Renal Transitional Cell Carcinoma Follow-up

  • Author: Bagi RP Jana, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Jan 17, 2012
 

Further Outpatient Care

  • Because of the high risk of local and bladder recurrences, long-term follow-up care for these patients is mandatory. Include ureteroscopy, cystoscopy, and either IVU or RPG in the routine follow-up procedures.
  • Urine markers are used more and more frequently in the follow-up of patients with UCs. Specificity of these tests (eg, BTA Stat, ImmunoCyt, FISH) is acceptable for follow-up, and their sensitivity is much better than that of urine cytology.
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Deterrence/Prevention

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Complications

  • Perforation (0-10%) and stricture formation (5-13%) are the major complications of ureteroscopic treatment.
  • Use of lasers (especially Ho:YAG laser, with low tissue penetration) may decrease the rate of stricture formation.
  • Seeding through the nephrostomy tract (at least one case has been reported) remains a concern during percutaneous management.
  • Other serious complications of percutaneous treatment include perforation (5.5%) and uretero-pelvic-junction stricture (1.4%). Frequency of stricture is much less than after ureteroscopy.
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Prognosis

  • Tumor stage is the most important prognostic factor for upper-tract UC. Survival correlates closely with tumor stage. The TNM staging system of the UICC for upper-tract carcinomas is the most comprehensive (see Staging).
  • Tumor grade is another predictor of prognosis (see Histologic Findings). Tumor grade usually follows tumor stage, and patients with high-grade carcinomas have more advanced (ie, high-stage) disease. Stage and grade correlate in up to 83% of cases, although stage remains a more accurate predictor of prognosis.
  • Stage T3 renal tumors have a better prognosis than ureteral tumors. A retrospective study by Park et al found that in patients with stage pT3 disease, 5-year cancer-specific survival rates were 77.5% for renal pelvic tumors invading the renal parenchyma versus 49.7% for tumors invading peripelvic or periureteral fat (p = 0.014); 5-year recurrence-free survival rates were 75.6% versus 32.0%, respectively (p=0.003).[14] These authors suggest that the thickness of the renal parenchyma may protect against local tumor spread.
  • Five-year survival rate after radical surgery depends on disease stage.
    • Stages Tis, Ta, or T1: 91%
    • Stage T2: 43%
    • Stages T3, T4, N1, or N2: 23%
    • Stages N3 or M1: 0%
  • TCC may develop in the contralateral kidney after radical nephroureterectomy. In a European multicenter dataset of patients who had undergone nephroureterectomy for non-metastatic TCC, a history of bladder TCC preceding the upper-tract TCC was the only variable predictive of recurrence of TCC in the contralateral upper tract. The 5-year probabilities of being free from contralateral upper-tract TCC were 96.6% for patients with de novo upper-tract disease, 91.1% for those having prior non–muscle-invasive bladder TCC, and 55.3% for those with prior muscle-invasive bladder TCC.[15]
  • The 5-year survival rate in selected patients after conservative surgery is reported to be 70-90%.
  • Recurrences in the remaining urothelium after conservative treatment are relatively frequent because of the multifocal nature of TCCs. Ipsilateral recurrence rates may reach 25-50%. Most low-grade recurrences can be treated with repeat conservative excision. Five-year survival rates in these patients with low-grade, low-stage disease can approach 100%.
  • The prognosis is poor for patients with advanced SCC.
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Patient Education

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Contributor Information and Disclosures
Author

Bagi RP Jana, MD  Assistant Professor, University of Texas Medical Branch, Galveston, TX

Bagi RP Jana, MD is a member of the following medical societies: American Cancer Society, American Medical Association, American Society of Clinical Oncology, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Coauthor(s)

Kush Sachdeva, MD  Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Perry, MD, MS, MACP  Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

Georgi Guruli, MD, PhD, and Badrinath R Konety, MD, are gratefully acknowledged for their contributions to this topic.

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. Jul-Aug 2009;59(4):225-49. [Medline]. [Full Text].

  2. American Cancer Society. Cancer Facts & Figures 2009. Available at http://www.cancer.org/downloads/STT/500809web.pdf. Accessed December 12, 2009.

  3. Margulis V, Shariat SF, Matin SF, Kamat AM, Zigeuner R, Kikuchi E, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. Mar 15 2009;115(6):1224-33. [Medline].

