Management of urothelial carcinoma of the upper urinary tract – similarities and differences with urothelial bladder cancer

DOI: 10.22591/magyurol.2017.2.kubika.52

Authors:
Kubik András dr., Szarvas Tibor dr., Módos Orsolya dr., Keresztes Dávid dr., Horváth András dr., Nyirády Péter dr. (Semmelweis Egyetem, Urológiai Klinika, Budapest (igazgató: Nyirády Péter dr.))

Summary

The upper tract urothelial carcinoma (UTUC) and urothelial bladder carcinoma (UBC) were considered as one tumour entity with different anatomical locations. The aim of this review was to discuss current progress in UTUC research and to highlight the molecular, histopathological and clinical differences and similarities between UTUC and UBC. UBC and UTUC sharing common risk factors including smoking and aromatic amines, while aristolochic acid exposure or familiar Lynch syndrome are rather specific for UTUC. The grading of UBC and UTUC are identical, but inherent from their different anatomical locations, there are some differences between their stage classifications.

The primary treatment for both UBC and UTUC is surgery. Because of the inaccurate preoperative or transurethral staging of UTUC, many patients are overtreated by nephroureterectomy. Therefore, combined predictive tools including molecular, pathological and imaging parameters are needed in order to improve the prediction of tumor stage. Currently, the clinical benfit of lymph node dissection (LND) as well as the optimal number and sequence of lymph node removal is unclear. Systemic neoadjuvant and adjuvant chemotherapies may be considered, however their benefit has to be confirmed by large prospective studies.

click here to read the full article