Materiały źródłowe

• #1 Ureteric carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5470567/

  Ureteric neoplasms are rare tumors. The annual incidence (during the period 1995-2005) was 0,95-1,15/100.000 person-year. They are almost always urothelial tumors, especially papillary transitional cell carcinoma, as in the image above, and are less common than tumors of the renal pelvis and 10 times less common than urinary bladder tumors. […] Environmental factors have been implicated. In 2013, Holmng et al published a retrospective study of 930 UUTT cases and found a relationship to previous abdominal radiotherapy in 16,7% of cases generally with a latency period of at least 15 years. Phenacetin-containing analgesics is known to be related to UUTT; Steffens and Nagel showed 22% of these tumors associated with analgesic abusers. In Taiwan, arsenic exposure was associated with the development of upper urinary tract cancer. Chinese herbs containing aristolochic acid may cause progressive renal fibroses and is also associated with significant increase in the incidence of urothelial tumors of renal pelvis or ureter. Other contributory factors include Balkan endemic nephropathy and Lynch syndrome. […] Over 90% of the UUTT are of urothelial origin (transitional cells) with almost 8% being squamous cell carcinoma. The tumor growth pattern may be solid, papillary or mixed; the former presents a poor prognosis.

• #2 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. […] The ureter is the least common location for transitional cell carcinoma (TCC) of the urinary tract, 2-3 times less common than TCC of the renal pelvis, and 100 times less common than transitional cell carcinoma of the bladder. It accounts for only 1% of all upper urinary tract malignancies. […] The distal ureter is more frequently affected, presumably due to greater stasis. […] As is the case elsewhere, two main morphologic patterns are recognized: papillary and non-papillary. […] Prognosis depends on the stage of the tumor and histological grade has little influence. Metastases are most frequently to the liver, bone, and lung.

• #3

  https://journals.lww.com/ijpm/fulltext/2024/67030/papillary_urothelial_carcinoma_of_the_ureter___a.49.aspx

  Urothelial carcinoma is the most common epithelial origin tumor arising in the upper urinary tract. Ureteral urothelial carcinoma is a rare malignancy and much rare in comparison to bladder and renal malignancy. Over the past few years, ureteral urothelial carcinoma incidence has risen from 0.69 to 0.91 cases per 1,00,000 individuals. The mean age of presentation is 73 years. Ascending tumors occur when a tumor is present in the bladder. Clinically, these tumors present with hematuria followed by symptoms of obstruction like flank pain, bladder irritation, and other constitutional symptoms. Surgical management of such upper urinary tract ureteric malignancy includes open radical nephroureterectomy, which remains the gold standard; Though open radical nephrouretectomy is the operative gold standard for such ureteric lesions, other modalities of surgical intervention like retrograde ureteropyeloscopy, percutaneous antegrade endoscopy procedure, distal ureterctomy and other nephron sparing or conservative management like ureteroscopic abalation intracavity therapy, or removal of the involved segment are also commonly practiced. Diagnosis of ureteral urothelial tumors is made most commonly by computed tomography (CT) urogram, magnetic resonance (MR) urogram, and urine cytology.

• #3

  https://journals.lww.com/ijpm/fulltext/2024/67030/papillary_urothelial_carcinoma_of_the_ureter___a.49.aspx

  In malignancy of the ureter, multifocal implants can be commonly seen during the intraoperative procedure. Metastasis of these tumors occurs by the lymphatic route to the nodes, lungs, liver, bones, and brain. Patients with high-grade invasive ureteral carcinoma and systemic lymph node metastasis usually have a poor prognosis. […] Hence, the abovementioned case scenario definitely reaffirms the significance of extensive tumor mass evaluation through the histopathological assessment despite the bland character of tumor on gross, and that a possibility of a ureteric mass (of malignant potential) should be taken into account when dealing with a case of hydronephrosis and/or chronic pyelonephritis as the ureteric mass can be the underlying cause for this pathology. […] Tumors arising from the epithelial lining or the smooth muscle layer of the ureter, either benign, or malignant may cause reflux neuropathy and that a possibility of a ureteric mass (of malignant potential) should be taken into account when dealing with a case of hydronephrosis and/or chronic pyelonephritis, multifaceted specialty approach toward patient care and diagnostics and profoundly affect patient management and prognosis.

