or immunotherapy agents, whereas muscle-invasive tumors require more radical treatment such as bladder removal or radiation.

• #2 Ureteral cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-cancer/diagnosis-treatment/drc-20360722

  To diagnose ureteral cancer, a healthcare professional might start by asking about your symptoms and examining your body. You might have a procedure to see inside your urinary tract to look for signs of cancer. Other tests and procedures include urine tests and imaging tests. […] Imaging tests make pictures of the body. They may help your healthcare team better understand the size of the cancer. Imaging tests also can look for signs that cancer may have spread beyond the ureter. Imaging tests used for ureteral cancer may include: […] You may undergo a urinalysis to analyze your urine. A urine cytology test may be used to look for concerning cells in a urine sample. […] During a procedure called ureteroscopy, a healthcare professional inserts a thin, lighted tube equipped with a camera into the urethra. The device is passed through the bladder and into the ureters.

• #2 Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma – Zganjar – Translational Andrology and Urology

  https://tau.amegroups.org/article/view/116230/html

  While there have been improvements in the visualization of UTUC, the endoscopic yield of biopsies remains a key factor in the reliability of risk stratification for UTUC. […] Various clinical scenarios can present significant challenges for the use of diagnostic ureteroscopy. […] In addition to low risk of tract seeding with percutaneous biopsy, this approach may also decrease the risk of intravesical recurrence. […] The relationship between ethnicity and UTUC outcomes is also uncertain, with some studies finding differences in survival between ethnic groups and others finding no significant differences. […] The predictive ability of the EAU risk stratification system to identify pT2/N+ stage patients at radical nephroureterectomy was recently evaluated and compared to a new preoperative risk model.

• #2 Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10560346/

  A recent comprehensive systemic review and meta-analysis was performed utilizing 23 studies (almost 3,600 patients) to evaluate the accuracy of ureteroscopic biopsies in predicting the stage and grade of UTUC. […] These data demonstrate that invasion of the subepithelial connective tissue in the ureteroscopy specimen has a strong correlation with pathologic stage, however biopsy of the subepithelium is one of the main challenges of ureteroscopic biopsy. […] Various pre-operative serum and urine-based biomarkers have been investigated to help predict the prognosis of UTUC, however none of the investigated markers have been validated yet to support their introduction into routine clinical decision-making. […] The predictive ability of the EAU risk stratification system to identify pT2/N+ stage patients at radical nephroureterectomy was recently evaluated and compared to a new preoperative risk model utilizing over 1,200 patients in a multi-institutional retrospective cohort. […] These preoperative nomograms can be used to select patients more optimally for preoperative systemic chemotherapy and facilitate clinical trial enrollmentalthough some caution should be used as none have benefited from external validation.

• #2 Ureteral Cancer and Ureteral Urothelial Carcinoma | Saint John’s Cancer Institute – Santa Monica, CA

  https://www.saintjohnscancer.org/urology/conditions/ureteral-cancer/

  Stage 1 occurs in 25% of patients. […] Stage 2 involves muscle-invasive upper tract urothelial carcinoma. […] Stage 3 cancers occur in 24% of patients. […] Stage 4 upper tract urothelial carcinoma can involve surrounding organs. […] 35% are low grade or non-aggressive tumors while 65% are high-grade or aggressive.

• #2 Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/non-metastatic-upper-tract-urothelial-carcinoma

  Clinicians should provide patients with a description of the short- and long-term risks associated with recommended diagnostic and therapeutic options. This includes the need for endoscopic follow-up, clinically significant strictures, toxicities associated with surgical treatment and side effects from neoadjuvant and adjuvant therapies. (Clinical Principle) […] Tumor ablation should be the initial management option for patients with LR favorable UTUC. (Strong Recommendation; Evidence Level: Grade B) […] Clinicians should recommend RNU or SU for surgically eligible patients with HR UTUC. (Strong Recommendation; Evidence Level: Grade B) […] For patients with LR UTUC, clinicians may perform LND at time of NU or ureterectomy. (Conditional Recommendation; Evidence Level: Grade C) […] For patients with HR UTUC, clinicians should perform LND at the time of NU or ureterectomy. (Strong Recommendation; Evidence Level: Grade B)

• #2 Bladder and Ureteral Cancer – Scott D. Miller, MD

  https://scottdmillermd.com/patient-information/bladder-and-ureteral-cancer/

  A diagnosis can be prompted by pain, increased urinary frequency, blood in the urine (visible or detected by urinalysis), or a coincidental finding on an x-ray such as a CT scan. […] The diagnosis can sometimes be made by a variety of x-ray tests. However, placing a telescope inside these structures is often necessary. Examination of the urine for cancer cells (urinary cytology), abnormal DNA (FISH test), or certain chemicals can be helpful. […] In order to make an informed decision, patients should undergo CT scan of the abdomen and pelvis, chest x-ray, and telescopic examination of the bladder (cystoscopy). […] A FISH test helps detect abnormal DNA in the urine from cancer cells that may have shed from the lining of the urinary tract. […] Once diagnosed with transitional cell carcinoma of the bladder or ureter, long-term regular examination of the entire urinary tract is mandatory.

