Ureteral cancer causes symptoms prevention and treatment

Ureteral cancer is a rare disease, but it’s very important to know all about it. The ureter is the tube that connects the kidneys to the bladder, and any changes in it can affect kidney function and pose serious health risks. In this Dalili Medical article, we’ll talk about the causes of ureteral cancer, the symptoms you should watch out for, as well as the latest prevention and treatment methods. If you want to protect yourself or someone in your family, you need clear and simple information — and that’s exactly what you’ll find here.

What is Ureteral Cancer?

The ureter is a thin, hollow tube that carries urine from the kidneys to the bladder. Ureteral cancer begins in the cells lining the inside wall of the ureter and can sometimes spread to surrounding tissues. This type of cancer is called transitional cell carcinoma (TCC) — the same type that can develop in the bladder.

Ureteral cancer can affect the kidneys or bladder at the same time, and it is classified based on the stage of the disease and how far the cancer cells have spread. The earlier it’s detected, the better the chances of successful treatment. That’s why it’s so important not to ignore any of the following symptoms.

???? Can Children Get Ureteral Cancer?

Q: Can children develop ureteral cancer?
A: It’s extremely rare in children, but possible, especially if there are genetic factors involved.

Q: What are the early signs of ureteral cancer in children?
A: Blood in the urine, abdominal or flank pain, or changes in urination frequency.

Q: Is ureteral cancer hereditary in children?
A: Sometimes it’s linked to specific genetic mutations, but it’s usually not hereditary.

Q: How is ureteral cancer diagnosed in children?
A: Through blood tests, urine analysis, and imaging such as CT scans or MRI.

Q: Does ureteral cancer affect a child’s growth?
A: With early treatment, most children continue to grow normally without long-term problems.

Q: Do children need long-term follow-up after treatment?
A: Yes, regular check-ups with scans and tests are essential to ensure the cancer doesn’t return.

Q: What are possible complications after treatment?
A: Some children may experience reduced kidney function or recurrent infections, but these are usually manageable.

???? Risk Factors and General Questions

Q: Does smoking increase the risk of ureteral cancer?
A: Yes, smoking is one of the main risk factors, especially in men.

Q: Does ureteral cancer affect sexual function or fertility?
A: Usually not, unless the cancer spreads or the kidneys are severely affected.

Q: Are symptoms different between men and women?
A: They’re mostly similar — blood in the urine and flank pain — though some women may experience frequent infections or changes in urination.

Q: Can ureteral cancer affect pregnancy or fertility?
A: Generally, no, unless treatment involves removing a large portion of the urinary tract.

Q: Does family history increase the risk?
A: Yes, having relatives with cancer can slightly increase the risk.

Q: What’s the link between chronic ureteral inflammation and cancer?
A: Chronic inflammation can irritate the cells and increase the risk of malignant transformation.

Q: Can ureteral cancer be detected early?
A: Yes, regular urine tests and imaging can help detect it before symptoms become severe.

Q: What lifestyle habits can reduce the risk?
A: Drinking plenty of water, eating fruits and vegetables, and avoiding smoking or chemical exposure.

Q: What is the long-term impact on kidney function?
A: If treated early, kidney function is usually preserved. Late treatment, however, can cause permanent damage.

Q: Is ureteral cancer related to menopause or age?
A: It’s more common after age 50 but not directly linked to menopause.

Q: How can ureteral cancer be distinguished from recurrent urinary tract infections?
A: Persistent blood in the urine without infection or symptoms that don’t improve after treatment may indicate cancer.

Q: Does treatment affect daily life?
A: Sometimes temporarily during treatment, but most patients can return to normal activities afterward.

Q: When should someone see a doctor immediately?
A: If you notice persistent blood in the urine, ongoing flank pain, frequent urinary infections, or unexplained weight loss.

Q: Can women combine surgery with chemotherapy or radiation?
A: Yes, in many cases combining treatments can improve outcomes depending on the cancer stage.

???? Stages of Ureteral Cancer

Ureteral cancer is divided into four main stages based on how far the tumor has spread through the ureter wall and other parts of the body. Each stage helps determine the right treatment approach.

???? Stage I

Description: The tumor is confined to the inner lining of the ureter and hasn’t invaded deeper layers.
Treatment: Partial surgical removal of the affected section. Cure rates are very high if detected early.
Symptoms: Mild — blood in the urine or slight side pain.