• #4 Global burden, risk factors, and temporal trends of ureteral cancer: a comprehensive analysis of cancer registries | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03485-x

  Ureteral cancer is a rare cancer. This study aimed to provide an up-to-date and comprehensive analysis on the global trends of ureteral cancer incidence and its association with lifestyle and metabolic risk factors. […] Higher HDI and gross domestic product (GDP) and a higher prevalence of smoking, alcohol drinking, physical inactivity, unhealthy dietary, obesity, hypertension, diabetes, and lipid disorder were associated with higher incidence of ureteral cancer. […] Although ureteral cancer was relatively rare, the number of cases reported was rising over the world. […] Other risk factors include male gender, smoking, chemical exposure, and some region-specific factors, such as the consumption of aristolochic acid in Eastern Asia. […] Smoking was proven to be one of the factors associated with ureteral cancer incidence in the current study.

• #4 Global burden, risk factors, and temporal trends of ureteral cancer: a comprehensive analysis of cancer registries | BMC Medicine | Full Text

  https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03485-x

  Alcohol drinking was also an associated risk factor of ureteral cancer. […] In some specific regions, Chinese herb nephropathy and Balkan endemic nephropathy were also related to ureteral cancer. […] On the population level, we identified hypertension as a risk factor of ureteral cancer, which was in line with a previous study. […] However, the underlying mechanism remains uncertain and further studies are needed. […] The overall trend of ureteral cancer was increasing; the significant rises were found in countries in different regions. […] The rising trends among females were more evident compared with the other subgroups, especially in European countries. […] Further studies could be conducted to examine the recent trend in European countries and confirm the relationship of the risk factors identified in our study, but not previously proved.

• #5 Ureteral cancer | Beacon Health System

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

  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 happens when cells in a ureter develop changes in their DNA. A cell’s DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time. […] In cancer cells, the DNA changes give other instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells. […] The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it’s called metastatic cancer.

• #6 Ureteral cancer | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/ureteral-cancer

  Ureteral cancer happens when cells in a ureter develop changes in their DNA. A cell’s DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells to die at a set time. […] In cancer cells, the DNA changes give other instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells. […] The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it’s called metastatic cancer.

• #7 Urethral cancer – Pathway

  https://m.pathway.md/diseases/urethral-cancer-rec2oz3TDCtYJT5iV

  Urethral cancer is a rare malignancy originating from the epithelial cells of the urethra, with histological types including SCC, transitional cell carcinoma, and adenocarcinoma. […] The pathogenesis of urethral cancer involves the malignant transformation of urethral epithelial cells, often preceded by dysplastic changes. SCC is more common in the distal urethra, while transitional cell carcinoma typically arises in the proximal urethra. The tumor can invade adjacent tissues, including the bladder, vagina, or prostate. […] Chronic inflammation of the urethra, such as recurrent UTIs and urethral strictures, is a recognized risk factor for urethral cancer. HPV 16 infection, STIs, and prolonged catheter use are also risk factors for urethral cancer.

