Ureteric Cancer

Treatment

Treatment options for ureteral cancer are:

• Surgery: Surgery is the preferred treatment option in cases where the ureteral cancer is limited to the ureter or renal pelvis. The type of surgery used depends upon the stage and location of cancer in the ureter. The types of surgeries for ureteral cancer are:
  Radical nephroureterectomy: It is one of the most common procedures for treating ureteral cancer. The procedure involves the removal of the affected kidney, ureter, and section at which the ureter connects with the bladder. The oncosurgeons may also remove the surrounding lymph nodes and healthy tissues. The surgery performed under general anesthesia is usually done with the help of a laparoscope (laparoscopic surgery). However, open surgery may also be used in certain cases.
  Segmental resection of the ureter: The procedure is performed when the cancer is limited only to the lower ureter. The oncosurgeons remove the affected part of the ureter and then reattach the remaining part with the bladder. Segmental resection is performed under general anesthesia and may be conducted as open or laparoscopic surgery.
  Endoscopic surgery: The surgery involves the removal of the ureteral tumor through an endoscope. This technique is usually performed when the cancer of the ureter or the renal pelvis is at an early stage and of low grade. The surgery may be performed as either a ureteroscopy or percutaneous intervention. During ureteroscopy, the ureteroscope is inserted into the urethra and guided to the ureter and renal pelvis. During the percutaneous intervention, an incision is made at the back of the body or on the side for passing the endoscope into the ureter or renal pelvis.
• Chemotherapy: Chemotherapy uses cytotoxic chemicals to kill cancer cells. It can be used after the surgery (adjuvant therapy) or before the surgery (neoadjuvant therapy). Chemotherapy is usually used to damage cancer cells that spread beyond the ureter or reduce the risk of metastasis. In most cases, the drug is administered intravenously or orally, reaching the site of action through blood. In some cases, the chemotherapeutic drugs are directly instilled in the bladder, ureter, or renal pelvis after the surgery.
• Radiation therapy: It is not as commonly used to manage ureteral cancer as other modalities. However, it is often used in palliative care for relieving the symptoms.
• Immunotherapy: Immunotherapy involves strengthening the immune system or restoring the ability of the immune cells to find and kill cancer cells. Immunotherapy is used in advanced or metastatic ureteral cancer cases that have not responded to primary treatments.
• Ablation: Ablation is used when ureteral cancer is detected at an early stage and is limited only to the upper surface of the ureter. It includes laser therapy and electrosurgery. During laser therapy, a beam of laser light destroys cancer cells. Electrosurgery uses electric current to damage the tumor.