  4. Grollman AP, Shibutani S, Moriya M, Miller F, Wu L, Moll U, et al. Aristolochic acid and the etiology of endemic (Balkan) nephropathy. Proc Natl Acad Sci U S A. Jul 17 2007;104(29):12129-34. [Medline].

  5. Colin P, Koenig P, Ouzzane A, Berthon N, Villers A, Biserte J, et al. Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract. BJU Int. Nov 2009;104(10):1436-40. [Medline].

  6. Vikram R, Sandler CM, Ng CS. Imaging and staging of transitional cell carcinoma: part 2, upper urinary tract. AJR Am J Roentgenol. Jun 2009;192(6):1488-93. [Medline].

  7. Jeong YB, Kim HJ. Is It Transitional Cell Carcinoma or Renal Cell Carcinoma on Computed Tomography Image?. Urology. Dec 21 2011;[Medline].

  8. Rastinehad AR, Ost MC, Vanderbrink BA, Greenberg KL, El-Hakim A, Marcovich R, et al. A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guérin therapy?. Urology. Jan 2009;73(1):27-31. [Medline].

  9. Demery ME, Thézenas S, Pouessel D, Culine S. Systemic chemotherapy in patients with advanced transitional cell carcinoma of the urothelium and impaired renal function. Anticancer Drugs. Feb 2012;23(2):143-8. [Medline].

  10. Pak RW, Moskowitz EJ, Bagley DH. What is the cost of maintaining a kidney in upper-tract transitional-cell carcinoma? An objective analysis of cost and survival. J Endourol. Mar 2009;23(3):341-6. [Medline].

  11. Hsueh TY, Huang YH, Chiu AW, et al. A comparison of the clinical outcome between open and hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. BJU Int. Oct 2004;94(6):798-801.

  12. Kawauchi A, Fujito A, Ukimura O, et al. Hand assisted retroperitoneoscopic nephroureterectomy: comparison with the open procedure. J Urol. Mar 2003;169(3):890-4; discussion 894. [Medline].

  13. Ong AM, Bhayani SB, Pavlovich CP. Trocar site recurrence after laparoscopic nephroureterectomy. J Urol. Oct 2003;170(4 Pt 1):1301. [Medline].

  14. Park J, Ha SH, Min GE, Song C, Hong B, Hong JH, et al. The protective role of renal parenchyma as a barrier to local tumor spread of upper tract transitional cell carcinoma and its impact on patient survival. J Urol. Sep 2009;182(3):894-9. [Medline].

  15. Novara G, De Marco V, Dalpiaz O, Galfano A, Bouygues V, Gardiman M, et al. Independent predictors of contralateral metachronous upper urinary tract transitional cell carcinoma after nephroureterectomy: multi-institutional dataset from three European centers. Int J Urol. Feb 2009;16(2):187-91. [Medline].

  16. Boorjian S, Ng C, Munver R, et al. Impact of delay to nephroureterectomy for patients undergoing ureteroscopic biopsy and laser tumor ablation of upper tract transitional cell carcinoma. Urology. Aug 2005;66(2):283-7.

  17. Chen GL, Bagley DH. Ureteroscopic surgery for upper tract transitional-cell carcinoma: complications and management. J Endourol. May 2001;15(4):399-404; discussion 409. [Medline].

  18. Chew BH, Pautler SE, Denstedt JD. Percutaneous management of upper-tract transitional cell carcinoma. J Endourol. Jul-Aug 2005;19(6):658-63.

  19. Clark PE, Streem SB. Endourologic management of upper tract transitional cell carcinoma. ScientificWorldJournal. Jun 7 2004;4 Suppl 1:62-75.

  20. Daneshmand S, Quek ML, Huffman JL. Endoscopic management of upper urinary tract transitional cell carcinoma: long-term experience. Cancer. Jul 1 2003;98(1):55-60. [Medline].

  21. Deligne E, Colombel M, Badet L, et al. Conservative management of upper urinary tract tumors. Eur Urol. Jul 2002;42(1):43-8. [Medline].

  22. Gettman MT, Segura JW. Endourological management of upper tract transitional cell carcinoma. BJU Int. Dec 2003;92(9):881-5. [Medline].

  23. Goh M, Montie JE, Wolf SJ, Jr. Urothelial carcinoma of the upper urinary tract. In: Gillenwather JY, Grayhack JT, Howards Ss, Mitchell ME, eds. Adult and Pediatric Urology. Philadelphia: Lippincott Williams & Wilkins. 2002;Vol. 1, 4th ed:Chapter 17.

