Is there a difference in clinical behavior between urothelial carcinoma of the upper urinary tract and that of the lower urinary tract? What is the risk of developing tumors in the contralateral and lower urinary tracts in patients presenting initially with an upper urinary tract cancer? Conversely, what is the risk of developing an upper urinary tract tumor in patients who initially present with a lower urinary tract tumor?


Urothelial neoplasms involving the upper urinary tract are uncommon, accounting for about 5% of primary urothelial neoplasms. Unlike tumors involving the lower urinary tract (mostly urinary bladder), more than 50% of them are of high grade and high stage (pT2 or higher) and typically require radical surgery such as nephrectomy or ureterectomy with or without nephrectomy. The risk of developing carcinoma in the contralateral kidney is 1%–3%.The projected incidence of a tumor in the contralateral kidney rises progressively from 2.7% to 6.5% during a follow-up from 5 years to 15 years, respectively. The incidence of bladder carcinoma subsequent to an upper tract carcinoma ranges from 9% to 48%. Bladder cancer is also significantly more common among patients with bilateral upper tract cancer. This high risk is probably due to both spreading of the original cancer and field changes (new cancer). For patients presenting with bladder cancer, the risk for developing upper tract cancer is 1%–4%.


Bladder Cancer Bladder Tumor Renal Pelvis Transitional Cell Carcinoma Urothelial Carcinoma 
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