European Association of Urology 2013: Urothelial Carcinomas of the Upper Urinary Tract

open access

 INTRODUCTION
The last European Association of Urology (EAU) guidelines on upper urinary tract tumours known as upper tract urothelial carcinomas (UTUCs) were published in 2011 (1). The EAU Guidelines Working Panel for UTUCs has prepared the current guidelines to provide evidence-based information for the clinical management of these rare tumours and to help clinicians incorporate these recommendations into their practice. The current update is based on a structured literature search........

"The natural history of UTUCs differs from that of bladder cancer: 60% of UTUCs are invasive at diagnosis compared with only 15-25% of bladder tumours (13,14). UTUCs have a peak incidence in people in
their 70s and 80s, and they are three times more prevalent in men than in women (15,16). There are familial/hereditary cases of UTUCs linked to hereditary non-polyposis colorectal carcinoma
(HNPCC (Lynch Syndrome)) (17).
Among patients with UTUCs, HNPCC cases can be screened during a medical interview
(18). There is a suspicion of hereditary UTUC if the patient is < 60 years of age, has a personal history of an HNPCC-associated cancer, a first-degree relative aged < 50 years with HNPCC-associated cancer, or two
first-degree relatives with HNPCC-associated cancer (18). These patients should undergo DNA sequencing to identify hereditary cancers that have been misclassified as sporadic cancers by insufficient clinical data (19). The presence of other HNPCC-associated cancers should also be evaluated. These patients should be closely monitored, and genetic counselling is advocated (17,19)."

"Computed tomography urography can also detect wall thickening of the renal pelvis or ureter, which is a sign of UTUC, even when there is no luminal mass effect, but flat lesions are not detectable unless they
exert a mass effect or cause urothelial thickening (54). The secondary sign of hydronephrosis on imaging in the presence of UTUC is associated with advanced pathological disease and poorer oncological outcomes (51,55)."