  24. Ho KL, Chow GK. Ureteroscopic resection of upper-tract transitional-cell carcinoma. J Endourol. Sep 2005;19(7):841-8.

  25. Holmang S, Johansson SL. Urothelial carcinoma of the upper urinary tract: comparison between the WHO/ISUP 1998 consensus classification and WHO 1999 classification system. Urology. Aug 2005;66(2):274-8.

  26. Ignjatovic I, Dinic L, Prjiv B, Stojkovic I. CT staging of the upper urinary tract urothelial tumors. Medicine and Biology. 2003;10:135-8.

  27. Johnson GB, Grasso M. Ureteroscopic management of upper urinary tract transitional cell carcinoma. Curr Opin Urol. Mar 2005;15(2):89-93.

  28. Kirkali Z, Tuzel E. Transitional cell carcinoma of the ureter and renal pelvis. Crit Rev Oncol Hematol. Aug 2003;47(2):155-69. [Medline].

  29. Matin SF. Radical laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: current status. BJU Int. Mar 2005;95 Suppl 2:68-74.

  30. McCaffrey JA, Herr HW. Adjuvant and neoadjuvant chemotherapy for urothelial carcinoma. Surg Oncol Clin N Am. Oct 1997;6(4):667-81. [Medline].

  31. Melamed MR, Reuter VE. Pathology and staging of urothelial tumors of the kidney and ureter. Urol Clin North Am. May 1993;20(2):333-47. [Medline].

  32. Messing EM. Urothelial tumors of the renal pelvis and ureter. In: Walsh PC, Retik AB, Vaughan ED, Wein AG, eds. Campbell's Urology. Philadelphia: Saunders. 2002;Vol 4:2765-84.

  33. Michaelson MD, Kaufman DS, Oh WK. Transitional cell carcinoma of the upper uroepithelial tract. Clin Adv Hematol Oncol. Feb 2003;1(2):102-4; discussion 105.

  34. Pohar KS, Sheinfeld J. When is partial ureterectomy acceptable for transitional-cell carcinoma of the ureter?. J Endourol. May 2001;15(4):405-8; discussion 409. [Medline].

  35. Sagalowsky AI, Jarrett TW. Management of urothelial tumors of the renal pelvis and ureter. In: Walsh PC, Retik AB, Vaughan ED, Wein AG, eds. Campbell's Urology. Philadelphia: Saunders. 2002;Vol 4:2845-75.

  36. Scher HI, Yagoda A, Herr HW, et al. Neoadjuvant M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for extravesical urinary tract tumors. J Urol. Mar 1988;139(3):475-7. [Medline].

  37. Srinivas S, Guardino AE. A nonplatinum combination in metastatic transitional cell carcinoma. Am J Clin Oncol. Apr 2005;28(2):114-8. [Medline].

  38. Stewart GD, Bariol SV, Grigor KM, et al. A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tract. BJU Int. Apr 2005;95(6):791-3.

  39. Wang SS, Ho HC, Su CK, et al. Seeding of malignant renal tumor through a nephrostomy tract. J Chin Med Assoc. Jun 2004;67(6):308-10. [Medline].

 
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CT scan with contrast, vascular phase. Mass can be seen in the left renal pelvis (black arrows). Patient underwent nephroureterectomy. Tumor was high-grade urothelial carcinoma invading subepithelial tissue (stage T1) and measuring 7.5 X 3.2 X 3 cm.
CT scan of the same patient as in Image 1, delayed phase. Enhancing mass can be visualized in the left renal pelvis (white arrows).
Retrograde pyelography. Filling defect can be seen in the left renal pelvis and lower calix (black arrows). Patient underwent left nephroureterectomy. Tumor was low-grade urothelial carcinoma measuring 2.5 X 2 X 1 cm.
This radiograph shows a right retrograde pyelogram demonstrating a large filling defect in the mid-ureter due to transitional cell carcinoma (large arrow). Note the characteristic appearance of radiographic contrast material just distal to the obstruction (small arrow), which gives rise to the so-called goblet sign. Contrast is also visible beyond the partially obstructed segment of the ureter in the renal pelvis and collecting system.
Urothelial tumor of the renal pelvis (white arrows), pathology specimen.
 
 
 
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