What is the first treatment for upper tract urothelial cancer?

This cancer begins in the lining of the renal pelvis or ureter. The care team considers whether it appears low risk or high risk, where it is located, whether it has invaded nearby tissue, and how well each kidney works. Kidney removal surgery may include the kidney, ureter and a small area where the ureter enters the bladder. For selected people, chemotherapy before surgery can be discussed, particularly when kidney function may change after an operation. Chemotherapy after surgery may be considered when the pathology shows features that make additional treatment useful.

Ask how the tumour was assessed and whether the proposed operation is partial or complete removal of the affected urinary tract. Kidney function testing helps the team judge whether chemotherapy is suitable before or after surgery. Discuss the effect on the remaining kidney, urinary changes, recovery time and follow-up examinations. Tell the team about medicines, previous chemotherapy and any history of kidney disease before a treatment decision is made.

Seek urgent medical advice for inability to pass urine, severe flank pain, heavy blood in the urine with clots, fever with urinary symptoms, or sudden weakness. After surgery, worsening wound redness, persistent vomiting, reduced urine output or breathlessness also needs prompt assessment. During chemotherapy, report fever or signs of infection immediately because treatment can affect blood counts.

What is the tumour risk and exact location? Should kidney removal surgery come first? Could chemotherapy be given before or after surgery? How will the remaining kidney be protected? Which urinary or wound symptoms require urgent help?