• #8 Urothelial Tumors of the Renal Pelvis and Ureters: Practice Essentials, Epidemiology, Etiology

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

  Urothelial carcinoma is the most common histology observed, accounting for greater than 95% of upper urinary tract urothelial tumors. As noted above, urothelial carcinomas are strongly associated with smoking. […] Several molecular mechanisms have been associated with the development of UTUC. Tumor suppressor genes P19, P16, RB1, and P53 have all been associated with UTUC. Losses of P53, P19, and P16 are associated with low-grade cancers, while a loss of RB1 has been associated with higher-grade, more aggressive tumors. […] Tumor microsatellite instability (MSI) has been studied as a prognostic indicator for upper urinary tract tumors. In general, high levels of MSI seem to correlate with a more favorable prognosis, particularly in younger patients with T2 or T3/N0 disease. […] E-cadherin, hypoxia-inducible factor-1, Ki-67, survivin (a protein apoptosis inhibitor), epidermal growth factor receptor (EGFR), and telomerase RNA component have been identified as independent markers of advanced disease and/or prognosis. However, none has been externally validated or widely used.

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

  https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/chapter/epidemiology-aetiology-and-pathology

  Lynch syndrome is characterised by a predisposition to early onset colorectal cancer and several extra-colonic malignancies related to pathogenic germline mutations in one allele of the mismatch repair (MMR) genes MLH1, MSH2, MSH6 or PMS2. After colorectal and endometrial cancers, UTUC is the 3rd most common malignancy in the Lynch syndrome spectrum. […] From a genetic perspective, the majority of tumours develop in MSH2 and MSH6 mutation carriers. The carcinogenesis is related to the somatic mutation of the second allele of the germline-mutated MMR gene. […] Upper urinary tract tumours are almost always UCs with pure non-urothelial histology being rare. […] A number of studies focussing on molecular classification have been able to demonstrate genetically distinct groups of UTUC by evaluating DNA, RNA and protein expression. The most common genomic alterations included FGFR3, chromatin remodelling genes (i.e., KMT2D and KDM6A), TP53/MDM2, and other typical tumour suppressors/oncogenes such as CDKN2A or RAS.

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

  https://uroweb.org/guidelines/upper-urinary-tract-urothelial-cell-carcinoma/chapter/epidemiology-aetiology-and-pathology

  Urothelial carcinoma (UC) is the second most common urological malignancy in developed countries. […] Upper tract UC and BC exhibit significant differences in the prevalence of common genomic alterations. In individual patients with a history of both tumours, BC and UTUC are often clonally related. Genomic characterisation of UTUC provides information regarding the risk of bladder recurrence and can identify tumours associated with Lynch syndrome. […] A number of environmental risk factors have been implicated in the development of UTUC. […] Aristolochic acid, a nitrophenanthrene carboxylic acid produced by aristolochia plants, exerts negative effects on the urinary system by irreversibly injuring renal proximal tubules resulting in chronic tubulointerstitial disease, while the mutagenic properties of this carcinogen can lead to UTUC.

• #10 Medical Student Curriculum: Upper Tract Urothelial Carcinoma – American Urological Association

  https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/upper-tract-urothelial-carcinoma

  Identifying distinct mechanisms for bladder and upper tract urothelial cancer is challenging owing to its tendency to develop multiple discontinuous foci along the urinary tract. The 'field effect’ theory suggests that urothelial cancer may be present but grossly undetectable throughout urinary tract tissue. Clonal accumulation of mutations occurs before the patient experiences symptoms or observable disease. […] Low-grade primary UTUC also share similar genetic mutations with urothelial bladder cancer. Genes involved in UTUC include CDKN2a, which promotes cell proliferation, and FGFR3 overexpression, a modulator of cell proliferation and growth. However, high-grade UTUC frequently presents p53 mutations, a tumor suppressor gene and major regulator of the cell cycle, found in more aggressive UTUC.

