What is upper urinary tract urothelial cancer (UTUC)?

Upper urinary tract urothelial cancer (UTUC) is cancer that starts in the upper urinary tract. This is made up of the ureters and an area of the kidneys called the renal pelvis.

UTUC is uncommon. Usually, only one ureter or renal pelvis is affected.

UTUC is sometimes called transitional cell carcinoma (TCC). This is because around 9 in 10 cancers of the ureter or renal pelvis (90%) start in cells called transitional cells. Transitional cells line the renal pelvis, ureters, bladder and urethra.

This information is about cancer that starts in the ureter or renal pelvis. We have separate information about kidney cancer (renal cell cancer) and bladder cancer.

See also

Symptoms of upper urinary tract urothelial cancer (UTUC)

Some people do not have symptoms but are diagnosed when having a test or scan for another reason.

The most common symptoms of UTUC are:

  • blood in the urine (haematuria)
  • pain in one side of the lower back.

Sometimes the ureter becomes blocked, either by cancer cells or by a blood clot. This causes urine to stay in the kidney and ureter. This is called hydronephrosis. If this happens, symptoms such as back pain may develop more quickly and be more severe.

See also:

Causes and risk factors of upper urinary tract urothelial cancer (UTUC)

There are certain things that can affect the chances of developing UTUC. These are called risk factors.

Having a risk factor does not mean you will definitely get UTUC. And if you do not have any risk factors, you may still develop cancer.

Diagnosis of upper urinary tract urothelial cancer (UTUC)

If you have symptoms, you usually start by seeing your GP. They will examine you and arrange for you to have some tests. They may test your pee (urine). They may also do blood tests to check:

  • your general health
  • the number of cells in your blood (full blood count)
  • how well your kidneys and liver are working.

If your GP is not sure what the problem is, or they think your symptoms could be caused by cancer, they will usually refer you to the hospital to see a specialist doctor. This doctor is called a urologist.

If you have blood in your urine, you may be referred to a specialist clinic. This is called a haematuria clinic. Usually, these clinics can do tests on the same day.

At the hospital

The urologist or a specialist nurse will ask you about your symptoms and your general health. They will also examine you and arrange some of the following tests:

  • Blood tests

    Blood tests help your doctors check how well your kidneys and liver are working. They also show the number of blood cells in your blood. This is called a full blood count.

  • Urinary cytology

    During a urinary cytology, a sample of your urine is checked for cancer cells.

  • CT scan

    A CT scan takes a series of x-rays which create a three-dimensional (3D) picture of the inside of the body.

  • CT urogram

    A CT urogram is a type of CT scan to look at the kidneys, ureters and bladder.

  • Flexible cystoscopy

    A flexible cystoscopy is a test that looks for changes in the bladder.

  • Cystoscopy and ureteroscopy

    Cystoscopy and ureteroscopy are tests that let the doctor look inside the bladder, ureter and renal pelvis.

  • MRI scan

    An MRI scan uses magnetism to build up a detailed picture of areas of your body.

Waiting for test results can be a difficult time. We have more information that can help.

Staging and grading of upper urinary tract urothelial cancer (UTUC)

Your cancer doctor needs certain information about the stage and the grade of the cancer to advise you on the best treatment for you.

The stage of the cancer describes its size and whether it has spread. The grade of the cancer gives an idea of how quickly the cancer might grow and spread.

Staging and grading information comes from the tests you have had.

Treatment for upper urinary tract urothelial cancer (UTUC)

A team of specialists will discuss your treatment options. This is called a multidisciplinary team (MDT).

Treatment depends on a number of factors, including the position, type, stage and grade of the cancer. Your doctors will also consider:

  • how well your kidneys work
  • your general health
  • your personal preferences.

Your cancer doctor will explain the different treatments and their side effects. They will also talk to you about the things you should consider when making treatment decisions.

You may also have some treatments as part of a clinical trial.

  • Surgery

    Surgery aims to remove the area affected by cancer. It is usually the main treatment for UTUC that has not spread to distant parts of the body. After surgery, you may be offered other treatments to try and get rid of any remaining cancer cells. This may reduce the chance of the cancer coming back. This is called adjuvant treatment.

  • Chemotherapy

    Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy to reduce the risk of cancer coming back after surgery. Or you may have it as the main treatment for cancer that has spread to other parts of the body.

  • Immunotherapy

    Immunotherapy drugs encourage the body’s immune system to fight cancer cells. You may have a type of immunotherapy called BCG after surgery to reduce the risk of cancer coming back. If the cancer has spread to other parts of the body, you may have immunotherapy drugs called checkpoint inhibitors.

  • Targeted therapy

    Targeted therapy drugs affect the way that cancer cells grow. These are sometimes used after chemotherapy and immunotherapy to treat cancer that has spread to other parts of the body. Your cancer doctor or specialist nurse will tell you if they think a targeted therapy drug is suitable for you. Some drugs are not available on the NHS. But there may be ways you can still have them. Your doctor can discuss this with you.

After treatment for upper urinary tract urothelial cancer (UTUC)


After your treatment has finished, you will have regular check-ups with your cancer doctor to monitor how you are recovering after treatment. These will usually include a physical examination. They may also involve taking some urine (pee) or blood samples.

You may have regular checks with a CT urogram, or a regular ureteroscopy. You may also have a cystoscopy to detect any changes in the bladder. This is because people with cancer of the ureter or renal pelvis have an increased risk of Bladder cancer after a few years.

If the cancer is advanced, you may continue having treatment while it is working for you. You may have regular CT scans to see how the cancer is responding.

You can talk to your cancer doctor or specialist nurse about any problems or worries you have at these check-ups. If you have any problems or notice any new symptoms between your appointments, tell your doctor as soon as possible.

You may feel anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation. You may want to join a local support group. Your nurse may be able to give you details.

Macmillan is also here to support you. If you would like to talk, you can:

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes to the way you live, such as eating well and keeping active, can improve your health and well-being and help your body recover.

About our information

  • References
    Below is a sample of the sources used in our upper urinary tract urothelial cancer (UTUC) information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
    European Association of Urology. Upper urinary tract urothelial carcinoma guidelines. EAU Guidelines. Edn. presented at the EAU Annual Congress Copenhagen 2018. ISBN 978-94-92671-01-1. Available from www.uroweb.org/wp-content/uploads/Upper-Urinary-Tract-Urothelial-Carcinoma-large-text-V3.pdf (accessed April 2021).
    National Institute for Health and Care Excellence (NICE). Atezolizumab for untreated PD-L1-positive locally advanced or metastatic urothelial cancer when cisplatin is unsuitable. Technology appraisal guidance (TA492). Published 06 December 2017. Last updated 12 July 2018. Available from www.nice.org.uk/guidance/TA492  (accessed April 2021)
    Birtle A, et al. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial. The Lancet, 2020; 395, 10232, 1268-1277. Available from www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30415-3/fulltext (accessed June 2021).


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Lisa Pickering, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Date reviewed

Reviewed: 01 November 2021
Next review: 01 November 2024
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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