Pelvic and ureteral tumors

The urine produced in the kidney comes to the kidney pool through the channels and is carried to the bladder through the urinary channel called the ureter. The urine stored in the bladder is kept there until it is expelled by urination. The type of cancer called transitional epithelial cell carcinoma arises from the epithelial layer lining these structures. Therefore, the type of cancer in the bladder and the type of cancer in the kidney pool are the same. This type of cancer is called pelvis renalis tumor of the kidney. Transitional epithelial cell carcinoma develops with the structural defect of the “transitional epithelial cells” lining the kidney pool (renal pelvis) and ureteral ducts. This is also called “urothelial carcinoma”. Transitional epithelial cell cancer of the kidney pool accounts for 7.2% of all kidney cancers. If the tumor has sold out at an early stage, the probability of curing the cancer is over 90%. However, even if it is limited in the kidney pool and ureter (not exceeding the tissue boundary), if it has advanced to the deep muscle layer, the chance of cure may decrease to 15%.

Risk Factors: There are almost the same factors as bladder cancer risk factors such as excessive and long-term use of painkillers, close contact with paints and chemicals used in the plastic, leather and rubber industries, and smoking.

The most common clinical symptom

Symptom:Low back pain, blood in the urine (if this happens once, you should definitely go to the doctor)

Pain on the right or left side of the waist that does not go away, Extreme weakness Unexplained weight loss, Painful and frequent urination

Physical examination:

Urine analysis:It is necessary to demonstrate the presence of blood in the urine.

Ultrasonography: There may be an enlargement due to the kidney tumor blocking the urinary canal. Or the mass structure in the kidney can be seen.

IVP:Although it is an old diagnostic method, medicated kidney film, that is, intravenous pyelography, is a radiological examination that is still frequently used today and shows important findings especially in pelvis renalis and ureter tumors.

Computed Tomography:While it gives important information about the size of the mass in the kidney pool or ureter and whether it has spread to the environment, it also evaluates whether there is an unexpected spread in the liver and lymph nodes.

Ureteroscopy: With an endoscopic instrument (this is usually a flexible ureteroscope), the urinary canal called the ureter is entered and the kidney pool is reached under the image and all small pools in the kidney pool are checked. If necessary, biopsy samples are taken from here.

Once diagnosed, there are some factors that affect the prognosis (chance of recovery). According to these factors, the treatment option is discussed with the patient. The two factors that affect the prognosis in the first step are the stage of the tumor and the grade of the tumor cells. While the grade of cancer cells is good in most of the superficial cancers with transitional epithelium cells, this grade is poor in tumors that have spread to the deep layers. The risk of such a tumor in the opposite kidney system at the same time or at a different time is between 2-4%. However, in cases where renal pelvis renalis (kidney pool) or ureter tumor is detected, the risk of developing this type of tumor in the bladder (urinary bladder) is between 30-50% in simultaneous or further follow-ups.

TREATMENT

1-Conservative-kidney sparing treatment: For low-risk ureter and pelvis tumors, conservative allows preservation of the kidney. A conservative approach may be mandatory in some cases (renal failure, solitary kidney) or may be considered in cases with low-grade, low-stage tumors. This is related to the anatomical location of the tumor and the surgeon’s experience.

Ureteroscopy:Endoscopic closed surgery can be applied in highly selected cases.

These situations are:

Flexible ureteroscope, laser and forceps can be used for biopsy.

The patient should be informed more closely for follow-up.

Complete removal-resection is required.

Segmental resection: Surgery for the total removal of the cancerous part of the ureter and reconnecting it end-to-end has begun to be performed more frequently today. This type of surgical treatment is possible for low- and high-risk lower-end ureteral tumors.

Tumors of the renal pelvis and upper ureter: Open resection of tumors of the renal pelvis and calyx is almost absent.

It is difficult and has a higher risk of recurrence compared to ureteral tumors. Percutaneous introduction in closed method

may be considered for low-grade non-disseminated tumors in the renal pelvis.

After removal of these tumors, the ureter and pelvis can be flushed percutaneously or endoscopically with chemotherapy drugs and BCG.

2-Radical Nephro-Ureterectomy-Partial Cystectomy: The ideal treatment for kidney collecting system cancers is surgical removal of the kidney and ureteral duct, including the normal tissue around the part where this duct enters the urinary bladder. In these operations, which have been performed with traditional open surgery for years, 2 separate incisions were applied to remove the kidney and the lower part of the ureteral canal. Today, in this surgery, which can also be performed laparoscopically, only the kidney and other tissues are removed in the patient, 7 cm. A scar remains. Clinical studies show that laparoscopy and robotic surgery methods can be applied safely in this type of cancer. Another point to be considered during these surgical procedures is the condition of the bladder. It should not be forgotten that cancerous cells can also be seen in the bladder in most cases in kidney and ureteral cancers. Therefore, the lower urinary system and especially the bladder should be checked not only during the operation but also during the postoperative controls.

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