• #10 Medical Student Curriculum: Upper Tract Urothelial Carcinoma – American Urological Association

  https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/upper-tract-urothelial-carcinoma

  Mutations in mismatch repair genes (MLH1, MSH2, MSH6, PMS2, or EPCAM) also provide insights into the significance of DNA damage and microsatellite instability in urothelial cancer development. These mutations result in an autosomal dominant inheritance pattern that contribute to Lynch Syndrome, which is associated with an elevated risk of urothelial cancer of both the bladder and upper tract, colorectal cancer, endometrial cancer, and other malignancies. […] Environmental risk factors for UTUC are linked to urothelial cancer and thought to be related to chronic exposure of nephrotoxic or carcinogenic chemicals within filtrate from systemic circulation. Patient-specific factors, such as age and comorbidities, may influence the ability to counteract these carcinogens, rendering some individuals more susceptible to disease progression and a poorer prognosis.

• #11 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. […] 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. […] Patients with a syndrome called Lynch Syndrome also have an increased chance of developing upper tract urothelial carcinoma. Lynch Syndrome is an inherited cancer syndrome. We estimate that 21% of patients with upper tract urothelial carcinoma have a variant of Lynch Syndrome. […] 20-25% of patients with carcinoma in the bladder will develop upper tract urothelial carcinoma.

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

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

  It is well known that tobacco increases risk for all types of cancer and carcinoma. Patients are two to three times at increased risk of developing urothelial carcinoma if they have exposure to aniline dyes. […] The following industries/careers are at a higher risk of carcinogenic chemical exposure: Certain industries have a greater risk for developing UTUC. […] Immunotherapy is generally ideal of patients with higher-grade disease, though it may become part of the treatment process for low-grade cancers in the future. UTUCs have a high rate of genetic mutations and unstable genes, which makes them more susceptible to immunotherapy treatments. These specific drugs are generally called checkpoint blockade. […] Aggressive cancers may involve removal of the kidney and the ureter, and sometimes the bladder. If patients have more aggressive disease, as with stage-2 or 3 UTUC, then the course of treatment involves radical surgery, with or without chemotherapy.

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

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

  Stage 0, or stage TA or TIS is a tumor that is just involving the mucosa, the lining on the top. […] Stage 1 occurs in 25% of patients. The tumor not only invades the mucosa, but the lamina propria. […] Stage 2 involves muscle-invasive upper tract urothelial carcinoma. Tumors not only invade the mucosa, and lamina propria, but they also invade the muscle lining of the ureter, or the renal pelvis. […] Stage 3 cancers occur in 24% of patients. It involves the mucosa, the lamina propria and the muscle. […] Stage 4 upper tract urothelial carcinoma can involve surrounding organs. If it spreads to lymph nodes in the lung or in the retroperitoneum, it would be considered locally advanced or stage 4 upper tract urothelial carcinoma. […] 35% are low grade or non-aggressive tumors while 65% are high-grade or aggressive.

• #12 Malignancies of the renal pelvis and ureter – UpToDate

  https://www.uptodate.com/contents/malignancies-of-the-renal-pelvis-and-ureter

  Malignancies of the renal pelvis and ureter […] The mucosal surfaces of the renal collecting tubules, calyces, and pelvis, as well as the ureter, bladder, and urethra, all have the same embryologic origin, and the term „urothelium” is used to delineate the lining surface epithelium. This common embryologic origin has important implications for the management of patients with these tumors. […] Urothelial (formerly known as transitional cell) carcinomas of the upper urinary tract (UTUC), bladder, and urethra tend to be multifocal. This phenomenon is termed „field cancerization” and is thought to be caused by exposure of the urothelium to potential carcinogens that are either excreted in the urine or activated by hydrolyzing enzymes in the urine. […] Over 90 percent of tumors of the renal pelvis and ureter are of urothelial origin and are histologically identical to those originating in the bladder.

