Ureteric Cancer Treatment in Singapore

This represents the most common form of ureter cancer. These tumours develop from transitional cells lining the inner surface of the ureters. They can appear as papillary growths (finger-like projections) or flat lesions and range in aggressiveness.

This type arises from flat cells lining the ureter. It typically occurs in response to chronic irritation or inflammation, such as from long-term kidney stones or recurrent infections. This type tends to be more aggressive than transitional cell carcinoma.

The rarest form of ureter cancer, adenocarcinoma, develops from glandular cells. This type is often associated with chronic inflammation or congenital abnormalities of the urinary system.

Primary ureter cancer originates in the ureter itself, while secondary ureter cancer results from cancer spreading from nearby organs such as the bladder, kidney, or colon. The distinction is important for determining an appropriate treatment approach.

• Blood in urine (haematuria) – may be visible or microscopic
• Changes in urine colour (pink, red, or cola-coloured)
• Increased frequency of urination
• Mild flank pain or discomfort
• Unexplained weight loss

• Severe flank or back pain on one side
• Persistent pain during urination
• Decreased urine output from the affected kidney
• Fatigue and weakness
• Loss of appetite
• Swelling in legs or feet
• Palpable mass in the abdomen

• Bone pain if cancer has spread
• Severe anaemia symptoms
• Persistent cough or breathing difficulties
• Jaundice if the liver is affected
• Severe kidney dysfunction signs

Chemotherapy can be used in treating ureter cancer, particularly for advanced stages or as adjuvant therapy after surgery. Treatment regimens may include a combination of gemcitabine and cisplatin. Patients who are unsuitable for cisplatin may receive carboplatin-based treatment. Neoadjuvant chemotherapy before surgery may help reduce tumour size.

Checkpoint inhibitors such as pembrolizumab and atezolizumab may be considered for advanced or metastatic ureter cancer. These medications aim to help the immune system recognise and attack cancer cells. Treatment duration and frequency can be determined by your healthcare professional based on individual response and tolerability.

For select low-grade tumours, medications can be instilled directly into the ureter or renal pelvis through a nephrostomy tube or ureteral catheter. BCG (Bacillus Calmette-Guérin) or mitomycin C may be used. Treatment schedules can be determined by your healthcare professional.

Laser ablation or fulguration through ureteroscopy can treat small, low-grade tumours while preserving kidney function. This approach requires close surveillance with regular monitoring. Suitable candidates may include those with solitary kidneys, bilateral disease, or those who are not suitable surgical candidates.

For tumours limited to the lower ureter, removing only the affected segment while preserving the kidney may be possible. The remaining healthy ureter is then reimplanted into the bladder. This procedure may be suitable for select patients with small, localised tumours.

This surgical treatment involves removing the entire kidney, ureter, and a small portion of the bladder where the ureter connects. This can be performed through open surgery, a laparoscopic approach, or a robotic-assisted technique.

Regional lymph node removal may be performed during nephroureterectomy to accurately stage the cancer and remove potentially affected nodes. The extent of dissection depends on tumour location and preoperative imaging findings.