Introduction to Urothelial Cancer

Abstract

The natural history of urothelial carcinoma varies depending on tumor location. Approximately 75–85 % of patients with bladder cancer present with nonmuscle invasive disease, while 60 % of patients with UUT–UCC are invasive at diagnosis. The standard treatment of noninvasive UUT–UCC is still radical nephroureterectomy. However, minimally invasive techniques which may spare the kidney are increasingly being used and are currently indicated under special circumstances. Invasive UUT–UUC require accurate staging and when localized are treated with major extirpative surgical techniques. The later includes radical nephroureterectomy along with extensive lymphadenectomy. Metastatic disease is still considered incurable as the response to chemotherapy is poor and major surgery is futile. Radiologic imaging plays an important role in the detection, differential diagnosis staging, and follow-up of urothelial cancer. Despite significant advancements, it has not been able to replace invasive diagnostic procedures such as cystoscopy and ureteroscopy. Modern imaging is undoubtedly a valuable tool in the diagnosis of upper tract urothelial cancer and certainly has replaced conventional intravenous urography (IVU). Significant evolution in imaging technology provides the urologist with an increased armamentarium for more accurate staging of urothelial cancer fact which may alter treatment strategies.