What is the treatment for transitional cell cancer of the kidney (renal pelvis) or ureter?

• How your doctors decide your treatment
• Surgery
• How you have surgery
• Chemotherapy
• Radiotherapy
• Research
• Follow up

We have a separate question and answer about transitional cell cancers of the kidney and ureter which tells you about what they are, the possible causes, and tests you have to diagnose them. 

Your doctor considers many factors when deciding which treatment is most suitable for you including

• How far your cancer has grown or spread (stage)
• How fast growing your cancer is (grade)
• Your general health
• Your age and level of fitness

The earlier your cancer is found the easier it is to control and possibly cure it.

The most common treatment for transitional cell cancer of the kidney is surgery. Surgery for this type of cancer is usually a major operation and you need to be fit enough to make a good recovery.

Depending on the stage and grade of the cancer you may have chemotherapy after surgery, or rarely radiotherapy.

If your cancer is more advanced you may have chemotherapy or a combination of chemotherapy and radiotherapy.

Before you have treatment your doctor will arrange for you to have tests to check the stage of your cancer and your general health.

Whether your cancer is in your kidney or ureter, you will probably have surgery if your cancer hasn’t spread and you are fit enough. Most people have their kidney, ureter, and part of their bladder removed. This type of surgery is called a radical nephroureterectomy and gives the best chance of getting rid of the cancer completely. You may also have some of the nearby lymph nodes removed and some surrounding tissue.

Your surgeon may consider other types of surgery depending on whether your cancer is in the ureter or the kidney.

If your cancer is in the ureter it may be possible to remove part of the ureter. This is called a segmental ureterectomy. This type of surgery is only done if the tumour is small and is in the area of the ureter close to the bladder.

If you have only one kidney, your kidneys aren’t working fully, or you aren’t well enough for an operation, it may be possible to have laser treatment. This treatment is usually only for people who have early cancers which have a low risk of coming back. Doctors don’t use laser treatment very often because there is a high risk of the cancer coming back afterwards.

There are different ways to have surgery. You may have

• Open surgery
• Keyhole (laparoscopic) surgery
• Percutaneous endoscopic surgery

Open surgery

Open surgery means that you will have a wound either on your back and side or on your front, across the chest and abdomen. This type of surgery allows the surgeon to easily remove the kidney or ureter and some surrounding tissue.

Keyhole (laparoscopic) surgery

Keyhole or laparoscopic surgery is also called minimal access surgery. It means that you have surgery without needing to have a major wound (incision). The specialist surgeon uses an instrument called a laparoscope, which is a thin, flexible tube with a camera and light on the end. Instead of one large wound you have several small cuts about 1cm long made in your skin. The surgeon uses these to put the laparoscope and other instruments through to do the surgery. There is detailed information about the advantages and disadvantages of keyhole surgery in the types of surgery section in the kidney cancer section.

Percutaneous endoscopic surgery

For people who only have one kidney it may be possible for the surgeon to remove just the tumour using an endoscope. The surgeon makes a small cut in the skin at the side of the body. Then they use an ultrasound or CT scan to guide them and put the endoscope into the kidney to remove the tumour from the kidney or the top of the ureter. This type of operation is not done very often because there is a high risk of the cancer coming back.

If your surgeon finds that your cancer has spread into the surrounding tissue or the lymph nodes you may have chemotherapy after surgery. The chemotherapy reduces the risk of the cancer coming back.

Your doctor may also recommend chemotherapy if your cancer is advanced when you are diagnosed or if you cannot have surgery for other health reasons.

Chemotherapy treatment usually involves having a combination of drugs. The combinations include

• GC – gemcitabine and cisplatin
• GemCarbo – gemcitabine and carboplatin
• MVAC – methotrexate, vinblastine, doxorubicin and cisplatin

Rarely, doctors give treatment directly into the ureter. This is called regional chemotherapy. The drugs you have are BCG or the chemotherapy mitomycin. You either have this put through a tube that the doctor inserts through your urethra and into the ureter. Or through a tube put into the kidney (a nephrostomy tube). This treatment is only used for people who have one kidney, or whose kidneys aren’t working very well, or for people who can’t have an operation.

You can find more information about the side effects of these combinations by using the highlighted drug name links above to go to the cancer drugs section.

Radiotherapy is not often used for TCC of the kidney or ureter. You may have radiotherapy to the area of the kidney or ureter if you are not fit enough to have an operation or your cancer has spread into surrounding tissue (locally advanced TCC).

Sometimes doctors recommend radiotherapy after surgery, to reduce the risk of the cancer coming back.

Researchers are looking into new treatments for transitional cell cancers. The SUCCINCT trial is looking at combining sunitinib (Sutent) with GC chemotherapy for transitional cell cancer of the lining of the kidney or the ureter. Sunitinib is a type of biological therapy. It helps to stop cells from growing. The trial is for people whose cancer has grown into the surrounding tissue (locally advanced) or has spread to another part of their body. It aims to find out whether adding Sutent to GC chemotherapy works better than GC chemotherapy alone and to find out which side effects it causes. You can find information about the trial on the clinical trials database in the trials and research section of CancerHelp UK.

After you have finished your treatment you will be followed up closely. In the first year you usually have appointments every 3 months. In the second and third year you have appointments every 6 months. And after that you have them yearly.

As part of your follow up you will have regular cystoscopies. This is to check for cancer in your bladder. This is because transitional cell cancers come back in the bladder in about 1 in 5 people (20%).

Your doctor will tell you exactly how they will keep a check on you.