When is chemotherapy recommended for upper tract urothelial cancer?

Upper tract urothelial cancer starts in the lining of the renal pelvis or ureter. Treatment planning considers scans, tissue findings, whether the tumour has invaded the surrounding wall, and whether it has spread. Chemotherapy before surgery can treat cancer cells beyond the visible tumour and may be considered when the cancer is at meaningful risk of returning. After surgery, it may be offered when the pathology shows features that raise concern for recurrence. If surgery is not suitable or the disease has spread, drug treatment can be used to control cancer and ease problems caused by it.

Kidney function matters because some chemotherapy medicines leave the body through the kidneys. Removing a kidney and ureter can also change kidney function, so the treatment team may discuss timing before surgery or select another approach afterward. The exact drugs, schedule and combination are individual decisions.

Ask the urologist and medical oncologist to review the biopsy or surgical pathology, imaging, kidney blood tests and treatment goal together. Bring a list of medicines and supplements, and mention hearing problems, nerve symptoms, previous chemotherapy or other health conditions. Discuss whether chemotherapy is intended before surgery, after surgery, or to control advanced disease; how it will be given; and how side effects will be monitored.

Contact the cancer team promptly for fever, chills, new breathlessness, uncontrolled vomiting, inability to drink, reduced urine, or bleeding that does not settle. Seek urgent help for severe weakness, confusion, chest pain or difficulty breathing. These symptoms can have causes other than treatment, but prompt assessment is needed during chemotherapy.

What feature of my cancer makes chemotherapy appropriate? Is treatment planned before or after surgery? How will kidney function affect the choice? What symptoms should I report between doses?