Affecting about 40,000 men and 22,000 women annually, renal pelvis cancer is an aggressive form of cancer that can be treated most effectively when diagnosed early. According to the US-based National Cancer Institute, kidney and renal pelvis cancers constitute 4.2 per cent of all new cancer cases in the United States and only about 1–4 cases per 1,00,000 are found to be cancer of the renal pelvis.
According to the Centers for Disease Control and Prevention (CDC), the renal pelvis is the upper part of the ureter, which forms the middle of the kidney and collects urine. Ureters are two tubes carrying urine from the kidneys to the bladder. The renal pelvis and ureters are together called the upper urinary tract. The most common type of cancer seen in this part is called transitional cell carcinoma, which starts in the urothelial cells inside the lining of the renal pelvis and ureter.
What is cancer of the renal pelvis?
“Cancer of the renal pelvis is high-risk with the potential of being aggressive and spreading rapidly to nearby tissues and other organs. Men are more likely to get this cancer compared to women. It must be detected early to be treated effectively,” says Dr P N Maheshwari, senior consultant and head of urology at Fortis Hospital, Mumbai.
“But the overall survival rates may not be as promising as that for bladder cancer because detection and diagnosis are often delayed, so the cancer is often at an advanced stage before treatment begins,” added Dr Maheshwari.
What are the risk factors?
Dr Maheshwari lists out some of the risk factors for renal pelvis cancer:
- Smoking/tobacco use
- History of bladder cancer
- Family history of cancers of the upper urinary tract, bladder, or kidney
- Age, as people older than 65 years are more likely to get this form of cancer
- Exposure to certain chemicals increases the risk of this cancer. Consumption of some herbal medicines, specifically certain Chinese medicines containing aristolochic acids, found naturally in some herbs, has been shown to increase the risk of renal pelvis cancer among patients.
“Recurrent urinary tract infections (UTIs) and kidney and bladder stones that are untreated for a long time can also increase the risk of developing cancer of the renal pelvis. Taking a lot of painkillers such as phenacetin can also contribute” says Dr Sanjay Paruchuri, consultant urologist and professor and head of the department of urology at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru.
What are the symptoms of renal pelvis cancer?
- Blood in urine
- Pain in the flank (the area between the ribs and the back, on the side of the abdomen)
- Unexplained weight loss
What are the precautions advised?
“As in most cancers, smoking is the biggest threat for developing cancer of the renal pelvis, so avoiding smoking is the best preventive measure, especially if there is a family history of cancers in the pelvic region,” says Dr Maheshwari.
“Those who have been earlier diagnosed and treated for bladder cancer must go for routine follow-ups and have a CT scan done every 2–3 years,” advised Dr Maheshwari.
What is the diagnosis for renal pelvis cancer?
Renal Pelvis Cancer is overlooked and difficult to diagnose, says Dr Paruchuri, a urologist. He explains the diagnosis:
- If the individual presents with blood in urine and recurrent episodes of pain in the flank, evaluation of the kidney, ureter and bladder with ultrasound is suggested after a physical examination. This will usually pick up any lesions in the pelvis.
- A CT scan of the abdomen and pelvic region is done to check if the tumour is confined to the renal pelvis or has spread to nearby lymph nodes and other organs.
- Urine cytology (to check for abnormal cells in the urine) is also done.
- In some cases, flexible ureteroscopy, a procedure where an endoscope (a tube-like device with a light and camera at one end) is inserted into the ureter to look inside for malignancies. During this procedure, a biopsy may be conducted by taking out a small part of the tumour and sending it for testing.
How is renal pelvis cancer treated?
- For low-grade cancer, that is, if the tumour is discovered in the early stages and confined to only the renal pelvis, treatment would be resection of the tumour with the help of laser, as described in a study titled Laser photoablation of renal pelvic tumours, published in Canadian Urological Association Journal.
- But most of the time, renal pelvis cancer presents in the advanced stages and surgery to remove the kidney, ureter, and a small part of the bladder, where it connects with the ureter, is the most common treatment option. This procedure, called Nephroureterectomy, is done through open or minimally invasive methods.
- Chemotherapy is used when the tumour is in a locally advanced stage and has spread to nearby tissues and lymph nodes.
Takeaways
- Renal pelvis cancer is an aggressive form of cancer that is more commonly seen in men than women.
- People with blood in the urine and pain in the flank should undergo a complete evaluation of the kidney, ureter and bladder to increase the chances of an early diagnosis.
- When diagnosed in advanced stages, surgery and chemotherapy are used to treat this form of cancer.