• #13 Synchronous Bilateral Carcinoma of the Ureters. Report of a Case and a Short Discussion of the Literature | In Vivo

  https://iv.iiarjournals.org/content/34/4/2057

  The most common histologic type of ureteral cancer is urothelial (transitional epithelium) cancer and though it is rare, it can be synchronously present in the contralateral ureter. […] Known risks factors for developing urothelial carcinomas include the use of tobacco, (smokers having an up to seven-fold greater risk) […] Currently, no biomarker is routinely used for this type of cancer, which is unfortunate, because this specific type is usually asymptomatic until it has progressed. […] Urothelial cancer is a complex disease that is often followed by chronic kidney failure prior or after surgery and requires a high index of clinical suspicion to be diagnosed, since it rarely causes bothering symptoms and has a relative high mortality. […] Bilateral ureteral carcinomas are rare and usually have poor prognosis even if treated with RNU, unless histology shows low grade disease and a more conservative therapy is advocated.

• #14 Risks for renal pelvis and ureter cancer | Canadian Cancer Society

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

  Smoking tobacco is the main risk for renal pelvis or ureter cancer. […] Smoking tobacco increases your risk for renal pelvis or ureter cancer. The more you smoke and the longer you smoke, the greater your risk. After you quit smoking, the risk decreases over time. […] People who took 3 or more phenacetin pills a day over several years have a higher risk for renal pelvis or ureter cancer. […] People who take herbal products with aristolochic acids have a higher risk for renal pelvis or ureter cancer, as well as greater risk for kidney damage. […] People with BEN have a higher risk of developing cancer of the renal pelvis or ureter. […] People who have a lot of kidney stones or kidney infections have a higher risk of developing squamous cell carcinoma, which is usually rare, in the renal pelvis or ureter.

• #14 Risks for renal pelvis and ureter cancer | Canadian Cancer Society

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

  Type B increases the risk for several cancers, including colorectal cancer, other cancers of the digestive system and cancers of the urinary tract, such as renal pelvis or ureter cancer. […] People who received radiation therapy to the abdomen or pelvis have a higher risk for renal pelvis or ureter cancer. People who are exposed to radiation at work or who have survived atomic bombs or nuclear accidents also have a higher risk for renal pelvis or ureter cancer.

• #15 Renal Pelvis / Ureteral Cancer | The Urology Group of Virginia

  https://www.urologygroupvirginia.com/urologic-cancer-center/kidney-cancer/renal-pelvis-ureteral-cancer

  The lining of the urinary system is made up of specialized cells called transitional cells. These cells are designed to pass urine without absorbing toxins from the urine. When these cells become cancerous, it is called transitional cell carcinoma. Transitional cell carcinoma can occur in the renal pelvis, the ureter, or the urinary bladder. […] It is not always clear what causes transitional cell cancers to form. Cigarette smoking and exposure to industrial chemicals are clearly defined risk factors. Cigarette smoking alone has been estimated to cause 50% of all transitional cell cancers. Workplace exposure to chemical compounds such as paints and solvents may cause another 20-25% of transitional cell cancer cases. […] When there is a history of transitional cell carcinoma elsewhere, such as bladder cancer, there may be an increased risk of developing cancer of the renal pelvis or ureter. Some less common factors which may predispose to the formation of cancer to the renal pelvis or ureter include Balkan ancestry, analgesic (phenacetin) abuse, occupational exposures (chemical, petrochemical, plastics, coal, asphalt, tar), chronic irritation from infection or stones, cyclophosphamide chemotherapy, and use of contaminated Chinese herbs and family history (eg Lynch Syndrome II).

• #16 Bladder and Ureteral Cancer

  https://www.froedtert.com/prostate-cancer/bladder-ureteral-cancer

  Ureteral cancer is a cancer that arises in the ducts that transport urine from the kidneys to the bladder (the ureters). It is essentially the same kind of malignancy as bladder cancer. […] Bladder/ureteral cancer arises in the cells that line these organs. The disease appears to be caused by carcinogens excreted in the urine. Inhaled tobacco is the most common source of these carcinogens, but occupational exposure to certain industrial chemicals can also play a role. In addition, there may be a link between vitamin D deficiency and incidence of bladder cancer.

