Carcinoma of the renal pelvis

Carcinoma of the renal pelvis represents approximately10 to 20% of all renal tumors. The majority are transitional or urothelial cell carcinomas. Squamous cell carcinomas are less frequent and are often associated with calculi. Two causes deserve special attention : analgesic abuse and Balkan nephropathy. The diagnosis is most frequently made when patients consult a physician because of painless haematuria. Bilateral tumors may occur time and again. A tumor in the upper tract may be followed by urothelial tumors in the bladder caused by cellular dissemination.

Treatment for carcinoma of the upper urinary tract is complete nephroureterectomy with a bladder cuff. If the ureter is not removed then the chance that recurrences will occur in the stump is high at about 15%. Survival is directly correlated with grade and stage of the tumor. Reported five-year overall survival ranges from 18 to 55%. Patients with bilateral tumors, renal insufficiency, high operative risk factors or tumors in solitary kidneys may be considered for more conservative surgical treatment. Radiologic, cystoscopic and cytologic follow-up should be similar to that for bladder cancer.