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Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.

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Holland-Frei Cancer Medicine. 6th edition.

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Secondary Tumors of the Ureter

, MD and , MD.

These uncommon tumors may originate in the upper urinary tract and disperse by seedling metastases from a distant site, spreading by blood or lymphatic channels; when the primary tumor is in proximity to the ureter, spread may occur by direct extension. With the exception of drop metastases, signs and symptoms of urinary tract involvement appear quite late in the course of the disease, and they may be recognized only preterminally or at autopsy.

Drop Metastases

These tumors can be difficult to segregate from those arising as separate primary lesions resulting from exposure of the entire urothelium to various carcinogens. Because ureteral tumors frequently can be seen in conjunction with bladder or renal pelvic tumors, the likelihood that cells can flow down from the renal pelvis or reflux up to the ureter and implant with subsequent growth is quite real. Weldon and associates demonstrated implantation of tumor cells in the bladder, especially in previously traumatized areas.41 In addition, the observation of recurrent bladder tumors clustered around the ureteral orifice of an affected ureter provides strong support for the theory of seedling metastases. Diagnostic features are the same as those for primary carcinoma of the ureter, and the treatment of choice is total nephroureterectomy with a cuff of bladder.

Metastatic Ureteral Tumors

Carcinoma metastatic to the ureter is rare; only 151 cases have been reported to date. Stow reported the first documented case, and Presman and Ehrlich summarized 35 cases from the literature and established criteria for the diagnosis of metastatic disease to the ureter.42,43 Symptoms referable to the genitourinary tract were lacking in most patients. Abeloff and Lenhard demonstrated that less than 50% of patients with metastatic tumors were symptomatic,44 and Cohen and associates found 85% of such patients to be asymptomatic, with tumors discovered only at autopsy.45

Richie and associates listed the sites of primary tumors that later involved the ureter in the following order of frequency: breast (10 patients), colon/rectum (7), cervix (6), prostate (6), bladder (6), retroperitoneal lymphoma (5), and miscellaneous (6).46 Predilection for the lower third of the ureter was evident, and the longest time interval from primary tumor to diagnosis of ureteral obstruction ranged from 8 months (carcinoma of the cervix) to 9 years (bladder carcinoma). In addition, Grabstald and Kaufman described 24 women with periureteral metastases and hydronephrosis from primary breast carcinoma.9 In their autopsy series of 215 patients with breast carcinoma, 42 (18.3%) were found to have genitourinary metastases (kidney, 9.8%; ureter, 6.4%; bladder, 2.1%). Less than 5% of these patients had symptoms of urinary involvement.

Therapy of ureteral obstruction secondary to metastatic tumor must incorporate ethical, moral, and medical considerations. The relief of ureteral obstruction by indwelling tubes, exteriorized tubes, or ureterolysis (with consequent prevention of terminal uremia) may serve only to prolong suffering, and it should be weighed carefully against the patient's prognosis and the availability of effective alternative treatment for the primary tumor.

Tumor from Direct Extension

Ureteral involvement most commonly occurs with carcinoma of the cervix, carcinoma of the colon, or retroperitoneal lymphoma. Most tumors compress rather than invade the ureter. Treatment is directed mainly toward the primary tumor and relief of bilateral ureteral obstruction as noted earlier.

By agreement with the publisher, this book is accessible by the search feature, but cannot be browsed.

Copyright © 2003, BC Decker Inc.
Bookshelf ID: NBK13147

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