The preferred method for treating most upper tract tumors is surgical removal of the kidney, ureter, and a portion of the bladder (nephroureterectomy). Partial removal of the ureter is not often recommended because there is a high risk for recurrence in the remaining portion.
Tumors that are confined to the lower third of the ureter may be treated using surgical removal of the ureter (ureterectomy) and surgical removal of regional lymph nodes (lymphadenectomy).
Patients with only one kidney and those with reduced kidney function, bilateral tumors (i.e., occurring on both sides), and metastatic upper tract tumors are not candidates for this procedure. These patients are treated using topical immunotherapy or chemotherapy.
Topical immunotherapy, also called biological therapy, is used to enhance the immune system's ability to fight cancer. In this treatment, BCG, a vaccine derived from the bacteria that causes tuberculosis, is infused through a catheter into the upper urinary tract to stimulate the immune system to destroy cancer cells.
Side effects include inflammation of the bladder (cystitis), inflammation of the prostate (prostatitis), and flu-like symptoms. If high fever (over 101.5 °F) occurs, it may indicate that bacteria have entered the bloodstream (called bacteremia, a life-threatening condition that requires antibiotic treatment).
Chemotherapy is used after surgery to treat metastatic upper tract tumors and as primary treatment for inoperable tumors. Chemotherapy involves using toxic drugs to destroy cancer cells. A combination of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) is often used for upper tract tumors. These drugs may be injected, administered intravenously, or taken in pill form. Chemotherapy has many side effects, some of which are severe.
Radiation may be used to reduce pain (called palliative treatment) for upper tract tumors.
Upper Tract Tumor Prognosis
The prognosis for upper tract tumors depends on the stage of the disease at diagnosis. Untreated upper tract tumors are fatal. Tumors of the renal pelvis have a better prognosis than tumors of the ureter.