Ureter Cancer
Ureter cancer is treated primarily with surgery and chemotherapy. Radiation plays a supporting role — after an operation when the risk of return is high, or to relieve symptoms.
About ureter cancer
The ureters are the two narrow tubes that carry urine from the kidneys down to the bladder. Cancer that starts there is almost always urothelial carcinoma, the same cell type that lines the bladder. Physicians group ureter tumors together with tumors of the renal pelvis, the funnel-shaped area where the kidney drains, and call them upper tract urothelial carcinoma. These cancers are uncommon.
Smoking is the strongest known risk factor. Others include long-term exposure to certain industrial chemicals, a history of bladder cancer, chronic irritation or infection of the urinary tract, and the inherited condition Lynch syndrome. Because the whole urinary lining shares the same risk, anyone treated for a ureter tumor is followed closely for new tumors elsewhere in the tract, particularly the bladder.
We want to be plain about where radiation fits. Your urologist leads this care. The standard treatment is surgery — either removing the kidney and ureter together, or a kidney-sparing approach that removes the tumor endoscopically when the disease is small and low grade. Chemotherapy is often given before or after that operation. Radiation is not the main treatment. It is added after surgery when the cancer extended beyond the wall of the ureter, when lymph nodes were involved, or when the surgical margin was not clear, and it is used on its own to control symptoms when an operation is not possible.
Signs and symptoms
Blood in the urine is by far the most common first sign, and it is often painless.
- Blood in the urine, visible or found on a routine urine test
- Pain or a dull ache in the flank or side, usually on one side only
- Passing blood clots, or pain when a clot passes
- Burning with urination, or needing to urinate more often or more urgently
- Pressure or a feeling of fullness in the side or back
- A lump felt in the side, which is uncommon
- Losing weight without trying, or unusual tiredness
When to call
These symptoms have many possible causes, most of them not cancer. But they are worth a conversation. If something has changed and hasn't resolved, contact your primary care physician — early evaluation is what makes treatment straightforward.
How we treat it
Because the ureter runs the length of the abdomen and lies next to the kidney, bowel and major blood vessels, radiation here must be shaped carefully. When it is part of your plan, it is usually given after surgery, often together with chemotherapy, to lower the chance of the cancer coming back in the same area. We coordinate directly with your urologist and medical oncologist on timing, and we keep an eye on the function of your remaining kidney throughout.
Intensity-modulated radiation therapy (IMRT)
IMRT shapes the beam into many small segments so the dose conforms to the treatment area while curving away from the remaining kidney, the bowel and the spinal cord. Protecting kidney function is a central concern when one kidney has already been removed, and IMRT is the main tool we use to do that. It is our usual choice for radiation given after surgery.
Volumetric modulated arc therapy (VMAT)
VMAT delivers an IMRT plan while the treatment machine rotates around you, changing the beam shape and dose rate as it goes. It produces the same conformal dose in a much shorter session, which means less time on the table and better day-to-day accuracy.
Image-guided radiation therapy (IGRT)
IGRT is the imaging taken on the treatment table right before each session, used to confirm your position and adjust it. In the abdomen and pelvis, where bowel and bladder filling change from day to day, this step is what keeps the dose on target and off everything else.
Stereotactic body radiation therapy (SBRT)
SBRT delivers a high dose to a small, well-defined target in one to five sessions. We use it selectively here — for a limited number of sites where the cancer has spread, or for a spot that needs firm local control while systemic treatment continues. It is not a substitute for surgery of the primary tumor.
Palliative radiation
A short course of external beam radiation can control bleeding, ease flank or back pain, or relieve pressure caused by a tumor blocking the urinary tract or pressing on nearby structures. Courses usually run from one to ten sessions and are planned to be as easy on you as possible.
What treatment involves
Treatment starts with a simulation, a planning appointment of about an hour. You lie on your back on a CT scanner in the position you will be treated in, often with a cushion molded to your shape and your arms above your head. We may give you instructions about drinking water beforehand so your bladder is a consistent size at each visit. A few small skin marks let the therapists position you the same way every day.
Your radiation oncologist and a medical physicist then build and verify your plan, which usually takes about a week. If chemotherapy is part of the plan, we coordinate the schedule with your medical oncologist.
Radiation given after surgery is typically delivered Monday through Friday for about five weeks. Each visit takes 15 to 30 minutes, most of it setup and imaging, with the beam on for only a few minutes. Palliative courses are much shorter, sometimes a single treatment. You will see your radiation oncologist weekly during the course. Treatment is painless, you are not radioactive afterward, and most people drive themselves and carry on with normal activity.
Possible side effects
Side effects are usually temporary and typically resolve shortly after treatment ends. Tell your care team about any discomfort — managing it is part of the treatment, not an interruption to it.
- Tiredness that builds over the weeks of treatment
- Nausea or a reduced appetite
- Loose stools, diarrhea or cramping
- Needing to urinate more often, or burning with urination
- Mild redness or dryness of the skin over the treated area
- Lower blood counts, particularly if chemotherapy is given at the same time
- Changes in kidney blood tests, which we monitor throughout
Caring for yourself during treatment
- Rest when you need to, and don't hesitate to ask for help.
- Follow your care team's advice — and ask when anything is unclear.
- Tell us about every medication, vitamin and supplement you take.
- Eat a balanced diet and drink plenty of fluids.
- Treat skin in the treatment area gently: no sun, no hot or cold packs, and only lotions your team has approved.
- Lean on support groups, family and friends. Coping is part of treatment.
Trusted resources
- Bladder Cancer Advocacy Network — 1-888-901-2226
- Urology Care Foundation — www.urologyhealth.org
- American Cancer Society — 1-800-227-2345
- National Cancer Institute — 1-800-422-6237
- RT Answers, American Society for Radiation Oncology — www.rtanswers.org
Clinical background adapted from materials by the American Society for Radiation Oncology (rtanswers.org) and the American Cancer Society.
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