Upper Tract Urothelial Cancer
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Upper Tract Urothelial Cancer
Treatment for upper tract urothelial cancer
You will be cared for by a multidisciplinary team (MDT) of health professionals during your treatment for UTUC. The team may include your GP, a urologist (to perform any surgery), medical oncologist (to prescribe and coordinate drug treatments which may include chemotherapy), radiation oncologist (to prescribe and deliver radiation therapy), pathologist (to examine cells and tissue samples to determine the type and extent of the cancer), specialist nurse and allied health professionals such as a dietitian, social worker, psychologist or counsellor, physiotherapist and occupational therapist.
Discussions with your health professionals will help you decide on the best treatment for your cancer depending on:
- the type of cancer you have and its exact location
- the grade and stage of your cancer
- your age, fitness and general health
- the health and function of your other kidney (if it is the kidney that is affected)
- your preferences.
The main treatments for UTUC include surgery, chemotherapy and sometimes radiation therapy. These 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.
- Keyhole (laparoscopic) surgery – the surgeon makes several small cuts (incisions) under general anaesthetic and passes a small tube with a camera (laparoscope) through one of the cuts. The camera sends images to a monitor. The surgeon then passes surgical tools through the other cuts to perform the procedure. A robot is sometimes used to help with keyhole surgery. Recovery from keyhole surgery is usually quicker that from open surgery.
- Open surgery – the surgeon makes a larger cut (incision) to perform the procedure.
The extent of the surgery depends on the location and stage of the tumour. Your surgeon will discuss the type of operation you may need.
Removing the whole kidney and ureter (nephroureterectomy) – The kidney, a layer of fat around the kidney and ureter are removed down to the bladder. An area of tissue where the ureter enters the bladder (bladder cuff) is also removed. The surgeon may also remove some regional lymph nodes to check if they contain cancer cells.
Removing part of the ureter (distal resection) – The bottom part of the ureter is removed down to the bladder. This is only possible if the tumour is in the pelvic part of the ureter. This procedure saves the kidney and the ureter is re-joined to the bladder.
Ureteroscopy – The surgeon passes a small tube with a camera (ureteroscope) into the bladder, ureter and renal pelvis. Often tissue samples are removed (biopsy) for further examination under a microscope.
Ureteroscopy surgery – Used for low-grade and early-stage cancers only. The surgeon passes a small tube with a camera (ureteroscope) through the urethra, bladder and ureter to the renal pelvis. The tumour is removed using laser or heat (diathermy).
Percutaneous renoscopy surgery – Used for low-grade and early-stage cancers only. The surgeon makes a small incision in your mid back and passes a small tube with a camera (endoscope) into your kidney to the renal pelvis. The tumour is removed using tools passed through the endoscope.
Chemotherapy (sometimes just called “chemo”) is the use of drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug, or a combination of drugs. This is because different drugs work in different ways.
Your treatment will depend on your situation and stage of the tumour. Chemotherapy may be used before or after you have surgery. Sometimes after surgery to remove the kidney and ureter (nephroureterectomy) a single dose of chemotherapy “wash” is put into the bladder. Usually this will be a drug called mitomycin and is given via the catheter that is left for one to two weeks after the surgery. Doing this can reduce the chance of the cancer recurring in the bladder. Your medical oncologist will discuss your options with you.
Chemotherapy is usually given through a drip into a vein (intravenously) or as a tablet that is swallowed. Chemotherapy is commonly given in cycles which may be daily, weekly or monthly. For example, one cycle may last three weeks where you have the drug over a few hours, followed by a rest period before starting another cycle. The length of the cycle and number of cycles depends on the drugs being given.
If your cancer has spread and is now known as advanced or metastatic upper urothelial cancer you may be offered immunotherapy. Immunotherapy uses the body’s own immune system to fight cancer. A new group of immunotherapy drugs called checkpoint inhibitors are available that work by helping the immune system to recognise and attack the cancer.
A checkpoint immunotherapy drug called pembrolizumab is now available in Australia for some people with advanced upper tract urothelial cancer. The drug is given directly into a vein through a drip, and the treatment may be repeated every 2–4 weeks for up to two years. Other types of checkpoint immunotherapy drugs may become available soon. Clinical trials are testing whether combining newer checkpoint immunotherapy drugs with chemotherapy and radiation therapy will benefit people with upper urothelial cancer.
Radiation therapy (also known as radiotherapy) uses high energy x-rays to destroy cancer cells. Radiation therapy, however, is less commonly used for UTUC. Your doctor will discuss your options with you.
