Thank you for visiting UroToday’s Center of Excellence on upper tract urothelial carcinoma (UTUC). We examine expert content in a variety of formats to help practicing clinicians stay up to date. This letter highlights some of the most exciting recent findings from clinical trials, observational studies, and molecular and genomic research.

Low-grade upper tract urothelial carcinoma (UTUC) comprises a substantial percentage of UTUCs. While mortality risk is low, diagnostic choices, therapeutic care, and continued management of these carcinomas are complex decisions. Low-grade UTUC can cause hematuria and urinary obstruction, and tumors tend to recur.  Periodic radiographic imaging is required as well as ureteroscopic interventions not only to treat disease, but also to monitor for recurrence.

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

As the entire world continues to battle the COVID-19 virus, current research endeavors in so many different areas have inevitably slowed but fortunately, progress in pushing forward completed research provides hope for patients. This quote from the FDA website reinforces this commitment:

Throughout 2019, we have continued to see progress in the diagnosis, risk assessment and genetic profiling, and possible treatment of upper tract urothelial carcinoma (UTUC). I would like to highlight some of the most exciting findings reported so far this year.

Targetable mutations in UTUC: At the Fred Hutchinson Cancer Research Center and the University of Washington, Dr. Brian R. Winters, Dr. Andrew
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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