Renal-Pelvic Tumor

Renal-pelvic tumor = epithelial tumor arising from the renal-pelvic mucosa. Age distribution is the same as renal carcinoma; more men than women; equal incidence in both kidneys; bilateral involvement is extremely rare.

Common Symptoms

Cachexia; urinary frequency; bone pain; bone metastasis; lymphatic metastasis; emaciation; secondary infection; dysuria; urinary urgency

Causes and Pathogenesis

(A) Etiology: Collecting ducts, calyces, renal pelvis, ureter, bladder and urethra mucosa share a common embryonic origin called 'urothelium'. Because of the common transitional epithelium, renal-pelvic and ureteral tumors are considered together. Transitional epithelium lining calyces and pelvis is exposed to many urinary potential carcinogens; excreted carcinogens may be activated by hydrolases in urine, producing carcinogenic effect in the urinary tract — explaining why bladder tumor incidence exceeds upper urinary tract. (B) Pathogenesis: Most renal-pelvic tumors are transitional-cell papillary tumors, single or multiple. Rich blood supply makes them prone to ulceration/bleeding → hematuria; exfoliated tumor cells may implant on ipsilateral ureter or bladder. Because renal-pelvic wall muscle is thin and surrounding lymphatics rich, early lymphatic metastasis is common. Transitional-cell carcinoma is most common; papillary transitional-cell carcinoma is well-differentiated and indistinguishable from normal pelvic epithelium. Squamous-cell carcinoma is rare (3%-4%); adenocarcinoma is rare. Tumors at the ureteropelvic junction may cause hydronephrosis. Renal-pelvic tumors spread via lymphatics, hematogenous route and direct extension.

Treatment

Drug therapy, rehabilitation

Preventive Measures

Like other malignancies, renal-pelvic tumor prevention has three tiers. 1. Primary prevention (etiologic): prevent cancer occurrence by researching causes/risk factors, taking measures against chemical/physical/biologic carcinogens and internal/external pathogenic conditions, and strengthening environmental protection, proper diet and exercise to promote health. (1) Avoid smoking: smoking is a well-established carcinogen related to 30% of cancers; tobacco tar contains many carcinogens/promoters; mainly causes lung/pharyngeal/laryngeal/esophageal cancer and raises risk at many other sites. (2) Adjust diet: reasonable diet prevents most cancers; plant foods contain diverse anti-carcinogens; colon, breast, esophageal, gastric and lung cancer are most likely preventable by dietary change. (3) Prevent occupation/environment/drug-related tumors: lung (asbestos), bladder (aniline dyes), leukemia (benzene). Some infections are closely linked: HBV and liver cancer, HPV and cervical cancer; schistosomiasis markedly raises bladder-cancer risk in some countries. Ionizing radiation and heavy UV (especially sunlight) cause skin cancer. Carcinogenic drugs include estrogens/androgens and anti-estrogen tamoxifen; postmenopausal estrogen use is linked to endometrial and breast cancer. 2. Secondary (pre-clinical) prevention: early detection/diagnosis/treatment to stop or slow disease, reverse to Stage 0. 3. Tertiary (clinical/rehabilitation) prevention: prevent deterioration and disability; use multidisciplinary diagnosis (MDD) and treatment (MDT), choose optimal regimen early, promote functional recovery/rehabilitation, prolong life and improve quality of life, even return to society.

Department to Visit

It is recommended to visit the Nephrology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.