Kidney and Ureter Cancer

Diagnosis

1. Imaging Tests

• Ultrasound: Initial test to evaluate kidney masses.
• Contrast-Enhanced CT Scan: Gold standard for diagnosing and staging.
• MRI: Useful for evaluating renal vein involvement or allergy to contrast agents.
• Ureteroscopy: Direct visualization for suspected UTUC (upper tract urothelial carcinoma).

2. Urine Cytology & Biomarkers

• Detects cancer cells in urine, especially useful for urothelial cancers.

3. Biopsy (Rarely needed in kidney cancer)

• Usually reserved for indeterminate renal masses or when systemic therapy is planned before surgery.

Treatment Options

1. Surgery (Curative for Localized Disease)

• Radical Nephrectomy: For large kidney tumors.
• Partial Nephrectomy: For small kidney tumors, preserves kidney function.
• Nephroureterectomy: For high-grade UTUC, removes kidney, ureter, and cuff of urinary bladder.

2. Targeted Therapy (For Advanced RCC)

• Tyrosine Kinase Inhibitors (TKIs): Sunitinib, Pazopanib, Axitinib.
• mTOR Inhibitors: Everolimus, Temsirolimus.
• VEGF Inhibitors: Bevacizumab.

3. Immunotherapy (Checkpoint Inhibitors)

• PD-1/PD-L1 Inhibitors: Nivolumab, Pembrolizumab.
• CTLA-4 Inhibitor: Ipilimumab (used in combination therapy).

4. Chemotherapy (For UTUC)

• Gemcitabine + Cisplatin: Preferred regimen.

5. Radiation Therapy

• Limited role in RCC: Used for bone or brain metastases.
• Palliative use: For advanced UTUC to relieve symptoms.

Prognosis and Follow-Up

• Localized RCC: 5-year survival rate is approximately 90–95%.
• Locally advanced RCC: 5-year survival rate is around 50–70%.
• Metastatic RCC: 5-year survival improves to 10–20% with current treatments.
• UTUC: Higher recurrence rate, requiring lifelong surveillance.
• Follow-up: Regular imaging (CT/MRI) every 3–6 months post-treatment to monitor for recurrence.