Upper Tract Urothelial Carcinoma (UTUC): Symptoms & Treatment 

August 19, 2026

Upper tract urothelial carcinoma (UTUC) is a type of urothelial cancer that develops in the lining of the kidney (renal pelvis) or ureters, the tubes that carry urine from the kidneys to the bladder. UTUC accounts for about 5–7% of urothelial cancers. Symptoms often include blood in the urine or flank pain and treatment depends on the cancer’s grade, stage and overall health of the patient. 

Key Takeaways 

• UTUC is a rare cancer of the kidney lining and ureters. 

• It makes up approximately 5–7% of urothelial cancers. 

• Blood in the urine is the most common symptom. 

• Treatment depends on stage, grade, and kidney function. 

• Early diagnosis improves treatment options and outcomes. 

What is upper tract urothelial carcinoma?

Upper tract urothelial carcinoma (UTUC) is a cancer that forms in the urothelial cells lining the: 

• Renal pelvis (the part of the kidney that collects urine). 
• Ureters (the tubes connecting the kidneys to the bladder). 

UTUC belongs to the same family of cancers as bladder cancer because both originate from urothelial cells. However, UTUC occurs in the upper urinary tract rather than the bladder. 

What are the types of upper tract urothelial carcinoma? 

Non-invasive UTUC  

• More than half of UTUC cases are non-invasive.  

The cancer stays in the urothelial cells that line the renal pelvis or ureters. 

Invasive UTUC 

• Cancer has grown beyond those urothelial cells. 

• Cancer may have spread to other parts of the body. 

• It often requires more aggressive treatment. 

UTUC	details
location	renal pelvis or ureters
percentage of bladder cancers	about 5–7%
Average age at diagnosis	73
most common symptom	blood in the urine (hematuria)
other symptom	flank pain
Treatment options	Surgery, chemotherapy, immunotherapy, targeted therapy

What Is the Difference Between Low-Grade and High-Grade UTUC? 

Tumor grade describes how abnormal cancer cells appear under a microscope. Doctors may also use imaging studies to stage UTUC. 

Low grade UTUC  

• Tumors are typically noninvasive. 

• Tumors are typically less aggressive. 

High grade UTUC  

• Tumors can be more aggressive. 

• It may spread to other parts of your urinary tract, or to other parts of your body. 

What are symptoms of UTUC? 

The most common signs and symptoms of upper tract urothelial carcinoma include: 

• Blood in the urine (hematuria) 

• Flank pain or discomfort below the ribs. 

• Urinary blockage caused by a tumor. 

• Recurrent urinary symptoms. 

• Kidney swelling due to obstruction. 
   

Can UTUC Occur Without Symptoms? 

Yes. 

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

How is Upper Tract Urothelial Carcinoma Diagnosed? 

Diagnosing and staging UTUC correctly can be difficult. Doctors can usually get just a very small amount of tissue for a biopsy.  

Doctors may use: 

1. Medical history and physical examination. 

2. Urine cytology to detect cancer cells. 

3. Urine-based molecular or genetic testing. 

4. CT urogram or other imaging studies. 

5. Ureteroscopy with biopsy. 

6. Pathology review to determine grade and stage. 

Accurate diagnosis is important because treatment decisions depend heavily on tumor grade and stage.

How Is UTUC Staged? 

Staging describes how far the cancer has spread. 

Doctors use: 

• Imaging studies 

• Biopsy results 

• Surgical pathology findings 

Stage	Description
early-stage	Cancer stays confined to the lining
locally advanced	Cancer has grown into surrounding tissues
advanced or metastatic	Cancer has spread beyond the urinary tract

 Understanding both stage and grade can help you decide the right treatment plan. 

What Are the Treatment Options for Upper Tract Urothelial Carcinoma? 

Treatment depends on: 

• Tumor grade 

• Cancer stage 

• Tumor location 

• Kidney function 

• Overall health 

Kidney-Sparing Treatments 

For selected low-grade tumors, treatment may include: 

• Endoscopic tumor removal 

• Intracavitary therapy delivered directly into the urinary tract 

• Close surveillance 

Surgery 

Surgery is often the primary treatment for UTUC. 

Options include: 

Partial Nephrectomy or Segmental Resection 

Removes only the affected part of the urinary tract while preserving kidney function. 

Radical Nephroureterectomy (RNU) 

Removes: 

• The kidney 

• The ureter 

• A part of the bladder where the ureter connects 

RNU is commonly used for high-grade or invasive disease. 

Systemic Treatments 

For advanced or metastatic UTUC, treatment may include: 

• Chemotherapy 

• Immunotherapy 

• Targeted therapy 

These treatments circulate throughout the body to attack cancer cells beyond the upper urinary tract. 

Why Is Understanding Your Pathology Report Important? 

Your pathology report provides critical information about: 

• Tumor grade 

• Tumor stage 

• Presence of invasive disease 

• Treatment implications 

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. 

Additional UTUC Resources

BCAN offers several educational resources to help patients and caregivers better understand UTUC, including: 

• UTUC fact sheet 

• Understanding Upper Tract Urothelial Carcinoma (UTUC) 

• Exploring Upper Tract Urothelial Carcinoma 

• Treatment Talk | Upper Tract Urothelial Carcinoma 

• Patient stories 

• Treatment comparison tool 

• Podcast: What You Need to Know About UTUC 

Frequently asked questions about  upper tract urothelial carcinoma

What is upper tract urothelial carcinoma? 

Upper tract urothelial carcinoma (UTUC) is a cancer that develops in the urothelial lining of the kidney’s renal pelvis or ureters. It accounts for approximately 5–7% of urothelial cancers. 

What are the first symptoms of UTUC? 

The most common early symptom is blood in the urine (hematuria). Some patients also experience flank pain, urinary obstruction, or no symptoms at all. 

Is upper tract urothelial carcinoma the same as bladder cancer? 

No. UTUC and bladder cancer both arise from urothelial cells, but UTUC develops in the upper urinary tract while bladder cancer develops in the bladder. 

What treatments are available for UTUC? 

Treatment options may include kidney-sparing procedures, surgery, chemotherapy, immunotherapy, targeted therapy or combinations of these approaches depending on the stage and grade of the cancer. 

What is the average age of UTUC diagnosis? 

The average age at diagnosis is 73. 

Is UTUC curable? 

Many early-stage UTUC cases can be successfully treated. Outcomes depend on factors such as stage, grade, overall health, and response to treatment.