• #2 Negative pathology of ureteral carcinoma significantly delaying the diagnosis of the primary tumor of osteoblastic metastases: A case report and review of the literature

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5038518/

  The present study describes a delayed diagnosis of ureteral UC due to the lack of pathological evidence. […] Currently, imaging and endoscopy, combined with pathological examination, are the main diagnostic approaches for UC. […] Hence, the difficulty in achieving pathological evidence (as reported in the present study) will delay the diagnosis, no matter which diagnostic method the patient received or how efficient this was. […] Considering the possibility of asymptomatic ureteral UC and negative pathology, a suitable screening test should be recommended for high-risk patients. Additionally, a more efficient diagnostic method is required. Moreover, the possibility of new diagnostic criteria that do not rely on the pathology of primary foci in ureteral UC should be considered due to the difficulty in achieving pathological evidence in certain patients.

• #2 Urothelial Tumors of the Renal Pelvis and Ureters Guidelines: Guidelines Summary

  https://emedicine.medscape.com/article/452449-guidelines

  The EAU guidelines in general concur with NCCN and include the following key recommendations: Cystoscopy is performed to rule out concurrent bladder tumor, CT urography is performed for upper tract evaluation and staging, Use diagnostic ureteroscopy (preferably without biopsy) if imaging and/or voided urine cytology are insufficient for the diagnosis and/or risk-stratification of patients suspected to have UTUC, Magnetic resonance urography or 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT may be used when CT is contraindicated. […] For metastatic disease in both renal pelvis and ureter tumors, systemic therapy is recommended by both guidelines.

• #2 Upper urinary tract urothelial cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/upper-urinary-tract-urothelial-cancer

  You usually have surgery if the cancer hasn’t spread, and you’re well enough. Your surgeon removes your kidney, ureter and part of your bladder. This is called a radical nephroureterectomy (neff-roh-your-ee-ter-eck-toh-mee). […] Your doctor may recommend you have chemotherapy after surgery if the cancer has: grown into the layer of muscle or deeper, spread to the nearby lymph nodes. […] Advanced upper urinary tract urothelial cancer means that the cancer has grown outside the kidney or ureter (locally advanced). Or has spread to another part of the body (metastatic cancer). The main treatments are chemotherapy and immunotherapy. […] You have regular follow up appointments after your treatment. […] At these appointments your doctor looks for signs of the cancer coming back or spreading.

• #2

  https://www.cancervic.org.au/cancer-information/types-of-cancer/upper_tract_urothelial/utuc_overview.html

  Most upper tract urothelial cancers will need follow-up cystoscopies and/or ureteroscopies, imaging and urine tests annually. […] The main treatments for UTUC include surgery, chemotherapy and sometimes radiation therapy, which can be given alone or in combination. This is called multi-modality treatment. […] Surgery is the most effective treatment for UTUC. Surgery may be performed as either keyhole surgery or open surgery. Each method has advantages in particular situations. Your doctor will talk to you about which type of surgery is appropriate for you. […] Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. Your treatment will depend on your situation and stage of the tumour. […] If your cancer has spread and is now known as advanced or metastatic upper urothelial cancer you may be offered immunotherapy, which uses the bodys own immune system to fight cancer.

• #2 Ureteral Cancer and Ureteral Urothelial Carcinoma | Saint John’s Cancer Institute – Santa Monica, CA

  https://www.saintjohnscancer.org/urology/conditions/ureteral-cancer/

  Upper tract urothelial carcinoma is a cancer that can occur anywhere from the inner linings of the kidney, down the ureter, in the bladder, and down the urethra. […] Between 5% and 10% of all urothelial cancers start in the ureter (or renal pelvis) and are diagnosed as upper tract urothelial carcinoma (UTUC). […] Ureteral cancer is uncommon and occurs mostly in older adults and in those who previously treated for bladder cancer. […] Ureteral cancer is closely related to bladder cancer. These are cancers that originate in the renal pelvis, calyx, or ureters that extend to the bladder and are referred to as descending tumors. 22-47% of the ureteral cancer cases will also develop bladder cancer at some time in the future. […] 20-25% of patients with carcinoma in the bladder will develop upper tract urothelial carcinoma.

