Ureteral Cancer: Treatment Options and Concerns for Patients

Ureteral cancer

Dear Dr.
Lai,
My mother was diagnosed with stage III ureteral malignancy in April of this year.
On April 21, 2016, she underwent surgery at Keelung Chang Gung Memorial Hospital to remove her left kidney, ureter, and a portion of the bladder cuff.
The doctor mentioned that the tumor was close to the lymph nodes, so she is scheduled for prophylactic chemotherapy (which has not yet started).
One month after the surgery, my mother continued to experience swelling at the urethral opening and hematuria.
She later visited a nearby New Taipei City United Hospital (with the pathology report from Keelung Chang Gung Memorial Hospital attached).
On June 24, 2016, a cystoscopy revealed a 0.5 cm tumor.
The doctor recommended a resection and medication treatment, without mentioning chemotherapy.
I have the following questions:
1.
Since the ureteral tumor is close to the lymph nodes but has not metastasized distantly, is chemotherapy absolutely necessary, or are there other treatment options, such as targeted therapy?
2.
My mother has only one kidney left; will chemotherapy affect her renal function or cause other adverse effects on her kidneys?
3.
Are the chemotherapy drugs for ureteral cancer the same as those for bladder cancer?

errorwu, 30~39 year old female. Ask Date: 2016/06/24

Dr. Lai Yicheng reply Oncology

Dear Ms.
Errorwu,
Thank you for your inquiry.
Here are the responses:
1.
Regarding the ureteral tumor that is close to the lymph nodes but has not metastasized distantly, whether chemotherapy is necessary depends on the pathology report indicating lymph node invasion.
If there is lymph node invasion, chemotherapy is essential.
If there is no invasion or if the surgery did not involve the lymph nodes, or if the preoperative CT scan highly suspects lymph node involvement, chemotherapy is still required.
Even in the absence of lymph node invasion, if the cancer cells are highly differentiated urothelial carcinoma, subsequent chemotherapy is recommended.
2.
If your mother has only one kidney left, chemotherapy can be performed as long as her kidney function is normal based on blood tests.
3.
Are the chemotherapy drugs for ureteral cancer and bladder cancer the same? Yes, if both ureteral cancer and bladder cancer are squamous cell carcinoma, the chemotherapy drugs would indeed be the same.
Thank you for reaching out.

Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology
Changhua Hospital

Reply Date: 2016/06/24

More Info

Ureteral cancer, particularly when diagnosed at an advanced stage, raises several treatment considerations and concerns for patients and their families. In your mother's case, she has been diagnosed with stage III ureteral cancer, which necessitated the surgical removal of the left kidney, ureter, and part of the bladder. Following surgery, the recommendation for adjuvant chemotherapy is common, especially when there is a risk of lymph node involvement. Let's address your questions in detail.

1. Necessity of Chemotherapy: The decision to proceed with chemotherapy after surgery is often based on the pathological findings and the risk of recurrence. In cases where the tumor is close to lymph nodes but has not metastasized distantly, chemotherapy may be recommended as a preventive measure to reduce the risk of recurrence. However, it is not always mandatory. Alternative treatments, such as targeted therapies, may be considered depending on the specific characteristics of the tumor and the patient's overall health. Targeted therapies can be effective in certain cases, particularly if there are specific biomarkers present in the tumor. It is essential to discuss these options with the oncologist, who can provide insights based on the latest research and the specifics of your mother's case.

2. Impact of Chemotherapy on Kidney Function: Chemotherapy can have varying effects on kidney function, especially in patients with a single kidney. Certain chemotherapeutic agents can be nephrotoxic, meaning they can cause damage to the kidneys. However, the extent of this risk depends on the specific drugs used, the dosage, and the patient's overall health status. It is crucial for the healthcare team to monitor kidney function closely during chemotherapy. If there are concerns about the potential impact on kidney function, the oncologist may adjust the treatment plan accordingly, possibly opting for less nephrotoxic agents or modifying dosages.

3. Chemotherapy Drugs for Ureteral and Bladder Cancer: Ureteral cancer and bladder cancer are both types of urothelial carcinoma, and they often share similar treatment protocols, including chemotherapy regimens. The standard first-line chemotherapy for urothelial carcinoma typically includes a combination of cisplatin and gemcitabine or other agents like carboplatin, depending on the patient's health and kidney function. However, the specific choice of chemotherapy may vary based on individual circumstances, including the tumor's characteristics and the patient's overall health.

In summary, the treatment of ureteral cancer, particularly in the context of your mother's situation, involves careful consideration of the risks and benefits of chemotherapy versus other treatment options. It is essential to have open discussions with her oncologist about the necessity of chemotherapy, potential impacts on kidney function, and the specific chemotherapy agents that may be used. Additionally, seeking a second opinion from a specialized cancer center may provide further clarity and options for her treatment plan. It is crucial to ensure that your mother receives comprehensive care tailored to her unique needs and circumstances.

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