From the Desk of the Editor: A New Resource for Upper Tract Urothelial Carcinoma

Sam Chang | April 15, 2019

Upper tract urothelial carcinoma is a heterogeneous disease that can be challenging to diagnose, treat, and survey. Its relative rarity has hampered its study in large prospective trials, and therapy has been guided primarily by retrospective data or by trials of urothelial bladder cancer, which we now know to be genetically and molecularly distinct.1-4 The location of upper tract urothelial carcinoma has made it difficult to collect high-quality biopsy specimens. Moreover, it is an insidious disease—the least obvious tumors can be the most dangerous, and those that appear obvious can be the most benign. For all these reasons, patients often are overtreated or undertreated, undermining quality of life and disease-free survival.

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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.

Library Resources
Evidence based monographs by experts to define and guide clinical practice
Written by Zachary Klaassen, MD, MSc
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
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.
Conference Coverage
Recent data from conferences worldwide
Barcelona, Spain (UroToday.com) Dr. Axel Merseburger presented the preliminary results of the Safety of Atezolizumab in locally advanced or metastatic UrotheliaL and non-urothelial carcinoma of the urinary tract (SAUL) study at the EAU 2019 Breaking News Session.
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.
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. 
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 from the bladder cancer urothelial carcinoma literature.
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, 
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