Out of all the Upper Urinary Tract Tumors (UUTT), only 34% are ureteral cancers. Either of the ureters may be involved in the development of cancer cells. Only in a few cases do both the ureters become involved. The occurrence is most common in males of an older age group.

The main cause of Ureteral cancer is unknown, but a mutation in cells is held responsible for the abnormal growth of cells. Mutation in DNA disturbs normal cell functioning and causes the abnormal growth of cells.

The development of tumours can be due to environmental implications. In some cases, abdominal radiotherapy tends to mutate cells in the region.

Causes of ureteral cancer involve smoking, exposure to chemical dyes in factories and a previous history of bladder cancer.

Although UUTTs share a close relationship with Phenacetin-containing analgesics, other contributory factors such as Balkan endemic nephropathy and Lynch syndrome may also cause them.

The symptoms of Ureteral cancers are not very different from cancers caused by other UUTTs. A few symptoms that you may notice are:

• Unintentional weight loss
• Blood/ blood clots in urine
• Black urine
• Pain/ burning sensation while urination
• Increased frequency urine
• Urinary hesitation
• ● Cramps in the juncture of ribs and spine
• ● Back pain

The diagnosis of Ureteral cancer cannot be made only by feeling for enlarged kidneys. A combination of several blood tests and diagnostic tests are involved:

• Physical tests: To diagnose the disease, the doctor will start by asking some questions related to the symptoms. A physical examination will also help the doctor to understand the symptoms better.
• Ureteroscopy: A camera attached to a thin, lighted tube is inserted inside the patient body through the urethra. The ureteroscope is entered into the ureter via the urinary bladder to examine the condition of the ureter. The doctor can also collect a few tissues from the ureter and send them for laboratory tests.

Gene mutation can also be examined through this process, and it helps in a better understanding of the disease.

• Urine tests: Urine samples are taken from the patient and are tested for any abnormality. Urine analysis, along with cytology, is done to test any abnormal cells in the urine.
• Imaging tests: Imaging tests used to diagnose ureteral cancer might include intravenous pyelograms or CT urography. A magnetic resonance urogram can test patients who cannot undergo a CT scan.
• ● Cystoscopy: Patients with bladder cancer are susceptible to Ureteral cancer. Cystoscopy can be useful to test for signs of bladder cancer.

Some other tests include:

1. 1. Abdominal CT scan
   2. Abdominal MRI
   3. Blood tests
   4. Kidney ultrasound
   5. Renal scan

The treatment of Ureteral cancer may involve a lot of different techniques. It depends on the size of the tumours, the location of the cancer, how aggressive the cells are, the patient’s age, overall health, and the typicality of cancer.

Since metastasis is plausible, it becomes even more critical to remove the tumours. Here are some of the treatment procedures involved in treating Ureteral cancer:

• Surgery: Surgery often depends on the severity of the tumour. Benign tumours can be removed easily, but for malignant ones, surgery may prove dangerous.

In a few cases, the affected ureter and surrounding organs may have to be removed. Different surgical procedures used for the treatment of ureteral cancer are:

1. Nephrectomy: This is the most common surgical treatment for ureteral cancer. In this, a part of the kidney or the complete kidney is removed.
2. Nephroureterectomy: In this surgical procedure, the kidney, ureter, and upper bladder are removed. In some patients, depending on the extent of the cancer, the adjacent lymph glands, fats, and tissues may also be removed.
3. Segmental ureterectomy resection: In this surgical procedure, the part of the ureter that is affected by cancer is removed. It’s effective only when the tumour is small and has not spread to other parts of the body.
4. Ureteroneocystostomy: In this surgical procedure, if the tumour has affected the lower part of the ureter, then it will be removed, and the remaining section of the ureter will be attached again with the bladder. This is also called reimplantation.
5. Chemotherapy: Chemotherapy is a standard therapy that uses chemicals to treat cancerous cells. Chemotherapy can be carried out before surgery to reduce the size of the tumours for easy removal. Chemotherapy is beneficial in treating advanced symptoms of ureteral cancer and can be used to control the cancer’s adverse effects on the body.
6. Immunotherapy: The immune system is capable of stopping the abnormal growth of cells in the body. Usually, the cells’ growth is controlled by the genes, but the genes get mutated in cancer. Cancer cells produce a specific protein that hides the immune cells, which makes the immune system weak. Immunotherapy can also be helpful in cases that are not responsive to other forms of treatment.
7. Follow up appointments: After the patient is thoroughly treated and diagnosed, the doctor will set up some follow-up examinations to monitor the tumour’s condition. Bladder cancer is also kept in check during these follow-ups.

Depending on how aggressive the cancer is, treatments for Ureteral cancer may vary from highly successful to moderately successful.

Risks of Surgery

The risks associated with surgery include blood loss due to bleeding, infection, blood clots, hernia and internal organ damage.

The following risk factors increase the chances of Ureteral cancer:

• Family history of cancer
• Previous cases of urinary bladder cancer or kidney cancer
• ● Smoking
• ● Ageing