An Update on Low-Grade Upper Tract Urothelial Carcinoma

Sam Chang | August 04, 2020

Upper tract urothelial carcinomas (UTUCs) are a heterogeneous group of malignancies arising from the urothelium at the level of the renal pelvis or ureter. They comprise 5% to 10% of all urothelial carcinomas and are diagnosed in approximately two per 100,000 persons in the United States annually, the majority of whom are adults older than 70 years.1-3  A significant percentage of UTUCs are low-grade; these primarily papillary tumors are substantially less aggressive than high-grade UTUCs and demonstrate a low rate of cancer-specific mortality, but hematuria and urinary obstruction are common and require management.4-6

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Sam S. Chang, MD, MBA, Patricia and Rodes Hart Endowed Professor of Urologic Surgery and Oncology, is the Oncology Fellowship Director and Vice-Chair of Urologic Surgery at Vanderbilt University Medical Center. His clinical practice focuses on urologic oncology and he has led numerous guideline panels in prostate, bladder and kidney cancer and formerly chaired the American Joint Committee on Cancer GU Staging Task Force. Author of more than 275 articles and recipient of multiple awards such as the SUO’s first-ever Distinguished Service Award, a CaPCURE Prostate Cancer Young Investigator Award, multiple Journal of Urology Best Reviewer, and the AUA Gold Cystoscope Award, he currently serves as Assistant Secretary of the AUA.

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Written by Christopher J.D. Wallis, MD, PhD and Zachary Klaassen, MD, MSc
May 20, 2020
While radical nephroureterectomy remains the gold standard treatment for patients with UTUC, this approach may not be suitable for some patients and for some tumors. More recently, the topical treatment of patients with UTUC advanced with the FDA approval of mitomycin (JELMYTO™). Results from the OLYMPUS Phase III study represent the first agent specifically approved for

 

Written by Zachary Klaassen, MD, MSc and Christopher J.D. Wallis, MD, PhD
May 1, 2020
Over the last several months, the diagnosis, treatment, and surveillance of genitourinary malignancies has been transformed by the global COVID-19 pandemic. The heavy demand for resources, exacerbated by limited excess health system capacity, means that health care systems have become quickly overwhelmed and hospitals have become sources for virus transmission. 
Written by Christopher J.D. Wallis, MD, PhD and Zachary Klaassen, MD, MSc
April 15, 2020

Upper tract urothelial carcinoma, which may affect the renal pelvis or ureter, is a relatively rare disease, accounting for less than 10% of all urothelial carcinomas. In parallel to how we view urothelial carcinoma of the bladder, the risk of recurrence and progression from upper tract urothelial carcinoma depends on tumor grade and stage. 

