Ureteral cancer
What are ureteral tumors?
Urothelial tumors are areas of tissue growth that may consist of normal or altered cells. They can occur in men and women, vary in histologic structure and size, and may be safe or pose a serious problem to the patient. Most neoplasms should be treated surgically, especially those that interfere with the flow of urine or may spread (metastasize) throughout the body. Tumors most often occur between the ages of 40 and 70.
Ureteral cancer, a relatively rare form of cancer, occurs in the ureters, the tubes that carry urine from the kidneys to the bladder. Understanding this disease, from its causes and symptoms to treatment options, is vital for early detection and effective management. This article provides a detailed exploration of ureteral cancer, offering essential insights for patients, caregivers, and healthcare professionals.
Understanding Ureteral Cancer
The ureters are part of the urinary system and are crucial for the elimination of waste from the body. Cancer in the ureters can obstruct this process and lead to severe complications. Ureteral cancer is often categorized as a type of urothelial carcinoma, as it typically arises from the same type of cells that line the bladder and the rest of the urinary tract.
Epidemiology
Although ureteral cancer is less common than other urological cancers, such as bladder or kidney cancer, its incidence has been rising, possibly due to better diagnostic methods and increased exposure to risk factors. It is more common in individuals over 60 years and tends to affect men more than women.
Classification: types and stages of urothelial tumors
All ureteral neoplasms can be divided into benign and malignant. The former consists of unchanged cells of the body that can reach a significant size but never grow into the thickness of tissues and do not metastasize. Malignant tumors are more dangerous because they gradually invade tissues and spread to nearby or distant organs.
Cancer of the ureter, in turn, has several stages of development, which are distinguished depending on the spread of pathologic tissues:
- Stage 1: the mass remains within the mucosa;
- Stage 2: The cancer affects the muscular wall of the ureter;
- Stage 3: pathological tissues spread to the neighboring tissue;
- Stage 4: tumor metastasis to lymph nodes or organs is detected.
Symptoms of ureteral tumors
In the early stages of development, most neoplasms do not manifest themselves. As a rule, the first signs of a developing ureteral tumor appear when it reaches a relatively large size. Patients may complain about:
- blood in the urine (visible visually or detected in a general test);
- pain in the projection of the neoplasm;
- urinary disorders.
If the mass is malignant, as it grows, the patient notes an unreasonable decrease in body weight, a slight fever (up to 37.5), persisting for a long time, loss of energy, etc. In advanced cases, hydronephrosis develops – fluid accumulation in the kidney due to impaired urine outflow.
Reasons
It is proven that the inner lining of the ureters is susceptible to the effects of unfavorable factors. Smoking, toxins, and certain medications all significantly increase the risk of neoplasms. Other risk factors include chronic diseases of the urinary tract and trauma to the ureter, including those associated with the presence of stones.
Diagnosis of urothelial tumors
Diagnosis begins with the collection of complaints and anamnesis, followed by objective examination: measurement of body temperature, saturation, and blood pressure, palpation of the abdomen (if the size of the neoplasm is significant, the doctor can feel it through the anterior abdominal wall). Presumptive diagnosis can be confirmed by following examinations:
- urinalysis and cytology;
- ultrasound, MRI, or CT scan of the kidneys;
- excretory or retrograde urography;
- general and biochemical blood tests.
If metastases are suspected, additional studies are prescribed to detect them: chest X-ray, abdominal ultrasound, bone scintigraphy, etc.
Treatment of ureteral tumors
Tumors of the ureter are subject to surgical treatment. Radical removal is the only way to get rid of the mass completely. Depending on the situation, surgeons use cavitary (open) and endoscopic interventions:
- Endoscopic transurethral resection: removal of the benign mass together with part of the ureter; the operation is performed with the help of endoscopic equipment, using a laser, which is inserted through the urethra;
- Nephroureterectomy with partial bladder resection: excision of the ureter along with part of the kidney and bladder; performed in malignant tumors.
To shrink the tumor and/or prevent recurrence of the disease, treatment of urothelial cancer, in addition to surgery, requires the use of the following treatment methods:
- Chemotherapy: May be used before or after surgery to shrink tumors or eliminate remaining cancer cells.
- Radiation Therapy: Sometimes used in conjunction with surgery or for palliative care.
- Immunotherapy: A newer form of treatment that helps the immune system recognize and fight cancer cells.
All these treatment options are available in more than 750 hospitals worldwide (https://doctor.global/results/diseases/ureteral-cancer). For example, ureteral cancer surgery is performed in 35 clinics across Germany (https://doctor.global/results/procedures/ureteral-cancer-surgery).
Prognosis and prevention
With timely detection and proper treatment, surgeons can completely eliminate ureteral tumors and the unpleasant symptoms associated with them. There are no specific preventive measures. It is recommended to undergo regular examinations with a urologist, take a general urine test, and treat all acute and chronic urinary system diseases.
Rehabilitation
The length of the rehabilitation period depends on the chosen type of intervention. With endoscopic removal, the patient is discharged home 2-3 days after the intervention, and full recovery takes several months. Physical activity, overheating, and lifting weights are limited during this time. Open surgery requires more extended hospitalization, and further recovery depends on the type of tumor, reaction to chemotherapy, and individual characteristics of the body.
Living with Ureteral Cancer
Coping with a ureteral cancer diagnosis can be challenging. Support from healthcare providers, counselors, support groups, and loved ones is crucial. It’s also important to discuss fertility preservation options before treatment, as some treatments can affect fertility.
Conclusion
Ureteral cancer, though rare, presents significant challenges due to its asymptomatic nature in early stages and potential severity. Early detection through awareness of symptoms and risk factors, along with advancements in treatment options, offers hope for better outcomes. Continuous research and developments in medical science hold the promise of more effective treatments in the future, emphasizing the importance of regular screening and early intervention.
