What are the treatments for ureteral tumors

Ureteral tumor is a type of tumor that occurs at any stage of the ureter and is also a primary ureteral tumor. This type of tumor is relatively rare in clinical practice and is common in metastatic epithelial carcinoma. The treatment of ureteral tumors is generally based on surgical treatment, and the prognosis of surgical treatment is also very important.

1. Treatment principles

(1) In principle, ureteral cancer involves complete resection of the kidney and ureter, including a 2-cm diameter bladder wall including the ureteral orifice.

(2) When ureteral cancer infiltrates surrounding tissues, radiotherapy can be performed to shrink the lesions, and surgical resection can be performed if resectable.

(3) Ureteral polyps should undergo partial ureterectomy at the pedicle and ureteral anastomosis.

2. Surgery

(1) The vast majority of ureteral tumors are malignant. Even benign papilloma has a high chance of becoming malignant. Therefore, for cases where the contralateral kidney has good function, radical surgical resection is generally recommended. The resection range includes the contralateral kidney, the entire length of the ureter, and a small part of the bladder wall around the ureteral opening, with particular emphasis on the resection of the bladder wall at the ureteral opening.

(2) Conservative surgical treatment

1) Absolute indications for conservative surgery: ① accompanied by renal failure; ② solitary kidney; ③ bilateral ureteral tumors.

2) Relative indications for conservative surgery: ① The tumor is very small and has no peripheral infiltration; ② The tumor has a narrow pedicle or a very small base; ③ Older patients; ④ Patients confirmed to have benign ureteral tumors.

(3) Treatment of bilateral ureteral tumors

1) If the tumor is in the lower third of the ureter on both sides, a one-time surgical approach can be used to remove the bilateral lesions and perform ureteral and bladder reimplantation.

2) For bilateral upper third ureteral tumors, bilateral ureterectomy, bilateral calyceal anastomosis or bilateral autologous kidney transplantation are performed.

3) If the tumor is in the upper ureter on one side and in the lower ureter on the other side, depending on the severity of the disease, the more serious side can be cured, or the kidney, ureter and part of the bladder on the upper side can be removed, and the other side can undergo intestinal ureteral replacement or autologous kidney transplantation.

3. Laser treatment

Laser treatment of tumors under ureteroscopy requires high technical skills and its value remains to be evaluated.

4. Chemotherapy and radiotherapy

Advanced ureteral tumors can be treated with radiotherapy, but if the effect is unsatisfactory, chemotherapy can be considered. (Note: ADM-doxorubicin, 5-FU-fluorouracil, DDP-cisplatin, CTX-cyclophosphamide, MTX-methotrexate, VLB-vinblastine, CBP-carboplatin, PTX-paclitaxel, GEM-gemcitabine)

5. Prognosis

The 5-year survival rate of well-differentiated grade I and II cancers is 56% to 67%, while that of poorly differentiated ones is about 16%; the 5-year survival rate of non-invasive ones is about 60%, while that of invasive ones is about 25%; the survival rate of those with metastasis is less than 3 years.