Upper tract urothelial cancer

Upper tract transitional cell carcinoma is a lethal disease with half the patients dead within 5 years of diagnosis. Unlike urothelial tumours arising in the bladder, the disease is more likely to be invasive at the time of diagnosis and in part reflects the poorer prognosis. It is a biologically aggressive disease with a high chance of recurrence even after local control. Diagnosis is made by a combination of upper tract imaging, urine cytology and ureteroscopic biopsy. Organ-confined disease is amenable to radical surgery, whilst superficial low-grade disease may be managed endoscopically. A number of prognostic factors have been incorporated into nomograms to predict non-organ confined disease. Even those with apparently organ-confined disease are prone to recurrence. As a result regular surveillance protocols are in place to identify both local and metastatic spread as well as metachronous bladder lesions.