⚠️ Stage II

Description: The tumor has reached the muscle layer of the ureter wall but remains localized.
Treatment: More extensive surgery — often removing the entire ureter and part of the kidney, depending on tumor location.
Symptoms: Noticeable back or side pain and persistent blood in the urine.

⚡ Stage III

Description: The tumor has spread to nearby tissues, the kidney, or surrounding organs.
Treatment: Surgery combined with chemotherapy or radiation therapy.
Symptoms: Severe and continuous pain, kidney weakness, weight loss, and fatigue.

???? Stage IV

Description: The cancer has spread to nearby or distant lymph nodes or organs such as the liver, lungs, or bones.
Treatment: Focuses on controlling symptoms and slowing disease progression; complete recovery is often not possible.
Symptoms: Intense pain, constant fatigue, loss of appetite, coughing or shortness of breath (if lungs are affected), and bone pain.

???? Causes of Ureteral Cancer

Although the exact cause of ureteral cancer is not fully understood, several factors can increase the risk of developing it:

1. ???? Smoking

One of the main direct causes.
The toxic chemicals in cigarettes enter the bloodstream, reach the kidneys, and then pass through the ureters with the urine.
These substances can damage the lining cells of the ureter, which may eventually turn into cancerous cells.

2. ???? Exposure to Chemicals

People who work with industrial dyes, benzene, or rubber products are at higher risk.
The kidneys filter out these toxins, which then pass through the ureter, causing chronic irritation and cell damage.

3. ???? Genetic Factors (Lynch Syndrome)

A hereditary condition that increases the risk of several cancers, including colon, kidney, bladder, and sometimes ureteral cancer.
Families with a history of Lynch syndrome should have regular medical checkups.

4. ???? Long-Term Use of Certain Medications

Some old painkillers containing phenacetin were linked to kidney and urinary tract problems.
Also, certain chemotherapy drugs can slightly increase the risk of ureteral cancer.

5. ???? Chronic Inflammation and Ureteral Stones

Repeated infections or stones can cause constant irritation of the ureter wall.
Over time, the damaged cells may change and turn cancerous.

6. ???? Age and Gender

Most cases occur after the age of 60.
Men are more likely to be affected than women, often due to smoking or occupational exposure to chemicals.

7. ???? History of Bladder or Kidney Cancer

Because the inner lining of the bladder and ureter is very similar, people who’ve had bladder or kidney cancer are more likely to develop ureteral cancer too.

⚠️ Symptoms of Ureteral Cancer

In its early stages, ureteral cancer may not cause clear symptoms, but as it progresses, several warning signs can appear depending on tumor size and location.

1. ???? Blood in the Urine (Hematuria)

The most common symptom.
Blood may be visible to the naked eye (urine appears red or dark) or detected only through urine tests.
Cause: Damage to the ureter lining due to tumor growth.

2. ⚡ Pain in the Side or Lower Back

Usually on one side — the side of the tumor.
Cause: The tumor blocks urine flow from the kidney to the bladder, causing kidney swelling and pain.
Pain may be mild or severe depending on the degree of blockage.

3. ???? Changes in Urination

Reduced urine output or difficulty urinating.
Burning sensation or feeling that the bladder isn’t completely empty.

4. ???? General Symptoms

Loss of appetite.
Unexplained weight loss.
Constant fatigue.
Occasional mild fever.

5. ♂️ Pain During or After Urination

Occurs if the tumor is near the bladder, causing irritation at the end of urination.

6. ???? Symptoms of Ureteral Obstruction

Swelling of the kidney (hydronephrosis).
Nausea and vomiting due to urine buildup.
Sometimes high blood pressure due to reduced kidney function.

7. ???? Advanced Symptoms (If Cancer Has Spread)

Bone pain (if it has spread to the bones).
Cough or shortness of breath (if it has spread to the lungs).
Yellowing of the skin and eyes (if it has reached the liver).

???? Types of Ureteral Cancer

Ureteral cancer isn’t just one disease — it varies based on the type of cells where it begins. Doctors classify it by the cell type and how it looks under the microscope.

1. ???? Transitional Cell Carcinoma (TCC)

The most common type, accounting for over 90% of cases.
It begins in the lining cells of the ureter and bladder — flexible cells that expand and contract with urine flow.
This is the same type often seen in bladder cancer.

