Which of the following diagnostic tests is used to examine the renal pelvis and ureters?

What you and your doctor choose depends on many issues, such as:

• tumor grade (how aggressive the tumor is)
• tumor size, location and extent
• your age
• medical history
• overall health
• kidney collecting system anatomy

Options include:

• surgery
• chemotherapy
• radiation

Surgery

Removal of Kidney and Ureter

The majority of upper urinary tract cancers are treated with nephroureterectomy (surgery to remove the kidney and an entire ureter). The "radical" form involves removing nearby lymph nodes and tissue as well. Since you will only have 1 kidney, your doctor will closely watch your overall kidney function. You would not need dialysis unless you already have serious kidney problems.

The type of surgery you are offered will depend on surgeon preference, tumor size, tumor location and tumor aggressivenes. Options include:

• traditional: a 10-inch cut into the abdomen is made to remove the tumor(s)
• laparoscopy: tube-like instruments are inserted into the abdomen through small "key-hole" cuts.

Kidney Sparing Surgery

In kidney sparing surgery your doctor will try to keep the remaining kidney and ureter on the side with the tumor. This is an option if you already:

• lost a kidney to cancer
• lost a kidney because of stones, infection or trauma
• have kidney problems because of diabetes, high blood pressure or glomerulonephritis

If your doctor decides to spare the kidney, the tumor can be managed with segmental resection or endoscopic removal.

Segmental resection: removing the cancerous part of the urinary tract and then reattaching it so the kidney is still joined to the bladder. This is done if the cancer hasn't spread past the surface.

Endoscopic removal: removing the tumor through a small scope called a ureteroscope. The ureteroscope is inserted through the bladder into the upper urinary tract. Then the tumor can be destroyed with a laser. This is done if the growth is small and low-grade.

Percutaneous tumor removal: a scope is placed directly into the kidney's collecting system through a small puncture in the back.

Chemotherapy

Topical chemotherapy and immunotherapy 
In bladder cancer, drugs can be inserted in the bladder to prevent cancer from coming back. But they are not often used for renal pelvis or ureteral cancer. The bladder holds fluid for hours, so the tissue has plenty of exposure to the drugs. But the upper urinary tract doesn't hold as much fluid as the bladder or for as long. Still, your doctor may use drugs in addition to surgery.

Systemic chemotherapy
Chemotherapy uses drugs to kill cancer cells. It may be used to treat upper urinary tract cancer before or after the kidney and ureter are removed.

You may receive chemotherapy in different ways: 

• By mouth: Some drugs are pills that you can swallow. They may be given before or after surgery.
• Into a vein (intravenous): The drugs enter the bloodstream and travel throughout your body. Chemotherapy may be given before or after surgery.

You may have your treatment in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, you may need to stay in the hospital.

Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.

If the drugs are given by vein or taken by mouth, the side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly: 

• Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
• Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
• Cells that line the digestive system: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care provider can give you medicines and suggest other ways to help with these problems. They usually go away when treatment ends.

Some drugs used for upper urinary tract cancer may also cause tingling or numbness in your hands and feet. Your health care team can suggest ways to control many of these side effects.

Radiation

High-energy radiation is used to destroy cancer cells with minimal damage to nearby organs. Radiation is rarely used for urothelial tumors since the area to be treated is so small and hard to target. Your doctor will only use radiation if he or she can avoid damaging nearby tissue.