TUMORS OF THE UPPER UROTHELIUM

Forty-two cases of malignant tumors of renal pelvis were reviewed: 28 were transitional cell carcinomas; and 14 were squamous cell carcinomas.

The natural history and spread of the disease is discussed in detail. Transitional cell carcinomas spread primarily to the ureter (40 per cent), followed closely by the renal bed (33 per cent) and bladder (30 per cent). Squamous cell carcinomas spread primarily through the renal bed (60 per cent), followed by the draining lymph nodes (28 per cent). The spread to other regions (bones, splanchnic organs, chest ... etc.), occurred with relatively less frequency, but more in squamous than transitional cell carcinomas. Transitional cell carcinomas seem to have a longer natural history than squamous cell carcinomas. Recurrences in bladder and the remainder of the urothelium seem to be controlled for relatively long periods of time, while those in lymph nodes and renal bed seem to be rapidly fatal.

The results of treatment and factors influencing them are discussed. Patients suffering from transitional cell carcinomas faired better than those with squamous cell carcinomas at the 5 year mark (25 and 15 per cent, respectively), but the 10 year results are poor in both.

The role of radiotherapy in the treatment of these tumors and the influencing factors are also discussed in detail. The response of these tumors to radiotherapy seems to be akin to that of the lower urothelium (bladder), provided adequate dosage is delivered to the relevant volume at the proper moment in time.

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