Written by Zachary Klaassen, MD, MSc and Christopher J.D. Wallis, MD, PhD
December 10, 2019
The urothelium lines the urinary tract from the renal pelvis to urethra. While cancers may arise anywhere along the urothelium, the vast majority (90-95%) occur in the lower urinary tract (bladder and urethra) while the remainder (5-10%) occur in the upper tract (ureter and renal pelvis)1.
Written by Zachary Klaassen, MD, MSc
April 15, 2019
Upper tract urothelial carcinoma, comprising either the renal pelvis or ureter, is rarer than urothelial carcinoma of the bladder accounting for only 5-10% of all urothelial carcinomas. However, similar to bladder urothelial carcinoma,
Written by Christopher J.D. Wallis, MD, PhD
January 29, 2019
Upper tract urothelial carcinoma (UTUC) comprises any malignancies arising from the urothelium between the level of the renal pelvis and the distal ureter. Owing to their relatively rarity, there is generally little data to guide the management of patients with these tumors and much of practice is extrapolated from the management of urothelial cancer of the bladder.
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Evidence based monographs by experts to define and guide clinical practice
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine
Arsenic exposure is associated with a higher risk of developing urothelial carcinoma (UC). Previous studies mostly focused on UC of the bladder.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Upper tract urothelial (UTUC) is an uncommon malignancy. Defining the impact of adjuvant chemotherapy on long term outcomes in UTUC patients is a critical clinical question. Recently, Birtle et al. reported
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Defining the prognosis of patients who develop intravesical recurrence (IVR) after radical nephroureterectomy (RNU) is critical for the optimal management of these patients.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Intravesical recurrence (IVR) rates remain high in urothelial carcinoma of the upper urinary tract (UTUC) patients following radical nephroureterectomy
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Lynch syndrome (LS), caused by a mutation in the mismatch repair (MMR) genes (MLH1, MSH2, MSH6, PMS2). LS increases the individual’s risk of getting upper urinary tract urothelial carcinoma (UTUC).
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Although urothelial carcinomas of the bladder and upper tract urothelial carcinoma (UTUC) can have similar histology, they significantly differ in prevalence and risk factors.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Upper tract urothelial carcinoma (UTUC) is a distinct clinical entity with poor clinical outcomes.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Lynch Syndrome (LS) is a common hereditary cancer syndrome that is characterized by mutations in the mismatch repair (MMR) genes.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Circulating tumor cells (CTCs) are cancer cells shed from the tumor that enter the circulation.
Written by Bishoy M. Faltas, MD
Englander Institute for Precision Medicine, Weill Cornell Medicine
Upper tract urothelial carcinoma is less common than bladder urothelial carcinoma. The biological characteristics of this form of the disease is not completely understood.
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Recent data from conferences worldwide
Presented by Chana Weinstock, MD
Washington, DC (UroToday.com) The expert panel of providers and FDA discussed ongoing and future collaborations with the FDA and bladder cancer. The FDA Oncology Center of Excellence (OCE) leverages the combined skills of regulatory scientists and reviewers. The panel reviewed the structure of the OCE and how expedited programs within the FDA strive to accelerate drug development and approval.
Presented by Seth Lerner, MD, FACS
Chicago, IL (UroToday.com) Low grade upper tract urothelial carcinoma (LG UTUC) can be managed with endoscopic resection/ablation however, the associated high recurrence rate requires repetitive intervention and intercavitary therapy for the frequently recurrent and multifocal disease.
Presented by Srikala (Kala) Sridhar, MD, MSc, FRCPC
Barcelona, Spain (UroToday.com)  Dr. Kala Sridhar, a medical oncologist from the University of Toronto, provided a summary of the current status of chemotherapy for upper tract urothelial carcinoma (UTUC).  UTUC accounts for 5-10% of urothelial malignancies, of which 60% are invasive at disease presentation. Radical nephroureterectomy remains the standard of care for localized and invasive disease.
Presented by Juan Palou, MD, PhD
Barcelona, Spain (UroToday.com) Upper tract urothelial carcinoma (UTUC) is a rare condition, making large clinical trials difficult to accrue for. More importantly, known concerns with the accuracy of pre-operative staging, and therefore, difficulties in accurately identifying high-risk patients...
Presented by Morgan Roupret, MD, Ph.D
Barcelona, Spain (UroToday.com) Upper tract urothelial carcinoma (UTUC) is a rare condition, making large clinical trials difficult to accrue for. More importantly, known concerns with the accuracy of pre-operative staging, and therefore, difficulties in accurately identifying high-risk patients make clinical trial accrual and accuracy difficult. As such, much of the data for UTUC is often extrapolated
Presented by Seth Paul Lerner, MD, FACS
San Francisco, CA (UroToday.com) -- UroGen Pharma Ltd., a clinical-stage biopharmaceutical company developing treatments to address unmet needs in the field of urology, with a focus on uro-oncology,  announced a new data presentation from an interim analysis of the ongoing pivotal Phase 3 OLYMPUS clinical trial of UGN-101 (MitoGel™),
Presented by Alison J. Birtle, MD, MRCP, FRCR
San Francisco, CA (UroToday.com) The management of patients with upper tract urothelial carcinoma (UTUC) is challenging due to the lack of high-level evidence, which results from the disease’s overall rarity. The standard of care for patients with high-grade disease or those suspected to have invasive disease is a radical nephroureterectomy,