The renal pelvis and ureters form the upper urinary tract and are part of the urinary excretory system. The renal pelvis is the hollow part in the middle of each kidney, also called the renal pool. The ureters are thin tubes that connect the kidneys to the bladder. Each ureter is approximately 25 to 30 cm long. Urine is your body's fluid waste and is made by the kidneys. It collects in the renal pelvis and travels through the ureters to the bladder, where it is stored. When the bladder is sufficiently filled with urine, it is excreted out of the body through the urethra.
Both renal pelvis and the wall of the ureters consist of three separate layers
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Mucosa: Urothelium (cells lining the pelvis, ureter and bladder) can be considered as the inner lining of both renal pelvises, ureters, bladder and urethra. These urothelial cells, which can stretch and change shape during urine flow, are also called transitional epithelium.
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Lamina propria: Under the urothelium of both renal pelvis and ureters is a thin connective tissue layer containing blood vessels, nerves and some glands. -
Muscularis propria : thick outer muscle layer of both renal pelvis and ureter. It consists of involuntary auto-working muscle (smooth muscle). It is responsible for pushing urine from the kidney to the bladder.
Other tissues surrounding the kidneys and ureters are:
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Adventitia layer: Loose connective tissue lining the kidneys and ureters
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Fat layer: A layer of fat surrounding the renal pelvis, kidney, and ureter
What is Pelvis and Ureteral Cancer?
Cancer of the renal pelvis and ureter, or in other words, cancers of the upper urinary tract; These are malignant, malignant cancers that start in the cells of the renal pelvis (the kidney's pool) and/or the ureter (a tubes connecting the kidney to the bladder). These cancers can spread to all layers in the pelvis and ureter, to neighboring tissues and to other distant parts and organs of the body. is Renal pelvis and ureter cancers are seen 3-4 times more frequently in men than in women, with an average age of 65 years.
Renal pelvis, Urothelial Cancers of the Ureters
The renal pelvis, ureter, bladder and urethra (urinary tract) are covered with cells of the same type called transitional epithelium, and cancers of these regions are collectively called urothelial cancers or transitional epithelial cancers. The urothelium cells covering these areas begin to proliferate, grow and become cancerous for a number of reasons, and if not noticed, they continue to spread. According to the place of residence; If it is in the bladder, it is called bladder cancer (most often), if it is located in the ureters, it is called ureter cancer, and if it is in the renal pelvis, it is called renal pelvis cancer. 90% of the cancers of these regions are such cancers, and the remaining 10% are squamous cancers and adeno cancers that originate from the same cells and undergo metamorphosis. Although cancer of the renal pelvis and ureter is most commonly seen in the renal pelvis, it can occur in the ureters at the same time, in several areas, or in the ureters only.
About 20% to 40% of patients with urothelial carcinoma of the pelvis and/or ureters also develop bladder cancer, originating from the same cells, simultaneously or in different time periods. Therefore, patients diagnosed with cancer of the pelvis and/or ureter should be checked for cancer of the bladder and other parts of the urinary tract. Conversely, in patients with bladder cancer, there is a possibility that this type of cancer in the pelvis and ureter (cancer of the upper urinary tract) may accompany or occur at different times, and this rate is 4%.
Pelvis and/or ureteral cancers (as in bladder cancer) are divided into two groups as superficial (non-invasive) or disseminated (invasive) depending on how much they grow on the walls of these structures.
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Superficial (Non-invasive) urothelial carcinoma: Superficial urothelial carcinoma means that the cancer is confined to the inner lining of the pelvis and/or ureter only. Become papillary, ie cauliflower-shaped or flat (without stem)
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Papillary superficial urothelial carcinomas tend to grow into small, finger-like projections and into the internal cavity of the pelvis and/or ureter . These superficial papillary urothelial cancers may be low or high grade. However, small papillary cancers generally tend to be low grade. These tumors are called low malignant potential papillary urothelial neoplasms (PUNLMP). Some low-grade tumors also have a small chance of turning into an invasive-spreading cancer.
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Flat-flat superficial urothelial carcinomas are tumors that grow along the lining of the pelvis and/or ureter. They are usually of high grade and are more likely to descend deeper into the layers of the pelvis and/or ureteral wall. This type of flat urothelial carcinoma more commonly includes carcinoma in situ (CIS) and has a high potential to spread.
