Upper Tract Tumors
Upper tract tumors develop in the renal pelvis (tissue in the kidneys
that collects urine) and the ureters (tubes that carry urine from the
kidneys to the bladder). Cancer that originates in the upper urinary tract
accounts for less than 1% of cancers of the genitourinary system
(reproductive and urinary systems). Upper tract tumors are often associated
with bladder cancer.
More than 90% of renal pelvis tumors develop in transitional epithelial
cells (surface lining cells). This type is called transitional cell
carcinoma (TCC). TCC often develops in multiple areas of the upper
Fewer than 10% of renal pelvis tumors are squamous cell carcinomas, which
develop in flat surface cells that line the renal pelvis. Adenocarcinoma,
which develops in glandular cells, is extremely rare. These types of renal
pelvis tumors are associated with inflammation caused by chronic urinary
tract infections and
Incidence and Prevalence
According to the American Cancer Society, incidence of upper tract tumors is
about 1-2 cases per 100,000 people each year. Renal pelvis tumors are more
common in men and in Caucasians. Peak incidence occurs in the 60- to 70-year
age group. The highest incidence is in Balkan countries such as Bulgaria,
Greece, Yugoslavia, and Romania.
Bilateral (occurring on both sides) upper tract tumors occur in less than
2% of cases.
Causes and Risk Factors
The cause of upper tract tumors is unknown. A personal history of
bladder cancer is the primary risk factor. Smoking cigarettes is
also a major risk factor. Smoking may contribute to as many as 60-80% of
cases. Other risk factors include the following:
- Balkan descent
- Chronic urinary tract infections
- Family history of transitional cell carcinoma
- Genetic mutation of the p53 gene
- Overuse of analgesics that contain phenacetin
- Recurrent kidney stones
- Use of chemotherapy drugs cyclophosphamide and ifosfamide
People who work in chemical, petroleum, aniline dye, and plastics
industries, and those exposed to coal, tar, and asphalt, also have an
increased risk for upper tract tumors. Consuming more than seven cups of
coffee a day may slightly increase the risk for the condition.
Signs and Symptoms
Blood in the urine (hematuria) is the most common symptom.
Hematuria may be gross (visible to the naked eye) or microscopic (visible
upon examination with a microscope). Other symptoms include bladder
irritation, constipation, and pelvic pain.