• #3 Ureteral Cancer – Best Hospitals, Doctors, Prices – Booking Health

  https://bookinghealth.com/disease/ureteral-cancer

  Ureteral cancer refers to urothelial cancer. It develops from the urothelial cells, which lines the urinary organs from the inside. Urothelial cancer is common: it ranks fifth among all malignancies after lung, prostate, breast and colon cancers. […] Urothelial cancer can be suspected based on the results of urine cytology. However, the sensitivity of this examination is low. Cancer cells usually enter the urine after the invasion of the muscle wall of the ureter. […] To make a diagnosis, instrumental diagnostic tests are required: […] Computed tomography is the best method for imaging the urinary tract. The technique detects 100% of neoplasms over 1 cm, 96% of tumors from 5 to 10 mm, 89% of neoplasms of 3-5 mm in size. […] Ureteroscopy is an endoscopic diagnostic method, the most accurate one, which allows the doctors to perform a biopsy and confirm the diagnosis. This is an optional examination. It is carried out mainly in those whose results of histological examination of the material can affect the cancer treatment regimen.

• #3 Ureteral cancer – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-cancer/symptoms-causes/syc-20360721

  Ureteral cancer is a growth of cells that starts in the ureters. The ureters are tubes that connect the kidneys to the bladder. The ureters are part of the urinary tract. They carry urine produced by the kidneys to the bladder. […] Ureteral cancer is closely related to bladder cancer. The cells that line the ureters are the same type of cells that line the inside of the bladder. People diagnosed with ureteral cancer have an increased risk of bladder cancer. So people with ureteral cancer are usually tested for signs of bladder cancer. […] Treatment for ureteral cancer typically involves surgery. In certain situations, chemotherapy, immunotherapy or targeted therapy may be recommended. […] It’s not clear what causes ureteral cancer. Ureteral cancer starts as a growth of cells in a ureter. The ureters are tubes that connect the kidneys to the bladder.

• #3 Diagnosis of cancer of the renal pelvis or ureter | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/renal-pelvis-and-ureter/diagnosis

  Retrograde pyelography is a test that makes images of the urinary system, including the kidneys and ureters. A dye is injected directly into the urinary system through a tube placed into the ureter using a cystoscopy. This procedure is sometimes used to find out what is blocking the flow of urine. It can also help diagnose cancer in the ureters or kidneys. […] A computed tomography (CT) scan uses special x-ray equipment to make 3D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A CT scan of the abdomen and pelvis is used to check the urinary system for any tumours or blockages. It is also used to check if cancer has spread to lymph nodes, the liver or other organs and tissue around the renal pelvis and ureter. […] Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. An MRI may be used to check if cancer has spread to organs or areas outside the urinary tract.

• #3 Ureteral cancer | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/ureteral-cancer?content_id=CON-20314003

  In the lab, tests can look for signs of cancer. Other tests might look for changes in the DNA inside the cancer cells. Results from these tests may help your healthcare team make a treatment plan. […] People diagnosed with ureteral cancer have a high risk of bladder cancer. Bladder cancer may occur at the same time as the ureteral cancer or grow soon after treatment. Imaging tests may be used to examine the bladder and look for signs of cancer. In a procedure called a cystoscopy, a healthcare professional may use a scope to see inside the bladder.

• #3 Ureteral cancer – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ureteral-cancer/diagnosis-treatment/drc-20360722

  To diagnose ureteral cancer, a healthcare professional might start by asking about your symptoms and examining your body. You might have a procedure to see inside your urinary tract to look for signs of cancer. Other tests and procedures include urine tests and imaging tests. […] Imaging tests make pictures of the body. They may help your healthcare team better understand the size of the cancer. Imaging tests also can look for signs that cancer may have spread beyond the ureter. Imaging tests used for ureteral cancer may include: […] You may undergo a urinalysis to analyze your urine. A urine cytology test may be used to look for concerning cells in a urine sample. […] During a procedure called ureteroscopy, a healthcare professional inserts a thin, lighted tube equipped with a camera into the urethra. The device is passed through the bladder and into the ureters.

