What is Upper Tract Urothelial Carcinoma (UTUC)?

April 13, 2023

Upper Tract Urothelial Carcinoma, or UTUC, is urothelial cancer that occurs in the renal pelvis or ureter(s). Approximately 5-7 % of urothelial cancer can occur in the inner lining of the kidney, called the calyx and renal pelvis. It could also occur in one or both of the ureter(s), a tubes that leads from each of your kidneys to the bladder. 

Video: What is UTUC?

What are the signs of UTUC?

In addition to the other regular signs of bladder cancer, individuals with UTUC may also experience flank pain (discomfort, or pain in the part of the body below the rib). This can occur because the tumor or bleeding may obstruct or block the ureter or kidney.

Some people have no signs or symptoms of UTUC. Their doctor finds the tumors when looking for other health problems during radiology tests or scans.

How is UTUC diagnosed?

Diagnosing and correctly staging UTUC can be difficult. Doctors can usually get just a very small amount of tissue for a biopsy. Some medical professionals also rely upon urine tests (cytology) to look for cancer cells. Others do genetic testing on the urine itself if cytology is not conclusive.

What are the types of upper tract urothelial carcinoma?

• Non-invasive: more than half the people have this type, where the cancer remains in the urothelial cells that line the renal pelvis or ureters.
• Invasive: the rest have this type, where the cancer has grown beyond those urothelial cells. Or it may have spread to other parts of the body.

Just as with bladder cancer, UTUC tumors can be low grade or high grade. The grade of the UTUC is important to know as you and your doctor choose the best treatment for your cancer. The grade of the tumor is determined by a pathologist who examines the cells under a microscope. Doctors may also use imaging studies to help them stage UTUC. In low grade UTUC, the tumors are typically noninvasive and are less aggressive. High grade UTUC can be more aggressive. It may spread to other parts of your urinary tract, or to other parts of your body. Ask your doctor to explain the details about your diagnosis and pathology report.

Understanding your UTUC combined with your overall health, will help your doctor recommend the best treatment options for your cancer.  

How is UTUC treated?

The stage and grade of the UTUC will determine the treatments available. Treatment options for UTUC include intracavitary (in the lining where the tumor is) and systemic (throughout your body) medications. Surgery can remove the area where a tumor is located (a partial nephrectomy) or the entire kidney and ureter (a radical nephroureterectomy or RNU, for high grade disease). Chemotherapy, immunotherapy and targeted therapies can also be used to treat UTUC that has spread beyond the urothelial lining in the upper tract. If you are diagnosed with UTUC, speak with your doctor about your best treatment options. 

Visit our treatment comparison tool to learn more about UTUC treatment options.

What age does upper tract urothelial carcinoma occur?

The average age at diagnosis is 73.

Where can I get more information about upper tract urothelial carcinoma?

BCAN has additional video-based explanations about upper tract urothelial carcinoma.

BCAN offers a webinar about UTUC. MD Anderson Cancer Center urologist Dr. Surena Matin, and medical oncologist Dr. Matthew Campbell and urologist Dr. Kate Murray from University of Missouri Medical Center, hosted a webinar, Understanding Upper Tract Urothelial Carcinoma (UTUC). They discussed how UTUC is similar and different from other forms of bladder cancer in its diagnosis and treatment options.

For more information about upper tract urothelial carcinoma, we invite you to watch our webinar, “Exploring Upper Tract Urothelial Carcinoma.” The webinar is moderated by urologist Dr. Gary Steinberg and the panelists include Dr. Ahmad Shabsigh from the Ohio State University, Dr. Alon Weizer from the University of Michigan, Dr. Seth Lerner from Baylor College of Medicine, Dr. Jennifer Linehan from the John Wayne Cancer Institute, Dr. Surena Matin from MD Anderson Cancer Center, and Dr. Monty Pal from City of Hope.

In the Treatment Talk | Upper Tract Urothelial Carcinoma, Medical Oncologist Dr. Jeannie Hoffman-Censits and urologist Dr. Nirmish Singla from the Greenberg Bladder Cancer Institute at Johns Hopkins University, along with patient advocates Tony and Christina discuss the ways in which high and low grade UTUC are treated.