• #17 Ureteral cancer – Wikipedia

  https://en.wikipedia.org/wiki/Ureteral_cancer

  Ureteral cancer is usually a transitional cell carcinoma. Transitional cell carcinoma is „a common cause of ureter cancer and other urinary (renal pelvic) tract cancers.” […] The exact causes of ureteral cancer are not clear. However, it is known that patients with a history of bladder cancer are more likely to develop ureteral cancer because both cancers contain the same cell type. As with other cancers, the cells lining the ureter undergo a DNA mutation resulting in abnormal growth of cells without programmed cell death; this eventually leads to blockage of the ureter and possibly other body parts if left untreated. […] Aside from genetic factors and predisposition to developing cancer, there are also a few environmental factors and lifestyle choices that may significantly escalate the chances of being diagnosed with ureteral cancer. For example, taking an overabundance of pain medications such as phenacetin, a probable carcinogen, can lead to an increased risk. Exposure to certain chemicals used to produce leather goods, plastics, rubber, etc. have also been proven to influence the likeliness of developing ureteral cancer.

• #18 SSA – POMS: DI 23022.345 – Ureter Cancer – with Metastases or Inoperable, Unresectable or Recurrent – 10/05/2023

  https://secure.ssa.gov/poms.nsf/lnx/0423022345

  Ureter Cancer forms in transitional cells in the lining of the bladder, ureter, or renal pelvis. Transitional cells are cells that can change shape and stretch without breaking apart. Misuse of certain pain medications can affect the risk of developing transitional cell cancer of the renal pelvis or ureter. […] Risk factors can include prolonged misuse of certain pain medications, smoking cigarettes, exposure to certain dyes and chemicals used in making leather goods, textiles, plastics, or rubber. […] If the cancer is inoperable or unresectable, treatment with radiation and/or chemotherapy may be utilized for palliation, but the prognosis is poor. […] Inoperable refers to a physician’s opinion that surgery would not be beneficial based on a review of imaging studies, laboratory results, and physical examination findings. […] Unresectable cancer is established when the operative report indicates that the cancer is not completely removed or the pathology report notes that the surgical specimen has positive margins.

• #19 Transitional Cell Cancer: Causes, Signs, and Treatment

  https://www.healthline.com/health/cancer-renal-pelvis-or-ureter

  Transitional cell cancer is less common than other kidney or bladder cancers. The causes of the disease haven’t been fully identified. However, genetic factors have been noted to cause the disease in some patients. […] Other potential risk factors for the development of this type of cancer include: abuse of phenacetin (a pain medication that hasn’t been sold in the United States since 1983), working in the chemical or plastics industry, exposure to coal, tar, and asphalt, smoking, use of cancer treating drugs cyclophosphamide and ifosfamide.

• #20

  https://journals.lww.com/ijpm/fulltext/2024/67040/primary_mucinous_adenocarcinoma_of_the_ureter_and.40.aspx

  Primary adenocarcinoma rarely occurs in the upper urinary tract and accounts for less than 1% of the urothelial tumors. […] Mucinous adenocarcinoma is presumed to be originating from intestinal metaplasia of the transitional epithelium. […] It is also considered to be related to chronic irritation such as urolithiasis, infection, inflammation, and hydronephrosis. […] Mucinous adenocarcinoma usually occurs following glandular metaplasia of the urothelium, which may occur as a response to injury often progressing to dysplasia and adenocarcinoma. […] Our case further confirms this association as we observed the entire spectrum of the pathogenesis of the disease, ranging from intestinal metaplasia, dysplasia, and carcinoma in situ to invasive adenocarcinoma of the ureter and renal pelvis in the presence of a staghorn calculus.

