Surgery is usually the main treatment for cancer that has not spread to distant parts of the body.

About surgery for ureter and renal pelvis cancer

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.

Laparoscopy

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.

 

Types of surgery

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)

This is usually only done if the cancer is in the lower third of the ureter. The surgeon removes the part of the ureter where the tumour is. They also remove a healthy area (margin) of ureter above the tumour and all the ureter below the tumour. Then they reattach the remaining ureter to the bladder.

Endoscopic surgery

It is sometimes possible to remove a low-grade, early-stage tumour in the renal pelvis using endoscopy. The surgeon passes a flexible tube called an endoscope up through the urethra, bladder and ureter to the renal pelvis. This is called a ureteroscopy. The surgeon then removes the tumour using tools passed through the endoscope.

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

Occasionally, if the cancer is low-grade and only growing on the lining of the ureter, it may be removed by laser or heat treatment (diathermy). A ureteroscope is passed up into the bladder and on into the ureter. A beam of laser or heat is then applied to the tumour to destroy it.

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.

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