Key Points:

It can recur after treatment, especially in the bladder.
Sometimes grows slowly, but without treatment, it may spread quickly.

2. ???? Squamous Cell Carcinoma

A rare form that develops when the lining cells become squamous (flat) due to chronic inflammation or irritation (like stones or infections).

Risk Factors:

Long-term infections.
Chronic ureteral stones.

This type is more aggressive and often detected at a late stage.

3. ???? Adenocarcinoma

Very rare — starts in glandular cells that produce mucus.
Usually caused by long-term inflammation that changes the ureter lining.
Hard to treat because it’s often diagnosed late.

4. ⚫ Extremely Rare Types

Small Cell Carcinoma
Undifferentiated Carcinoma

Both are aggressive and spread rapidly, though very uncommon.

⚠️ Complications of Ureteral Cancer

Ureteral cancer isn’t just a tumor in the urinary tract — it can cause serious complications if left untreated.

1. ???? Urinary Blockage

The tumor can block urine flow from the kidney to the bladder, leading to hydronephrosis (swelling of the kidney).
If untreated, it may cause kidney failure.

Possible Symptoms:
Severe flank pain, reduced urination, leg swelling, nausea.

2. ???? Kidney Damage or Failure

Blocked urine flow reduces kidney function, leading to toxin buildup in the blood.
This may cause permanent damage or full kidney failure, requiring temporary or long-term dialysis.

3. ???? Cancer Spread (Metastasis)

Cancer can spread to nearby lymph nodes or distant organs such as the liver, lungs, or bones, making treatment more difficult.

Symptoms:
Depend on where the cancer spreads — coughing, bone pain, fatigue.

4. ???? Recurrence After Treatment

Especially common in transitional cell carcinoma.
It may recur in the ureter, bladder, or kidneys.
That’s why regular follow-up with imaging and cystoscopy is crucial.

5. ???? Bladder Involvement

The tumor may extend to the bladder, leading to secondary bladder cancer and urinary symptoms like blood in urine or difficulty urinating.

6. ⚡ General Weakness and Weight Loss

Loss of appetite.
Rapid, unexplained weight loss.
Persistent fatigue and mild fever — especially in advanced stages.

7. ???? Psychological Impact

Long treatments and fear of recurrence can lead to stress, anxiety, or depression, affecting sleep, mood, and quality of life.

???? Diagnosis of Ureteral Cancer

Diagnosis requires a series of precise tests to determine the tumor’s location, type, and spread.

1. ???? Medical History and Physical Examination

The doctor asks about:

Blood in the urine.
Pain in the side or back.
Changes in urination.
Also asks about smoking, chemical exposure, or a history of bladder/kidney cancer.
Then examines the abdomen and back for pain or kidney swelling.

2. ???? Urinalysis

A basic test that detects:

Blood in the urine (even microscopic).
Abnormal or cancerous cells (via urine cytology).

Repeated tests may be needed since blood in urine can appear intermittently.

3. ???? Urine Cytology

Microscopic study of urine cells to identify abnormal or cancerous cells.
Helps differentiate between cancer types.

4. ????️ Imaging Tests

Used to visualize the tumor’s size, location, and spread:

CT Urography: The most accurate test. Uses contrast dye to highlight the kidneys, ureters, and bladder.
MRI Urography: Used for patients who can’t take contrast dye (e.g., kidney disease). Excellent for soft tissue imaging.
IVP (Intravenous Pyelogram): An older X-ray test that can show blockages or narrowing caused by tumors.

5. ???? Ureteroscopy

A thin scope inserted through the urethra and bladder into the ureter to directly view the tumor and take a biopsy.

6. ???? Biopsy

Tissue samples confirm the diagnosis and help determine:

The cancer type (transitional, squamous, glandular, etc.).
How deep the tumor has grown into the ureter wall.
The tumor grade (low or high risk).

7. ???? Tests for Staging and Spread

Once confirmed, additional scans are done to determine cancer stage:

CT scan of the abdomen and chest (to check liver or lungs).
Bone scan (if bone spread is suspected).
Ultrasound (to evaluate kidney function).

???? Treatment of Ureteral Cancer

Treatment depends on the stage and patient’s condition and usually includes one or more of the following:

Surgery
Chemotherapy
Radiation therapy
Immunotherapy or targeted therapy

Often, a combination approach gives the best results.

???? 1. Surgical Treatment

Surgery is the main and most effective treatment, especially in early stages.

