Ureteral Tumor

Ureteral tumors are clinically rare. In 1841 the French pathologist Rayer first described ureteral tumors; in 1902 Albarran reported the first case of primary ureteral tumor with pre-operative diagnosis. By 1976 world literature reported only 2,200 cases; domestic statistics on primary ureteral malignancies totaled over 280 cases by August 1996. Ureteral tumor refers to any tumor arising at any segment of the ureter; most are transitional-cell carcinoma and usually require surgery.

Common Symptoms

Abdominal mass; ureteral spasm; hematuria; abdominal pain; malignant ureteral stricture; hydronephrosis

Causes and Pathogenesis

(A) Etiology: Not fully understood; like renal-pelvic and bladder tumors, related to smoking, coffee, analgesic abuse, certain occupations, chronic inflammation, hydronephrosis, stones, cyclophosphamide chemotherapy and heredity. Smokers have higher ureteral-tumor risk than for renal-pelvic or bladder tumor, with dose-response; heavy coffee drinking also increases risk; long-term analgesic use (e.g. phenacetin) markedly raises incidence; chemical/petrochemical/plastics workers long exposed to coal, asphalt, coke, tar have increased risk. Chronic bacterial infection, urethral stones and obstruction tend to produce squamous-cell carcinoma; adenocarcinoma is rarer. Cyclophosphamide as chemotherapy raises not only bladder but also ureteral tumor risk. (B) Pathogenesis: Bilateral ureteral tumors (synchronous or metachronous) account for 0.9%-1.6%; ~73% are in lower ureter, ~24% in middle, ~3% in upper. Most ureteral tumors (~93%) are transitional-cell carcinoma with pathology similar to bladder TCC; squamous and adenocarcinoma are rarer. Among the minority of benign tumors, epithelial papilloma is most common (~75%); inverted papilloma often coexists with malignancy — literature reports ~18% of malignant tumors have synchronous/metachronous inverted papilloma, so inverted-papilloma patients must be worked up for ureteral malignancy. Another benign tumor is fibroepithelial polyp. TNM staging same as renal-pelvic tumor. Ureteral TCC spreads via epithelial extension (direct invasion or implantation) and lymphatic/hematogenous routes. 1. By origin: (1) Ureteral epithelium: malignant — TCC, SCC, adenocarcinoma, undifferentiated carcinoma; benign — transitional-cell papilloma. (2) Ureter and periureteral tissues: malignant — fibrosarcoma, leiomyosarcoma, liposarcoma, angiosarcoma, carcinoid sarcoma; benign — fibroma, neurilemmoma, leiomyoma, hemangioma, fibrous polyp. (3) Extra-ureteral organs/tissues: all malignant — metastatic carcinoma, metastatic sarcoma. 2. Clinical staging: mainly UICC and Jewett systems.

Treatment

Surgery, drug therapy, supportive therapy

Preventive Measures

Ureteral tumor patients, especially malignant ones, whether treated by ureteroscopy/conservative surgery or radical surgery, need a detailed strict follow-up plan: ① regular urinalysis and urine cytology; ② regular IVU or retrograde pyeloureterography; ③ regular cystoscopy/ureteroscopy — every 3 months for first 2 years, then every 6 months; ④ periodic bladder instillation with mitomycin or BCG to prevent recurrence.

Department to Visit

It is recommended to visit the Urology 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.