Cancer of the ureter (ureteral cancer) is an abnormal growth of cells on the inside lining of the tubes (ureters) that connect your kidneys to your bladder. Ureters are part of the urinary tract, and they carry urine produced by the kidneys to the bladder.

Ureteral cancer is uncommon. It occurs most often in older adults and in people who have previously been treated for bladder cancer.

Ureteral cancer is closely related to bladder cancer. The cells that line the ureters are the same type of cells that line the inside of the bladder. People diagnosed with ureteral cancer have a greatly increased risk of bladder cancer, so your doctor will recommend tests to look for signs of bladder cancer.

Treatment for ureteral cancer typically involves surgery. In certain situations, chemotherapy or immunotherapy may be recommended.

Signs and symptoms of ureteral cancer include:

• Blood in urine
• Back pain
• Pain when urinating
• Losing weight without trying
• Fatigue

When to see a doctor

Make an appointment with your doctor if you have any persistent signs and symptoms that worry you.

It's not clear what causes ureteral cancer.

Ureteral cancer happens when cells on the inside lining of the ureter develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do. The changes tell the cells to multiply rapidly and to continue living beyond their typical life cycle. The result is a growing mass of abnormal cells that can grow to block the ureter or spread to other areas of the body.

Factors that can increase the risk of ureteral cancer include:

• Increasing age. The risk of ureteral cancer increases with age. Most people diagnosed with this cancer are in their 70s and 80s.
• Previous bladder or kidney cancer. People who have been diagnosed with bladder cancer or kidney cancer have an increased risk of ureteral cancer.
• Smoking. Smoking tobacco increases the risk of ureteral cancer, as well as other urinary tract cancers, including kidney cancer and bladder cancer.
• Family history of cancer. Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC), increases the risk of colon cancer and other cancers, including ureteral cancer. If you have a strong family history of cancer, discuss it with your doctor. Together you may decide whether to consider genetic testing for Lynch syndrome and other inherited cancer syndromes.

Tests and procedures used to diagnose ureteral cancer include:

• Physical examination. Your doctor will ask you questions about your signs and symptoms and perform a physical examination to better understand your condition.
• Imaging tests. Imaging tests may be used to help your doctor assess the extent of your ureteral cancer. Imaging tests may include intravenous pyelogram or CT urography. In certain cases, a magnetic resonance urogram may be used if you can't undergo CT imaging.
• Urine tests. You may undergo a urinalysis to analyze your urine for any abnormalities. A urine cytology test may be used to look for abnormal cells in a urine sample.

• Use of a thin, lighted tube to view the ureters. During a procedure called ureteroscopy, your doctor will insert a thin, lighted tube equipped with a camera (ureteroscope) into your urethra. The scope is passed through your bladder and into your ureters.

  Ureteroscopy allows your doctor to visually inspect your ureters and, if necessary, remove a small sample of tissue for laboratory testing (biopsy).

  In the laboratory, a doctor who specializes in analyzing blood and body tissue (pathologist) will carefully examine your cells for signs of cancer. This may include sophisticated analysis of the gene mutations involved in your cancer.

• Tests for bladder cancer. Your doctor may examine your bladder using imaging tests or a scope to see inside your bladder (cystoscopy) to look for signs of bladder cancer. People diagnosed with ureteral cancer have a high risk of bladder cancer. It may occur at the same time as your ureteral cancer or grow soon after treatment.

Ureteral cancer treatment typically involves surgery. Your treatment options for cancer of the ureter will vary depending on the size and location of your cancer, how aggressive the cells are, and your own goals and preferences.

Surgery

Surgery is often recommended to remove ureteral cancer. The extent of your surgery will depend on your situation.

For very early-stage ureteral cancer, surgery may involve removing only a portion of the ureter. For more-advanced ureteral cancer, it may be necessary to remove the affected ureter, its associated kidney (nephroureterectomy) and a portion of the bladder.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is sometimes used before surgery to shrink a tumor and make it easier to remove during surgery. Chemotherapy may be used after surgery to kill any cancer cells that may remain.

For advanced ureteral cancer, chemotherapy may be used to control signs and symptoms of the cancer.

Immunotherapy

Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

Immunotherapy might be an option for treating advanced ureteral cancer that hasn't responded to other treatments.

Follow-up examinations

After your treatment, your doctor will create a schedule of follow-up exams to look for signs that your cancer has returned. These exams also look for signs of bladder cancer, since people diagnosed with ureteral cancer have an increased risk of bladder cancer.

The tests you'll undergo and the schedule of exams will depend on your situation. But expect to see your doctor every few months for the first year and then less frequently after that.

If you have any signs or symptoms that worry you, make an appointment with your doctor.

If you're diagnosed with ureteral cancer, you'll likely be referred to a doctor who specializes in conditions that affect the urinary system (urologist) or a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief and because there's a lot of information to discuss, it's a good idea to be prepared.

What you can do

• Note symptoms you're experiencing. If you have had signs and symptoms of illness or are just not feeling well, write down those details before your appointment. Your doctor will also want to know when you first noticed these symptoms and whether they've changed over time.
• Make a list of your medications. Include any prescription or over-the-counter medications you're taking, as well as all vitamins, supplements and herbal remedies.
• Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Questions to ask your doctor at your initial appointment include:

• What may be causing my symptoms or condition?
• Are there any other possible causes?
• What kinds of tests do I need?
• What do you recommend for next steps in determining my diagnosis and treatment?
• Are there any restrictions that I need to follow in the meantime?

Questions to consider if your doctor refers you to a specialist include:

• Do I have ureteral cancer?
• What are the goals of treatment in my case?
• What treatment do you recommend?
• Is it necessary to begin treatment right away?
• I have these other health problems. How can I best treat them together?
• What are the possible side effects of treatment?
• If the first treatment isn't successful, what will we try next?
• What is the outlook for my condition?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Thinking about your answers ahead of time can help you make the most of your appointment. Your doctor may ask:

• What are your symptoms, if any?
• When did you first begin experiencing symptoms?
• How have your symptoms changed over time?
• Have you been diagnosed or treated for any other medical conditions?
• What medications are you taking?