Types of Surgery:

a. Segmental Ureterectomy

Removal of only the affected part of the ureter, preserving the kidney and bladder.
Best for small, early tumors.
Advantages: Kidney preservation, quick recovery.
Disadvantage: Slight risk of recurrence — regular follow-up is needed.

b. Radical Nephroureterectomy

Removal of the affected kidney, the entire ureter, and a small portion of the bladder.
Recommended for moderate to advanced stages.

???? Treatment of Ureteral Cancer

1️⃣ Surgical Treatment (Surgery)

A. Partial Ureterectomy
Used when the tumor is small and limited to one part of the ureter.

✅ Advantages:

Preserves kidney function
Short recovery time

⚠️ Disadvantages:

Risk of cancer recurrence
Requires continuous monitoring

B. Nephroureterectomy (Removal of the ureter + kidney)
Used when the tumor spreads throughout the ureter or is located near the kidney.

✅ Advantages:

Reduces the risk of recurrence
Effective for cancer that spreads throughout the ureter

⚠️ Disadvantages:

The patient lives with one kidney
Requires close monitoring of kidney function

C. Endoscopic or Laser Surgery (Endoscopic / Laser Ablation)
Used for small tumors or for patients who cannot undergo major surgery.
A thin scope is inserted through the urinary tract to burn the tumor with a laser.

✅ Advantages:

No external incision
Short recovery period
Suitable for elderly patients or those with heart/kidney issues

⚠️ Disadvantages:

Higher risk of tumor recurrence
Requires regular follow-up

2️⃣ Chemotherapy

Uses drugs to kill or stop the growth of cancer cells.
It can be given before or after surgery depending on the case.

???? Types:

Neoadjuvant chemotherapy: Before surgery to shrink the tumor
Adjuvant chemotherapy: After surgery to prevent recurrence
Systemic chemotherapy: For advanced or metastatic cases

???? Common Drugs:
Cisplatin – Gemcitabine – Carboplatin – Methotrexate – Paclitaxel

⚠️ Side Effects:

Nausea and vomiting
Hair loss
Fatigue and weak immunity
Temporary effects on kidney function (requires monitoring)

3️⃣ Radiation Therapy (☢️)

High-energy rays destroy cancer cells or reduce tumor size.

???? Uses:

When surgery isn’t possible
After surgery to reduce recurrence
To relieve pain or control metastatic tumors

???? Types:

External Beam Radiation: From outside the body
Brachytherapy: Radiation source placed inside the ureter

⚠️ Side Effects:

Skin redness or irritation
Fatigue and nausea
Bladder or bowel inflammation

4️⃣ Immunotherapy & Targeted Therapy

A. Immunotherapy
Boosts the immune system to attack cancer cells.
Effective for advanced or chemotherapy-resistant cases.

???? Common Drugs:
Pembrolizumab – Atezolizumab – Nivolumab

⚠️ Side Effects:

Fatigue
Skin rash
Rarely, inflammation in the lungs or liver

B. Targeted Therapy
Targets specific proteins or genes that help cancer cells grow.
Useful in cases with specific genetic mutations.

???? Example:
Erdafitinib — for ureter and bladder cancer with FGFR3 mutation

❤️ 5️⃣ Palliative or Supportive Care

Used in very advanced stages.
The goal is to improve quality of life, not necessarily to cure the cancer.

Includes:

Strong painkillers
Balanced nutrition
Psychological and emotional support
Treating symptoms like nausea or anemia

???? Treatment by Stage

Stage I

Tumor limited to the inner lining of the ureter
Treatment: Partial ureterectomy or laser ablation
Follow-up: Regular check-ups (endoscopy, imaging)
Recovery rate: Very high (>90%)

Stage II

Tumor invades the muscle layer of the ureter
Treatment: Removal of the ureter + part of the kidney + adjuvant chemotherapy
Follow-up: Every 3–6 months with scans and endoscopy
Recovery rate: Moderate to high

Stage III

Tumor extends to nearby tissues or lymph nodes
Treatment: Removal of the kidney and ureter + lymph node dissection + chemotherapy ± radiation
Recovery rate: Lower than earlier stages

Stage IV

Cancer spreads to distant organs (liver, lungs, bones)
Treatment: Systemic chemotherapy + immunotherapy or targeted therapy + radiation for pain + supportive care
Goal: Slow down disease progression and improve quality of life, not complete cure.