Renal Pelvis Cancer

Urinalysis and urine cytology

• Urinalysis confirms the presence of hematuria (blood in the urine). Urine cytology — microscopic examination of shed urothelial cells in a voided urine sample — can identify malignant cells and is particularly sensitive for high-grade tumors. 

CT urogram (CTU)

• CT urography with intravenous contrast is the definitive imaging investigation for suspected renal pelvis cancer. Chest imaging is performed to exclude pulmonary metastases.

Ureteroscopy and biopsy

• Flexible ureteroscopy — passage of a thin, flexible endoscope through the urethra and bladder and up the ureter to the level of the renal pelvis — allows direct visualization of the collecting system and enables targeted biopsy of suspicious lesions. 

Cystoscopy

• Concurrent cystoscopy is performed to assess the bladder for synchronous tumors, which occur in a clinically meaningful proportion of patients with upper tract urothelial carcinoma.

Radical nephroureterectomy (RNU)

• Radical nephroureterectomy — complete surgical removal of the kidney, the entire ipsilateral ureter, and a cuff of bladder at the ureteral orifice — is the standard of care for the majority of patients with renal pelvis cancer, particularly those with high-grade or invasive tumors. 
• Minimally invasive approaches are the preferred surgical modality in most centers, providing equivalent oncological outcomes to open surgery with the advantages of reduced blood loss and shorter hospital stay.

Kidney-sparing approaches

• In selected patients for whom removal of the affected kidney would result in unacceptable renal insufficiency or dialysis dependence, kidney-sparing strategies may be considered:
  • Endoscopic (ureteroscopic) ablation or resection
  • Percutaneous nephroscopic resection

Perioperative chemotherapy

• Neoadjuvant chemotherapy (administered before surgery): Chemotherapy is recommended for high-grade, muscle-invasive, or locally advanced tumors before nephroureterectomy, as it may improve long-term survival. 
• Adjuvant chemotherapy (administered after surgery): Considered for patients with confirmed lymph node involvement or adverse pathological features at nephroureterectomy, though administration is often limited by post-operative decline in renal function.

Immunotherapy

• Immune checkpoint inhibitors are established treatment options for patients with locally advanced or metastatic urothelial carcinoma, including those with platinum-ineligible disease or progression after platinum-based chemotherapy.