TreatmentTreatment of Ureteral Cancer and Upper Tract Urothelial Carcinoma
There are two types of treatment for upper tract urothelial carcinomas:
Nephron sparing or conservative management which means we try to save the entire kidney, or part of the kidney, and try to preserve kidney function. We try to ablate and destroy the tumor using a small camera up in to the ureter and kidney. Sometimes we give chemotherapy or immunotherapy in the pelvis or the ureter.
Robotic surgical treatment depending on the location of the tumor, we remove all or part of the ureter, kidney and bladder to remove the cancer.
Minimally Invasive Surgical Techniques
New Conservative Treatment
A drug known as mitomycin-c, a chemotherapy drug, was initially developed as an antibiotic in 1963. It turned out to be fairly toxic as an antibiotic, but effective to treat cancers. We have used this for urothelial cancers in the bladder doing washes or instillations into the bladder.
How the drug is delivered in very important. We converted the liquid form of this drug to a gel form so it can stay in the kidney or ureter. This is a topical therapy, similar to putting cream on your skin, except it will be placed inside for better absorption.
These specific drugs are generally called checkpoint blockade. UTUC has a high rate of mutations and unstable genes and makes them more susceptible to immunotherapy. Doctors will not use immunotherapy for treating patients with low grade disease or localized disease at this time, but that may be part of the treatment in the future.
Robotic Surgical Treatment and Agressive UTUC
The second category of treatments is for more aggressive disease and for these patients we have to remove the kidney and the ureter, even sometimes the bladder. If patients have more aggressive disease as with stage 2 or 3 UTUC then we use radical surgery with or without chemotherapy. In addition to removing the kidney, ureter and part of the bladder, we also have to remove the lymph nodes around the ureter and the kidney. Typically this is done with minimally invasive surgery, like robotic surgery, where the incisions are small.
If the cancer has spread or appears invasive past the ureter or kidney then we need to add in chemotherapy, sometimes before and after surgery. Chemotherapy has been shown to improve survival. If there is locally advanced disease sometimes giving the chemotherapy before removing the kidney can shrink the tumor and improve the chance of resection, depends on the stage of the disease and if there is metastatic distant spread of the disease. The chemotherapy can go between two to six months. When we remove the kidney and the ureter, the kidney function can decreases because only one kidney.