• #21

  https://link.springer.com/article/10.1007/s13691-012-0028-z

  We report a case of urothelial carcinoma (UC) associated with a blind-ending bifid ureter. […] The main tumor was thought to originate from the blind-ending ureter and invade the adjacent main ureter, thereby causing the dilatations of the main and blind-ending bifid ureter. […] A long-term adverse effect of the blind-ending branch on the urothelial microenvironment may have important implications in the pathogenesis of malignancy. […] Chronic urinary stasis causes irritation to the urothelium leading to dysplasia, which at a later date develops into an overt cancer. […] To explain the mechanism of carcinogenesis of the urothelium, several theories have been proposed including chronic inflammation, infection, production of N-nitroso compounds by bacteria, and/or a change in mucosal electrolyte composition and/or pH.

• #21

  https://link.springer.com/article/10.1007/s13691-012-0028-z

  A long-term adverse effect of the blind-ending branch on the urothelial microenvironment may have important implications in the pathogenesis of malignancy. […] In summary, we presented a case of UC associated with a blind-ending bifid ureter treated by retroperitoneoscopic nephroureterectomy. At the blind-ending branch, prolonged contact with urinary carcinogens caused by urinary stasis may occur.

• #22 Transitional Cell Cancer of the Renal Pelvis and Ureter > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/transitional-cell-cancer-of-the-renal-pelvis-and-ureter

  Transitional cell cancer of the renal pelvis and ureter is a rare urinary tract cancer that typically affects adults ages 65 and older. […] Greater than 90% of cancers in these areas come from transitional cells that have become cancerous and grow in an uncontrolled way. […] Doctors dont yet know the exact cause of transitional cell cancer of the renal pelvis and ureter. Though genetics seem to be a factor, it also appears that environmental factors, including smoking and exposure to certain chemicals, raise risk as well. […] Kidney damage caused by the painkiller phenacetin is a risk factor for transitional cell cancer, but phenacetin been off the market since the late 1980s and was not frequently used in the U.S. No other painkillers have been associated with transitional cell cancer.

• #23 Renal Pelvic and Ureteral Cancers – Genitourinary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancers/renal-pelvic-and-ureteral-cancers

  Urothelial carcinoma of the renal pelvis accounts for about 7 to 15% of all kidney tumors. Urothelial carcinoma of the ureters accounts for about 4% of upper tract tumors (1). Risk factors are the same as those for bladder cancer (smoking, excess phenacetin use, long-term cyclophosphamide use, chronic irritation, exposure to certain chemicals). Inhabitants of the Balkans with endemic familial nephropathy are inexplicably predisposed to develop upper tract urothelial carcinoma. Genetically, urothelial carcinomas of the upper tract have been linked to Lynch syndrome and may be the presenting cancer. […] Risk of renal pelvis and ureteral cancers increases with smoking, phenacetin or cyclophosphamide use, chronic irritation, or exposure to certain chemicals.

• #24 Ureteral Metastasis: Uncommon Manifestation in Prostate Cancer | Anticancer Research

  https://ar.iiarjournals.org/content/35/11/6317

  Ureteral metastasis from a primary prostate cancer is a rare event in the initial diagnosis and progression of prostate cancer. […] We speculate that this unique ureteral prostate cancer metastasis was the result of hematogenic spread of prostate cancer, although microscopic spread through the lymphatic system could not be excluded. […] It is not clear whether ureteral metastasis is the result of lymphatic or hematogenic spread. […] The proposed hypothesis to explain the mechanism of metastasis in the ureter includes implantation by instrumentation, arterial emboli and venous or lymphatic dissemination in a retrograde manner. […] In summary, we believe that the reported patient suffered from a true metastasis from prostate cancer in the left ureter which was proven to be the sole location of progressive disease under treatment with AA plus prednisone.