• #3 Ureter Cancer | Diagnosis and Treatment

  https://www.genesiscareus.com/en/condition/cancer/ureter-cancer

  You may need to undergo a urine test so that your doctor can rule out possible urinary tract infection (UTI) or check for blood in your urine. […] During this test, your doctor passes a thin, lighted scope (ureteroscope) into your urethra (hole where urine exits your body), and into your bladder and ureters. Your doctor uses specialized viewing equipment to check for signs of cancer. […] Your doctor may use other diagnostic tests to find out more about your cancer, where its located and which treatments are likely to be most effective. Your doctor may use some of these tests to find out how well your treatment is working.

• #3 Upper urinary tract urothelial cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/upper-urinary-tract-urothelial-cancer

  Upper urinary tract urothelial cancer can start in a part of the kidney called the renal pelvis. Or it can start in the ureters. […] Upper urinary tract urothelial cancer is more common in older people. It’s also diagnosed more often in men than women. […] The symptoms of upper urinary tract urothelial cancer include: blood in your urine, pain in your side between the ribs and the hip (flank). […] Your GP will examine you and test your urine for blood. You may also have blood tests to check your general health. […] They may refer you to a specialist doctor (urologist) for further tests to find out the cause of your symptoms. These tests might include: a test using a CT scan and special dye (contrast medium) to look at the urinary system (CT urogram), a CT scan of your chest, using a thin flexible tube to look inside your bladder (cystoscopy) or your ureter and kidney (ureteroscopy) to check for abnormal areas – your doctor may take a small piece of tissue (biopsy) to check for cancer, looking for cancer cells in your urine your doctor sends a sample of your urine to the laboratory to be looked at under a microscope.

• #3 Diagnosis, workup, and risk stratification of upper tract urothelial carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10560346/

  Upper tract urothelial carcinoma (UTUC) is a relatively rare disease that presents unique challenges to urologists from both a diagnostic and management standpoint. […] Therefore, physicians caring for patients with UTUC must be facile with multiple diagnostic and therapeutic strategies in order to provide optimal patient care. […] We present an overview of the epidemiology, histology, risk factors, and contemporary approach to the diagnosis, laboratory evaluation, imaging, and risk stratification for patients with UTUC. […] Computerized tomographic urography, thorough endoscopic evaluation, and biopsy (endoscopically or percutaneously) remain the standard of care for the diagnosis and staging of patients with suspected UTUC. […] A thorough understanding of the various diagnostic challenges, imaging/pathologic limitations, biomarkers, and risk stratification tools will allow us as a field to develop new modalities to improve our diagnostic capabilities and reduce the risk of under diagnosis and over treatment for our patients.

• #3 Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/non-metastatic-upper-tract-urothelial-carcinoma

  For patients with suspected UTUC, a cystoscopy and cross-sectional imaging of the upper tract with contrast including delayed images of the collecting system and ureter should be performed. (Strong Recommendation; Evidence Level: Grade B) […] Clinicians should evaluate patients with suspected UTUC with diagnostic ureteroscopy and biopsy of any identified lesion and cytologic washing from the upper tract system being inspected. (Strong Recommendation; Evidence Level: Grade C) […] In cases where ureteroscopy cannot be safely performed or is not possible, an attempt at selective upper tract washing or barbotage for cytology may be made and pyeloureterography performed in cases where good quality imaging such as CT or MR urography cannot be obtained. (Conditional Recommendation; Evidence Level: Grade C)

• #3 Upper urinary tract urothelial cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/upper-urinary-tract-urothelial-cancer-UTUC

  During a urinary cytology, a sample of your urine is checked for cancer cells. […] A CT urogram is a type of CT scan to look at the kidneys, ureters and bladder. […] Cystoscopy and ureteroscopy are tests that let the doctor look inside the bladder, ureter and renal pelvis. […] After your treatment has finished, you will have regular check-ups with your cancer doctor to monitor how you are recovering after treatment. These will usually include a physical examination. They may also involve taking some urine (pee) or blood samples. […] You may also have a cystoscopy to detect any changes in the bladder. This is because people with cancer of the ureter or renal pelvis have an increased risk of Bladder cancer after a few years.

• #3

  https://www.cancervic.org.au/cancer-information/types-of-cancer/upper_tract_urothelial/utuc_overview.html

  Radiation therapy uses high energy x-rays to destroy cancer cells, however it is less commonly used for UTUC. Your doctor will discuss your options with you. […] Once your treatment has finished, you will have regular check-ups to confirm that the cancer hasnt come back. Ongoing surveillance for UTUC involves a schedule of tests, scans, scopes and physical examinations.

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