scholarly journals Delays to Diagnosis and Management of Upper Tract Urothelial Carcinoma

2019 ◽  
Vol 2 (3) ◽  
pp. e5-e11
Author(s):  
William S Taylor
Keyword(s):  
Urothelial Carcinoma ◽  
Renal Cancer ◽  
Incidental Finding ◽  
Day Treatment ◽  
Waiting Times ◽  
Upper Tract Urothelial Carcinoma ◽  
Patient Journey ◽  
Upper Tract ◽  
Diagnosis And Management ◽  
Carcinoma Of The Bladder

Background and Objective Upper tract urothelial carcinoma (UTUC) is rare in comparison to urothelial carcinoma of the bladder or renal cell carcinoma. UTUC may present with loin pain, haematuria or alternatively can be identified as an incidental finding on imaging. There are often delays to diagnosis as haematuria clinics are efficient for bladder and renal cancer but less effective for UTUC. The diagnosis and treatment of UTUC is more challenging, as it often requires two operations and multiple MDT discussions. Diagnosis must be certain to avoid unnecessary radical surgery.   We found that our patients were experiencing significant delays to definitive surgery. Our patients currently follow the pathway for bladder and renal cancer, as there is no UTUC pathway at or trust or published in the literature.  We audited our diagnostic pathway to see how we could tailor the pathway to be more effective for patients with UTUC. This will ensure that more patients will meet the NHS 62-day targets.   Materials and Methods A retrospective review of patients management pathway from December 2008 to December 2018. Patients were identified by the pathological code for UTUC.   Results A total of 62 patients underwent nephroureterectomy during a 10-year period. 48 patients were analysed. The median waiting time for haematuria clinic from referral was 21days, a further 73 days to ureterorenoscopy and biopsy, and then 14 days to definitive nephroureterectomy. Only one patient met the NHS 62-day treatment target.   Our waiting times are comparable with other published international series. We have implemented a new UTUC pathway to streamline the diagnosis and management of UTUC. Some patients with UTUC will still have inevitable delays as diagnosis can be very challenging but this new pathway should improve the patient journey and reduce the waiting times significantly.

Comparison of upper tract urothelial carcinoma and urothelial carcinoma of the bladder to reveal key differences in mutational profile and load.

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 4522-4522 ◽  
Author(s):  
Sumanta K. Pal ◽  
Siraj Mahamed Ali ◽  
Julia Andrea Elvin ◽  
Garrett Michael Frampton ◽  
Jo-Anne Vergilio ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Carcinoma Of The Bladder

Diagnosis and Management of Upper Tract Urothelial Carcinoma

2015 ◽  
Vol 29 (2) ◽  
pp. 271-288 ◽  
Author(s):  
Ilaria Lucca ◽  
Jeffrey J. Leow ◽  
Shahrokh F. Shariat ◽  
Steven L. Chang
Keyword(s):  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Upper Tract ◽  
Diagnosis And Management

Robotic nephroureterectomy in a horseshoe kidney for upper tract urothelial carcinoma

2021 ◽  
Vol 14 (6) ◽  
pp. e234901
Author(s):  
Edward Ramez Latif ◽  
Issam Ahmed ◽  
Milan Thomas ◽  
Ben Eddy
Keyword(s):  
Urothelial Carcinoma ◽  
Gold Standard ◽  
Incidental Finding ◽  
Horseshoe Kidney ◽  
Upper Tract Urothelial Carcinoma ◽  
Management Options ◽  
Upper Tract ◽  
The Right ◽  
Endoscopic Assessment ◽  
Robotic Nephroureterectomy

Upper tract urothelial carcinoma represents a small proportion (5%–10%) of all urothelial cancers. Although there are several management options, in undifferentiated or high-risk cases, surgery in the form of nephroureterectomy is the gold standard. Horseshoe kidney is the most common congenital renal fusion anomaly affecting 1 in 400–600 patients. We present the case of a smoker in her mid-50s with an incidental finding of a papillary lesion in the right renal pelvis of her horseshoe kidney on CT scan. She went on to have endoscopic assessment confirming no other foci of disease. She was definitively managed with a robotic nephroureterectomy.

scholarly journals UGN-101 (mitomycin gel): a novel treatment for low-grade upper tract urothelial carcinoma

