Cancer can occur in the cells lining, the renal pelvis (transitional cell carcinoma of the renal pelvis) and the ureters. The renal pelvis is the part of the kidney that funnels urine into the ureters (the slender tubes that carry urine to the bladder).

Symptoms and Diagnosis

Blood in the urine is usually the first symptom. Crampy pain in the flank or lower abdomen may occur if urine flow is obstructed.

The diagnosis is made by intravenous urography or retrograde urography. CT scans can help a doctor distinguish a kidney stone from a tumor or blood clot and may help show how much the cancer has grown. Microscopic examination of a urine sample may detect cancer cells. A fiber-optic device-a ureteroscope oг nephroscope-threaded up through the bladder or passed through the abdominal wall may be used to view, and occasionally even to treat, small tumors.

Treatment and Prognosis

If the cancer hasn't spread, the usual treatment is surgical removal of the kidney and ureter (nephroureterectomy) along with part of the bladder. However, in some situations--for example, when the kidneys aren't functioning well or a person has only one kidney--the kidney is usually not removed, because the person would then become dependent on dialysis. If the cancer has spread, chemotherapy is used, although this type of cancer doesn't respond quite as well to chemotherapy as does bladder cancer.

The prognosis is good when a cancer hasn't spread and can be completely removed surgically. Cystoscopies (insertions of a fiber-optic viewing tube to examine the inside of the bladder) are performed periodically after surgery, because people who have had this type of cancer are at risk of developing bladder cancer. If bladder cancer is detected at an early stage, it may be removed through the cystoscope or treated with anticancer drugs instilled into the bladder,

just as any other bladder cancer is treated.

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