Treatment of Upper Tract Urothelial Carcinoma

Upper tract urothelial carcinoma is a rare disease with complex treatment pathways. This disease typically affects elderly patients, except in those with hereditary disorders, and is associated with tobacco use and other environmental exposures. Patients can present with hematuria or renal colic due to obstruction, and the diagnosis is often made via imaging and endoscopic biopsy. Treatment modalities vary widely based on histology, location of disease, clinical stage, and patient comorbidities and may include endoscopic resection, intracavitary chemotherapy, radical resection, and systemic therapies. As this is a rare disease, there is no current consensus on surgical approach, bladder cuff management, or use of neoadjuvant chemotherapy. Systemic therapy with either chemotherapy or immunotherapy is the treatment of choice for metastatic disease, and metastasectomy may be indicated in some cases. Due to the high rates of bladder and systemic recurrence, these patients require close surveillance.