Urothelium neoplasm Urothelium cancer

Urothelium is an inner layer of tissue that lines the organs of the urinary system.

Tumors of the upper urothelium, which lines the pyelocaliceal cavities and the ureters, represent 5 to 10% of urothelial carcinomas with an incidence of 2 cases per 100,000 inhabitants. Pyelocaliceal tumors are more frequent and can be detected as multifocal in 10 to 20% of cases.

The presence of carcinoma in situ is related in 11 to 36% of cases, the bladder tumor is associated in 17% and, after treatment, bladder recurrence occurs in 22 to 47% of patients. About 2/3 of patients with upper urothelial tumor have invasive disease at the time of diagnosis and 7% present with metastases.
The peak incidence of this disease is in people between 70 and 90 years old, being three times more frequent in men. Risk factors are smoking, aristolochic acid (derived from a plant used worldwide especially in China and Taiwan), alcohol consumption above 15gr / day and Lynch Syndrome.

The most frequent symptom is hematuria or micro-hematuria (between 70 to 80%); lower back pain occurs in about 20% of cases. Systemic symptoms include anorexia (loss of appetite), weight loss, malaise, fatigue, fever, night sweats or cough, and require rapid assessment of possible metastases associated with a worse prognosis.

The exam with greater sensitivity and specificity in the diagnosis of urothelial tumor is computed tomography of the urinary tract (URO-TAC). However, a retrograde (ascending) ureteropielography will also be a good option for the detection of these tumors. As an integral part of the diagnosis, cystoscopy and urinary cytology should also be performed to screen for a concomitant bladder tumor. For visualization and biopsy of suspicions in the ureter, bacinete and chalices, a diagnostic ureteroscopy may be requested.

Treatment is surgical, but depends on the severity of the tumor.

In the case of localized and non-metastatic disease, the procedure may be less invasive by performing conservative surgery, preserving renal function, via an open, endoscopic or percutaneous route.

In the case of a high-risk non-metastatic disease, complete removal of the kidney and ureter (radical nephroureterectomy with perimeatic cystectomy). This surgery may be performed by minimally invasive techniques, namely laparoscopic and robotic.