A course of radiation therapy needs careful planning. During your first consultation session you will meet with a radiation oncologist who will arrange a planning session. At the planning session (known as CT planning or simulation) you will need to lie still on an examination table and have a CT scan in the same position you will be placed in for treatment. The information from the planning session will be used by your specialist to work out the treatment area and how to deliver the right dose of radiation. Radiation therapists will then deliver the course of radiation therapy as set out in the treatment plan.
Radiation therapy does not hurt and is usually given in small doses over a period of time to minimise side effects.
Your health professionals may suggest you take part in a clinical trial, or you can ask them if there are any clinical trials available for you. Cancer clinical trials are an important way to discover new treatments and methods to detect and diagnose cancer. If you join a randomised trial for a new treatment, you will be chosen at random to receive either the best existing treatment or the modified new treatment which has already been tested for safety. Over the years, trials have improved treatments and led to better outcomes for people diagnosed with cancer.
You may find it helpful to talk to your specialist, clinical trials nurse or GP, or to get a second opinion. If you decide to take part in a clinical trial, you can withdraw at any time. For more information about types of clinical trials and how to join a study, visit Australian Cancer Trials.
Complementary therapies are designed to be used alongside conventional medical treatments (such as surgery, radiation therapy and chemotherapy) and can increase your sense of control, decrease stress and anxiety, and improve your mood. Some Australian cancer centres have developed “integrative oncology” services where evidence-based complementary therapies are combined with conventional treatments to improve both wellbeing and clinical outcomes.
Some complementary therapies and their clinically proven benefits are listed below:
acupuncture – reduces chemotherapy-induced nausea and vomiting; improves quality of life.
aromatherapy – improves sleep and quality of life
art therapy, music therapy – reduce anxiety and stress; manage fatigue; aid expression of feelings
counselling, support groups – help reduce distress, anxiety and depression; improve quality of life
hypnotherapy – reduces pain, anxiety, nausea and vomiting
massage – improves quality of life; reduces anxiety, depression, pain and nausea
meditation, relaxation, mindfulness – reduce stress and anxiety; improve coping and quality of life
qi gong – reduces anxiety and fatigue; improves quality of life
spiritual practices – help reduce stress; instil peace; improve ability to manage challenges
tai chi – reduces anxiety and stress; improves strength, flexibility and quality of life
yoga – reduces anxiety and stress; improves general wellbeing and quality of life.
Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.
If you have been diagnosed with UTUC both the cancer and treatment will place extra demands on your body. Research suggests that eating well and exercising can benefit people during and after cancer treatment.
Eating a nutritious and well-balanced diet and being physically active can help you cope with some of the common side effects of cancer treatment, speed up recovery and improve quality of life by giving you more energy, keeping your muscles strong, helping you maintain a healthy weight and boosting your mood.
You can discuss individual nutrition and exercise plans with health professionals such as dietitians, exercise physiologists and physiotherapists.
All treatments can have side effects. The type of side effects that you may have will depend on the type of treatment and where in your body the cancer is. Some people have very few side effects and others have more. Your specialist team will discuss all possible side effects, both short and long-term (including those that have a late effect and may not start immediately), with you before your treatment begins.
One issue that is important to discuss before you undergo treatment is fertility, particularly if you want to have children in the future.
After treatment for upper tract urothelial carcinoma (especially surgery), you may need to adjust to changes in the digestion of food or bladder and bowel function. These changes may be temporary or ongoing, and may require specialised help. If you experience problems, talk to your GP, specialist doctor, specialist nurse or dietitian.
Common side effects may include:
Surgery – Mild bleeding and discomfort after surgery, the risk of infection, urine leaks or problems urinating after surgery, blockage of food and stools from adhesions from scar tissue, pain, blood clots, weak muscles (atrophy), hernias.
Chemotherapy – Fatigue, loss of appetite, nausea and vomiting, bowel issues such as diarrhoea, hair loss, mouth sores, skin and nail problems, increased risk of infections, loss of fertility, early menopause.
Radiation therapy – Fatigue, nausea and vomiting, bowel issues such as diarrhoea, skin problems, loss of fertility, early menopause.
This information is reviewed by
This information was last reviewed February 2021 by the following expert content reviewers: the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Consumer Advisory Panel; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Dr Tom Ferguson, Medical Oncologist, Fiona Stanley Hospital, Perth, WA; Prof Dickon Hayne, UWA Medical School, The University of Western Australia, and Head, Urology, South Metropolitan Health Service, WA; Steven Jones-Evans, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Carlo Yuen, Urologist, St Vincent’s Hospital, Sydney, NSW.