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Optimal Management of Upper Tract Urothelial Carcinoma: an Unmet Need

  • Mounsif AziziEmail author
  • Salim K. Cheriyan
  • Charles C. Peyton
  • Beat Foerster
  • Shahrokh F. Shariat
  • Philippe E. Spiess
Genitourinary Cancers (S Gupta, Section Editor)
  • 136 Downloads
Part of the following topical collections:
  1. Topical Collection on Genitourinary Cancers

Opinion statement

Upper tract urothelial carcinoma (UTUC) is a rare genitourinary entity of the renal pelvis and the ureter characterized by a more aggressive disease phenotype when compared with urothelial carcinoma of the bladder (UCB) with more than half of UTUC cases presenting with invasive disease at diagnosis compared to 20% for bladder tumors. There is growing evidence suggesting that its distinct natural history from that of bladder cancer can be related to several genetic and epigenetic differences. Treatment of low-risk disease consists of kidney-sparing surgeries such as ureteroscopic and percutaneous treatments, segmental ureterectomy, and adjuvant topical and intracavitary chemo-immunotherapies. The standard of care for high-risk non-metastatic disease remains radical nephroureterectomy and bladder cuff excision with increasing utilization rates of minimally invasive approaches leading to reduced morbidity without compromising outcomes while the role of lymphadenectomy is still being investigated. The prognosis of UTUC has been stagnant over the past decade highlighting the need for further studies on the role of multimodal therapy (neoadjuvant/adjuvant chemotherapy, immunotherapy, targeted therapy) to optimize management and improve outcomes.

Keywords

Upper tract urothelial carcinoma Kidney-sparing surgery Radical nephroureterectomy Minimally invasive surgery Adjuvant chemo-immunotherapy Systemic therapy 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mounsif Azizi
    • 1
    Email author
  • Salim K. Cheriyan
    • 2
  • Charles C. Peyton
    • 2
  • Beat Foerster
    • 3
  • Shahrokh F. Shariat
    • 3
  • Philippe E. Spiess
    • 2
  1. 1.Department of Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaUSA
  2. 2.Department of Genitourinary OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaUSA
  3. 3.Department of UrologyMedical University of ViennaViennaAustria

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