Invasive-Invasive urothelial carcinoma: Invasive urothelial carcinomas have grown into the deeper layers of the renal pelvis and/or ureteral wall. It may have protruded from the wall beyond the pelvis and/or ureter and grown into adjacent areas.
Sometimes disseminated-invasive urothelial carcinomas contain groups of cells of different character, differentiated or differentiated from the usual urothelial cancer cells and from these cells. which, in this case, the prognosis of this type of cancer is worse.It has different cell types mixed in. These different cell groups include squamous cells, secretory gland cells, and small cells.
There are rare subtypes of urothelial carcinoma called variant type. These subtypes usually grow and spread rapidly and tend to have a worse course than normal urothelial carcinoma.
Variant type renal pelvis and ureteral cancers include:
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Nested(introverted layer-by-layer)
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Microcystic
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Micropapillary
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Lymphoepithelioma-like
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Plasmacytoid
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Sarcomatoid
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Giant cell
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Poorly differentiated (poorly differentiated)
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Rich in oil
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Transparent cell
Rare cancers of the renal pelvis and ureter
Squamous cell carcinoma: Squamous cell carcinoma of the pelvis and/or ureter arises from smooth-squamous cells in the inner lining of the renal pelvis and ureter. It is usually associated with long-term (chronic) irritation or inflammation of the pelvis and ureter. This irritation is due to urinary stones or chronic urinary tract infections. Squamous cell carcinoma usually has a high potential for dissemination and usually has already spread when diagnosed and is treated with surgery and/or chemotherapy.
Adenocarcinoma: Adenocarcinoma It originates from glandular cells in the pelvis and ureter, or more often, it occurs when adenocarcinomas in other organs of the body metastasize to the pelvis and ureter, as a secondary cancer. Therefore, for a correct diagnosis, it is necessary to know where adenocarcinoma starts. There are many subtypes including mucinous, signet ring and clear cell. Their course is quite poor and is treated with surgery and chemotherapy. The probability of recurrence is high.
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What Causes Kidney Pelvic and Ureteral Cancers and What Are the Risk Factors?
A risk factor is a substance or condition that increases the likelihood of developing cancer. We cannot say that people with these factors will develop cancer. Although these risk factors play a leading role in the onset of cancer, the exact cause of this and other body cancers is unknown. Cancer of the pelvis and ureter can develop even in those who do not have any risk factors. But most cancers occur as a result of many risk factors. Even if coffee and alcohol are not a risk factor for pelvic and ureter cancers, alcohol consumption in particular has a general risk for this and other cancers in the body. It is considered as the k factor.
Definite known risk factors for pelvic and ureteral cancers include: There is evidence that the following factors increase the risk of cancer of the pelvis and ureter.
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Smoking
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Aristolochic acids
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Balkan endemic nephropathy
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Chronic kidney stones and/or infections
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Use of painkiller called phenacetin
Probable risk factors for pelvic and ureteral cancers include: The following risk factors are normally known risk factors for bladder cancer. Since these are similar cancers, it is thought that these risk factors may also increase the risk of cancer of the renal pelvis and ureter. Therefore, it is considered as a possible risk factor.
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Arsenic
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Occupational exposures
Smoking: Renal pelvis and It is a definite risk factor for ureteral cancer, the risk increases as the duration of smoking and the number of cigarettes increase.
Aristolochic acids: Aristolochic acids occur naturally in various plant species. This substance is used in traditional Chinese medicine as pain reliever and anti-inflammatory for joint pain, and kidney damage and cancer of the pelvis and ureter are more common in those who use this herbal product.
Balkan endemic nephropathy : Balkan endemic nephropathy is a kidney disease that is prevalent especially in the Balkan countries (Serbia, Bulgaria, Romania, Macedonia and Bosnia-Herzegovina) and mostly in rural areas of these countries. Kidney damage and cancer of the pelvis and ureter are observed more frequently in patients with this disease. In the studies conducted in this region, it has been determined that the seeds of plants containing Aristolochic acid are dense and those who live in these regions, especially in rural areas, consume the plants containing this substance. On the other hand, there is still an opinion that Balkan nephropathy is a genetic, familial disease.
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