Surgery is usually the main treatment for ureter and renal pelvis cancer that has not spread to distant parts of the body.
Surgery may be open or keyhole (laparoscopic):
- Open surgery
In open surgery, the surgeon makes one large cut (incision).
- Keyhole (laparoscopic) surgery
In keyhole surgery, the surgeon makes 2 to 3 small cuts. They pass a laparoscope through one of the cuts. A laparoscope is a thin tube containing a light and camera. It sends video images to a monitor. Then the surgeon passes specially designed surgical tools through the other cuts to remove the cancer.
The surgeon may use a specialised machine to help with keyhole surgery. There are instruments attached to the machine, which the surgeon controls. This is called robot-assisted surgery. It makes it possible for the surgeon to do very precise surgery.
Recovery from keyhole surgery is usually quicker than recovery from open surgery, because the wound is smaller.
Some surgical techniques are very specialised and may only be available at some bigger cancer centres. Your surgeon will talk to you about which type of surgery is appropriate for you.
Removing the whole kidney and ureter (nephroureterectomy)
This is the most commonly used operation to treat cancer of the ureter or renal pelvis. The surgeon removes:
- the kidney
- a layer of fat around the kidney
- the ureter
- an area of tissue where the ureter enters the bladder (bladder cuff).
The surgeon may also remove some lymph nodes close to the kidney to check if they contain cancer cells.
Removing a kidney is a big operation, and it is not suitable for everyone. Your doctors may need to do tests to check you are fit enough to cope with the surgery. You can live a normal life with just one kidney. It will be able to do the work of both kidneys.
Removing part of the ureter (segmental resection)
Sometimes the surgeon will reach the kidney by making a small cut in your back (percutaneous renoscopy). They then pass the endoscope into the kidney to reach the renal pelvis.
Endoscopic surgery may sometimes be done for higher-grade cancers if you only have one kidney. Or it may be done if your kidneys do not work well enough for you to cope with just one.
Laser or heat (diathermy) treatment
Sometimes a tube (stent) may be left in the ureter temporarily to keep it open.
If you have laser or heat treatment, you will need to be very closely monitored afterwards. This is because there is a risk the cancer could grow back. If this happens, it is important the cancer is found as soon as possible.