Upper Tract Urothelial Carcinoma (UTUC) is a rare cancer that forms in the lining of the kidney and ureter.
At Saint John’s Cancer Institute and Providence Saint John’s Health Center in Santa Monica, our urology specialists provide advanced diagnostic evaluation and personalized treatment planning for UTUC. Through a multidisciplinary approach of expert specialists, we deliver comprehensive care focused on preserving kidney function and improving long‑term outcomes.
What Is Upper Tract Urothelial Carcinoma?
Upper tract urothelial carcinoma develops from urothelial cells—the same cells that line the bladder—which extend through the ureters and into the kidneys. Because these cells can become cancerous anywhere along the urinary tract, UTUC shares characteristics with bladder cancer, but is significantly less common.
Due to its rarity, UTUC can be misdiagnosed.
Symptoms and Diagnosis
Below are the most common symptoms of UTUC and the common diagnostic tests used to confirm the disease. Understanding these signs and evaluation methods helps patients know what to expect during the diagnostic process.
Common Symptoms
UTUC symptoms can vary widely, and some individuals may not experience noticeable changes early on. Recognizing potential warning signs can help lead to earlier evaluation and treatment. Below are some of the most frequently reported symptoms.
- Blood in the urine (hematuria), either visible or microscopic
- Flank or side pain
- Occasionally: unexplained weight loss, appetite changes, or fatigue
Some individuals have no noticeable symptoms, and UTUC may be detected during imaging performed for other reasons.
Diagnostic Evaluation
- CT imaging of the kidneys and ureters
- Ureteroscopy with biopsy for direct tumor assessment
- Urine cytology to identify abnormal urothelial cells
- Bladder evaluation, since UTUC and bladder cancer can occur together
Treatment Options
From kidney‑sparing therapies to advanced clinical trials and surgical approaches, our team tailors each plan to the patient’s diagnosis, health, and goals, providing a full range of UTUC treatment options.
Kidney‑Sparing Approaches
Whenever possible, our urologic oncology team prioritizes kidney‑sparing therapy to help patients maintain long‑term kidney function. These treatments are especially effective for low‑grade UTUC and may reduce the need for major surgery. Saint John’s Cancer Institute was among the first centers in the nation to use UGN‑101, a targeted chemotherapy gel delivered directly into the kidney. Learn more about Kidney Cancer, diagnosis, and treatments.
Advanced Therapies and Clinical Trials
Saint John’s is actively involved in research and multi‑institutional clinical trials that expand treatment options for both low‑ and high‑grade UTUC. These studies explore new medications, drug‑delivery techniques, and minimally invasive therapies that may reduce the need for major surgery. Patients benefit from access to emerging UTUC treatments available at only a select number of centers nationwide.
Dr. Jennifer Linehan discusses research-based, UTUC treatment.
Surgical Management
For some individuals—particularly those with high‑grade or invasive UTUC—surgery may be the most effective treatment. Our surgeons specialize in minimally invasive and organ‑preserving techniques whenever appropriate. Surgical options may include:
- Endoscopic tumor removal
- Segmental ureterectomy
- Radical nephroureterectomy (removal of the kidney and ureter)
At Saint John’s Cancer Institute, UTUC care is guided by a multidisciplinary tumor board that includes urologic oncologists, medical oncologists, radiation oncologists, radiologists, pathologists, and clinical trial experts. This collaborative model ensures that every patient receives a comprehensive, evidence‑based treatment plan tailored to their diagnosis and personal goals. Our team is committed to delivering exceptional care with compassion, precision, and a focus on quality of life. Your care team will review all available options and recommend a personalized plan based on tumor grade, location, and overall health.
