Managing Ureteral Tumors in Elderly Patients with Bladder Cancer

Ureteral tumor resection

Hello Doctor: My mother has stage II bladder cancer along with ureteral cancer.
After undergoing endoscopic laser surgery and radiation therapy, the doctor mentioned that there is still a segment of the ureteral tumor that has not been removed.
She is scheduled for another endoscopic laser treatment in December.
My mother is 80 years old, has severe asthma, and her kidney function is not very good.
The doctor initially assessed that she is not suitable for surgery.
Now, with only a small segment left, the doctor also mentioned the risk of ureteral stricture if we proceed with the laser treatment.
Is it appropriate to perform endoscopic surgery to remove the tumor in this case? When we talk about removing the ureteral tumor, does it mean resecting the segment with the tumor and then suturing it? Or would it be better to do another laser treatment followed by chemotherapy? Thank you!

Xiao Yun, 50~59 year old female. Ask Date: 2022/10/29

Dr. Li Xinyi reply Urology

Based on your description, it seems that you are referring to an endoscopic laser tumor vaporization procedure, rather than a resection followed by suturing.
Endoscopic surgery is generally considered to be safer than traditional open surgery.
It is important to discuss the details with your attending physician for clarification.

Reply Date: 2022/10/29

More Info

Managing ureteral tumors in elderly patients, particularly those with a history of bladder cancer, presents unique challenges and considerations. In your mother's case, where she has been diagnosed with stage II bladder cancer and has a ureteral tumor, the treatment options must be carefully evaluated, especially given her age (80 years), severe asthma, and compromised kidney function.

Treatment Options
1. Endoscopic Laser Treatment: The use of endoscopic laser therapy is a minimally invasive approach that can be effective for tumor removal in the ureter. This method allows for targeted destruction of the tumor while preserving surrounding healthy tissue. Given your mother's age and health status, this approach is often preferred as it carries lower risks compared to open surgery. However, it is essential to consider the potential for ureteral stricture (narrowing) post-treatment, which can lead to complications such as hydronephrosis (swelling of the kidney due to urine buildup).

2. Surgical Resection: If the tumor is localized and accessible, surgical resection may be considered. This involves removing the segment of the ureter containing the tumor and then reattaching the remaining ureter. However, given your mother's age and existing health issues, this option may pose higher risks, including complications from anesthesia and recovery challenges.

3. Chemotherapy: If the tumor is not completely resectable or if there is a concern about metastasis, chemotherapy may be recommended. This can be administered after laser treatment to target any remaining cancer cells. The choice of chemotherapy agents will depend on the specific characteristics of the tumor and the patient's overall health.

Considerations for Elderly Patients
- Comorbidities: In elderly patients, comorbid conditions such as asthma and renal impairment must be taken into account when planning treatment. The anesthetic risks and potential for postoperative complications are higher in this population, making it crucial to weigh the benefits of aggressive treatment against the risks.

- Quality of Life: The goal of treatment in elderly patients often shifts from curative intent to palliative care, focusing on maintaining quality of life. Discussions with the healthcare team about the potential outcomes and side effects of each treatment option are vital.

- Multidisciplinary Approach: Involving a team of specialists, including urologists, oncologists, and geriatricians, can provide a comprehensive treatment plan tailored to your mother's specific needs. This team can help navigate the complexities of her condition and recommend the best course of action.

Conclusion
In summary, for your mother, the decision between further endoscopic laser treatment, surgical resection, or chemotherapy should be made collaboratively with her healthcare team, considering her overall health, the extent of the tumor, and her personal preferences. It is essential to have open discussions about the risks and benefits of each option, as well as the potential impact on her quality of life. Regular follow-ups and monitoring will be crucial in managing her condition effectively.

Similar Q&A

Understanding Ureteral Cancer: Treatment Options and Patient Concerns

Hello Dr. Lai: My mother was diagnosed with stage III ureteral malignant tumor in April of this year. She has undergone the removal of her left kidney, ureter, and a portion of the bladder. She is now preparing to undergo chemotherapy. I would like to ask: 1. Are there only two c...

Dr. Lai Yicheng reply Oncology
Dear Ms. Wu, 1. You have been diagnosed with urothelial carcinoma, and the standard treatment involves a chemotherapy regimen of Gemcitabine and Cisplatin, which is the first-line therapy and the most effective option available. 2. The medical center also utilizes this standard ...

Managing Stage III Renal Pelvis Cancer: Treatment Options for Elderly Patients

Director Du: My father underwent a CT scan that revealed a tumor in the renal pelvis, which was confirmed as renal pelvis cancer through a biopsy. He subsequently had a left nephrectomy and lymphadenectomy near the ureter, and the pathology report indicated stage III renal pelvis...

Dr. Du Shixi reply Urology
Hello: Your father should undergo examination and treatment at a major hospital, as he is already in stage 3. The 5-year survival rate is approximately 50-60%. If his physical condition is good, aggressive treatment can be pursued. However, if his health status is poor, such as l...

Managing Prostate Cancer in Elderly Patients: A Guide for Families

Hello, Dr. Hsu: My father is 81 years old and has recently experienced frequent urination with a prickling and burning sensation in his lower abdomen. He underwent an ultrasound examination at the hospital, which showed that his prostate is enlarged and his urine flow rate is ver...

Dr. Xu Weikai reply Urology
Mr. Gao: Hello, actually, whether to perform a biopsy or even whether to proceed with treatment should depend on the opinions of the patient and their family. Age is a consideration, but it is not the only factor. Let me first outline my general principles: 1. For patients under ...

Managing Urinary Difficulties in Elderly Patients with Comorbidities

Hello, Director. My elderly family member is nearly ninety years old and was diagnosed with benign prostatic hyperplasia two years ago. He has been regularly taking diuretics and tamsulosin, and his condition has been well controlled with normal urination. However, one to two mon...

Dr. Du Shixi reply Urology
Hello: Given the current situation, surgery is not appropriate. The main focus should be on resolving the internal medical issues and improving the overall health condition. Once the urinary catheter is removed, the patient may be able to urinate independently. Currently, we need...