• #25 Prostate Adenocarcinoma Metastasis to the Bilateral Ureters: a Rare but Potentially Important Finding

  http://www.annclinlabsci.org/content/46/4/425.full

  The ureter is an extremely rare location for metastasis from prostate carcinoma. […] Though it is a rare presentation, early diagnosis of this entity can potentially guide the treatment plan and improve clinical outcomes. […] Upper urinary tract obstruction caused by prostate carcinoma is most commonly due to direct invasion of the tumor to the ureter. […] However, true ureteral metastases from prostate adenocarcinoma are extremely rare. […] There are several hypotheses present that explain the mechanism of ureter metastasis, such as implantation by instrumentation, arterial emboli and venous or lymphatic dissemination in a retrograde manner. […] Ureteric metastasis is so rare because of segmental lymphatic circulation of the ureter, without any continuation in the ureteral wall. […] In our case we found several lymphovascular invasions in the ureter that explained the mechanism of metastasis.

• #26 Prognosis and risk factors of patients with upper urinary tract urothelial carcinoma and postoperative recurrence of bladder cancer in central China | BMC Urology | Full Text

  https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0457-5

  Advanced tumor stage and presence of a high-grade tumor were risk factors for not only poor UTUC prognosis but also BC recurrence. […] Factors influencing the long-term survival rate of UTUC patients were smoking, taking traditional Chinese medicine containing aristolochic acid, history of bladder cancer, age, tumor size, tumor stage, tumor grade, and lymph node metastasis. […] The risk factors related to postoperative bladder cancer recurrence were advanced tumor stage, high grade tumor, preoperative ureteroscopy, ureteral urothelial carcinoma, no postoperative bladder perfusion chemotherapy and DM without metformin use. […] In addition, tumor stage, tumor grade, preoperative ureteroscopy, UUC, and DM without metformin use were risk factors of BC recurrence, whereas regular postoperative bladder perfusion chemotherapy and DM with metformin use were protective factors for BC relapse.

• #26 Prognosis and risk factors of patients with upper urinary tract urothelial carcinoma and postoperative recurrence of bladder cancer in central China | BMC Urology | Full Text

  https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0457-5

  Our study also revealed that tumor size was a risk factor of UTUC, wherein a larger tumor diameter indicated worse prognosis. […] Our study confirmed that smoking was a risk factor of poor prognosis in UTUC patients. […] This may be due to the similar pathogenesis of UTUC and BC or a missed diagnosis of UTUC in some BC patients (especially for ureteral TCCs). […] This could be due to the mechanical stress caused by a higher urinary flow rate and larger chamber pressure, facilitating tumor cell metastasis. […] Our study showed that postoperative bladder perfusion chemotherapy was a protective factor of BC recurrence after RNU.

• #27 Cancerous tumours of the renal pelvis and ureter | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/renal-pelvis-and-ureter/what-is-cancer-of-the-renal-pelvis-or-ureter/cancerous-tumours

  Urothelial carcinoma (also called transitional cell carcinoma) is the most common cancer of the renal pelvis or ureter. It makes up about 90% of all upper urinary tract tumours. Urothelial carcinoma starts in the urothelial cells that line the inside of the renal pelvis and ureter (the lining is called the urothelium). […] Urothelial carcinoma may be described as non-invasive or invasive based on how much it has grown into the wall of the renal pelvis or ureter. […] Invasive urothelial carcinoma has grown into deeper layers within the wall of the renal pelvis or ureter. It may have grown through the wall to areas outside the renal pelvis or ureter. […] Sometimes invasive urothelial carcinoma has different types of cells mixed with the usual urothelial cancer cells (called divergent differentiation). When this happens, cancer of the renal pelvis or ureter usually grows and spreads faster (it is aggressive). It is then more likely to be diagnosed when its advanced.

• #27 Cancerous tumours of the renal pelvis and ureter | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/renal-pelvis-and-ureter/what-is-cancer-of-the-renal-pelvis-or-ureter/cancerous-tumours

  Squamous cell carcinoma of the renal pelvis or ureter is when flat squamous cells develop in the lining of the renal pelvis or ureter. It is often associated with long-term (chronic) irritation or inflammation of the renal pelvis and ureter. This irritation may happen from chronic urinary stones or chronic urinary tract infections (UTIs).

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