Urinary tract tumors - Find information and specialists

Urinary tract tumors occur in the upper urinary tract(kidneys and ureters) and lower urinary tract(bladder and urethra). What they all have in common is that there are as yet no established early detection tests. By the time symptoms appear, the disease is often already at an advanced stage.

If there is a family history of urinary tract tumors, endoscopy can be performed at regular intervals for monitoring and early detection. Various procedures are available today for the treatment of urinary tract tumors - from surgery to modern immuno-oncology.

Both the kidneys and the ureters that emerge from them, as well as the bladder and urethra, are lined with epithelial cells (urothelium). The epithelial cells can change under the influence of risk factors and become cancer cells. In the kidneys and adjacent ureters, such urothelial carcinomas account for around 8 % of all malignant kidney lesions

Patients with urinary tract tumors in the upper urinary tract often also show metastases in the lower urinary tract after some time. The reverse is also possible. Men also develop urinary tract tumors more frequently than women. The peak age is around 65 years.

What urinary tract tumors are there?

Cancers of the upper urinary tract include, among others

• Renal cell carcinoma
• Renal pelvis cancer
Ureteral tumor

In the lower urinary tract, the bladder is most commonly affected. The urinary tract tumor is then called urinary bladder carcinoma.

Causes of urinary tract tumors

The development of tumors in urothelial cancers is also promoted by certain risk factors. These include

• Tobacco smoking,
• chronic inflammation of the urinary bladder or upper urinary tract,
• aromatic amines as carcinogens and
• certain medications, including cyclophosphamide.

What are the symptoms of urinary tract tumors?

The primary function of the urinary tract is to collect urine and expel it from the body. Therefore, the symptoms associated with tumor formation are usually associated with pain and signs of congestion .

Depending on the location of the urinary tract tumor, it can lead to drainage problems and even the inability to pass urine. If the urine eventually backs up from the ureters into the kidneys, there is a risk of a congested kidney. This can end in urosepsis. In this case, urinary substances and bacterial pathogens from the congested areas in the kidneys enter the bloodstream. They trigger the classic blood poisoning (sepsis), which is accompanied by a high fever.

Pain also frequently occurs with drainage disorders and constrictions in the urinary system. This includes flank pain or knocking pains in the kidney area in the upper back. Depending on the stage of the disease, cells and blood are often shed from the tumor area. A urinalysis therefore reveals

• Cells from the urinary tract,
• immune cells,
• high protein levels and
• blood.

How are urinary tract tumors diagnosed?

After taking a medical history and performing a physical examination, various analytical and imaging procedures are available:

• In urine cytology, exfoliated urothelial and urothelial carcinoma cells can be examined microscopically directly from the urine.
• Ultrasound (sonography) reveals a possible urinary blockage in the kidneys or ureters.
• Using retrograde pyelography, urologists can visualize the renal pelvis and the renal calices using a contrast agent.
• Ureterorenoscopy provides a direct endoscopic view of the ureters and kidneys. Tissue removal (biopsy) is also possible.
• A similar endoscopic procedure is cytoscopy, in which the bladder wall in the inner lumen of the bladder is examined.
• The urogram is used for additional imaging, for example to detect urinary retention and loss of function in the kidneys affected by a urinary tract tumor.
• Computed tomography of the abdomen is the method of choice for staging and clarifying possible metastases.

Are urinary tract tumors treatable?

The treatment of urinary tract tumors depends on the type, location and stage of the disease. As with many tumor diseases, the earlier the cancer is detected, the better the course of the disease and prognosis.

The gold standard in the treatment of urinary tract tumors is organ-preserving surgery. This means removing the tumor without having to remove the organ in question. However, radical surgery is almost always necessary for large urinary tract tumors.

Due to a lack of early detection markers, many urinary tract tumors are only discovered at an advanced stage. As metastasis to the abdomen and chest can occur, further treatment is often carried out after the operation. Chemotherapeutic drugs are available for this purpose. Radiation or approved antibody therapies (checkpoint inhibitors) from the field of immuno-oncology are also available.

Which doctors treat urinary tract tumors?

Experts for urinary tract tumors can be found in urology, uro-oncology, oncology or nephrology (kidney medicine).

Here you will find specialists who specialize in the treatment of urinary tract tumours of the upper and lower urinary tract.