2020 ◽  
Vol 12 ◽  
pp. 175883592093795
Author(s):  
Andrea Kokorovic ◽  
Surena F. Matin
Keyword(s):  
Urothelial Carcinoma ◽  
Mitomycin C ◽  
Unmet Need ◽  
Invasive Disease ◽  
Upper Tract Urothelial Carcinoma ◽  
Phase Iii ◽  
Low Grade ◽  
Upper Tract ◽  
Carcinoma Of The Bladder ◽  
Rare Malignancy

Upper tract urothelial carcinoma (UTUC) is a rare malignancy. The standard treatment for localized high-risk disease is radical nephroureterectomy, which confers significant morbidity and is not appropriate for all patients. Patients harboring low-risk, non-invasive disease may be candidates for organ-sparing treatment, which includes endoscopic resection with or without intracavitary drug therapy. Successful administration of intracavitary chemotherapy to the upper tracts is impeded by rapid washout of the agent and short dwell times. This has limited the clinical utility of mitomycin C for treatment of upper tract tumors, despite the successful outcomes observed in low-grade urothelial carcinoma of the bladder. Currently, there is an unmet need for development of a technically feasible and oncologically sound intracavitary therapy for management of low-grade UTUC. UGN-101 (Jelmyto™) is a novel formulation of mitomycin C that uses a unique hydrogel designed to increase urinary dwell time, and thereby efficacy of treatment. Preclinical data demonstrated promising results regarding the safety and feasibility of this agent. Preliminary results of a phase III trial (OLYMPUS study) [ClinicalTrials.gov identifier: NCT02793128] demonstrated the efficacy of UGN-101 as a successful chemo-ablative agent for low-grade upper tract tumors. UGN-101 may represent a pivotal paradigm shift in the treatment of low-grade UTUC. Indeed, the drug has recently been granted approval by the US Food and Drug Administration as the first treatment for low-grade UTUC, which may lead to significant improvements in patient care and a long-awaited decrease in the burden of disease.

scholarly journals Comparison of Genomic Characterization in Upper Tract Urothelial Carcinoma and Urothelial Carcinoma of the Bladder

2021 ◽  
Author(s):  
Kaiwei Yang ◽  
Wei Yu ◽  
Huanhuan Liu ◽  
Feng Ding ◽  
Yanrui Zhang ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Biological Diversity ◽  
Upper Tract Urothelial Carcinoma ◽  
Driver Gene ◽  
Driver Genes ◽  
Upper Tract ◽  
Significant Difference ◽  
Genomic Characterization ◽  
Carcinoma Of The Bladder ◽  
Subclonal Mutation

Abstract Background: Different genomic characterization in urothelial carcinoma (UC) by site of origin, may imply contrasting therapeutic opportunities and pathogenetic mechanisms. The aim of this study was to investigate whether the differences between upper tract urothelial carcinoma (UTUC) and urothelial carcinoma of the bladder (UCB) result from intrinsic biological diversity.Methods: We prospectively sequenced 118 tumors and matched blood DNA from Chinese UC patients using next-generation sequencing (NGS) techniques, including 45 UTUC and 73 UCB.Results: There were marked disparities in the mutational landscape for UC according to race and site of origin. Signature 22 for exposure to aristolochic acid (AA) and signature 10 for defects in polymerase POLE were only observed in the UTUC cohort. Conversely, signature 6 for defective DNA mismatch repair only existed in the UCB cohort. Compared to UCB, UTUC had higher clonal (p<0.001) and subclonal mutation numbers (p=0.015). TP53, PIK3CA, and FGFR3 mutations may be the driver genes for UTUC, whereas for UCB, the driver gene may be BRCA1. UTUC patients had lower PD-L1 than UCB patients. There was no significant difference in the number of DDR mutations, copy number variation (CNV) counts, tumor mutational burden (TMB) or clinical actionability between UTUC and UCB.Conclusions: UTUC and UCB exhibit significant differences in the prevalence of common genomic landscape and carcinogenesis. Consequently, molecular subtypes differ according to location, and these results may have important implications for the site-specific management of patients with urothelial carcinoma. Mutational signature may be used as a screening tool to assist clinical differential diagnosis between UTUC and UCB.

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