Ureteric cancer, though rare, presents unique challenges that require careful treatment planning and ongoing monitoring. Understanding your options—from established surgical approaches to emerging therapies being tested in clinical trials—can help you and your healthcare team make informed decisions about the path forward.

How Doctors Approach Treating Ureteric Cancer

When you receive a diagnosis of ureteric cancer, treatment planning begins immediately. The primary goals are to remove or destroy cancer cells, prevent the disease from spreading to other parts of your body, and reduce the risk of cancer returning after treatment. Your medical team will consider several factors when recommending treatment, including how deeply the cancer has grown into the ureter wall, whether it has spread beyond the ureter, the grade of the cancer cells, and your overall health status.^[1]

Ureteric cancer treatment differs from person to person because each case is unique. A small, early-stage tumor confined to the inner lining of the ureter may require less extensive treatment than a larger, high-grade cancer that has invaded deeper layers or spread to nearby organs. Your age, kidney function, and whether you have cancer in one or both ureters also influence which treatments are most appropriate for your situation.^[3]

Medical societies and expert panels have established standard treatment approaches based on years of research and clinical experience. These guidelines help doctors provide care that has been proven effective for ureteric cancer. At the same time, researchers continue to explore new therapies through clinical trials, offering patients access to innovative treatments that may improve outcomes beyond what current standard care provides.^[8]

Standard Treatment Options

Surgical Approaches

Surgery remains the cornerstone of treatment for most ureteric cancers. The type of operation your surgeon recommends depends primarily on the location and extent of your cancer. For many patients with ureteric cancer, doctors recommend a procedure called radical nephroureterectomy, which involves removing the entire kidney, the complete ureter, and a small portion of the bladder where the ureter connects (called the bladder cuff). This extensive surgery is considered the gold standard because it offers the best chance of removing all cancer cells and preventing recurrence.^[5][12]

Surgeons typically perform radical nephroureterectomy using minimally invasive techniques. Laparoscopic surgery involves making several small incisions in your abdomen and using specialized instruments and a camera to remove the affected organs. This approach generally results in less pain, shorter hospital stays, and faster recovery compared to traditional open surgery, where a single large incision is made along your side. However, some situations may require open surgery, particularly if the cancer is large or has grown into surrounding tissues.^[12]

Not all patients need such extensive surgery. If you have a small tumor located in the lower part of the ureter near the bladder, and if the cancer is low-grade and hasn’t invaded deeply, your surgeon might recommend a segmental resection of the ureter. This procedure removes only the cancerous section of the ureter along with a margin of healthy tissue on either side. The remaining portions of the ureter are then reconnected to the bladder. This kidney-sparing approach preserves kidney function while still removing the cancer.^[3][17]

For very early-stage cancers that are small and low-grade, doctors may consider endoscopic surgery. This minimally invasive approach involves inserting a thin tube with a camera through either the urethra and bladder (ureteroscopy) or through a small incision in the flank (percutaneous endoscopy) to reach the tumor. The surgeon then destroys or removes the cancer using laser energy or cutting tools passed through the endoscope. Endoscopic surgery is particularly considered for patients who have poor kidney function, only one kidney, or cancer affecting both ureters, as it preserves as much kidney tissue as possible.^[12][14]

During surgery, your surgeon may also perform a retroperitoneal lymph node dissection, removing lymph nodes near the affected ureter and kidney. This helps determine whether cancer has spread beyond the urinary tract and may improve outcomes by removing any cancerous lymph nodes.^[12]

After surgery, you will experience some common side effects. Pain at the incision sites is normal and typically manageable with medication. You may notice blood in your urine initially, which should resolve as healing progresses. Some patients experience an urgent need to urinate or need to urinate more frequently than before surgery. If part of your bladder was removed, it may take time for your bladder to adjust to its new capacity. Rarely, complications such as ureter narrowing or blockage can occur, which may require additional procedures to correct.^[12]

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells throughout your body. For ureteric cancer, chemotherapy can be given at different times during your treatment journey. Neoadjuvant chemotherapy is administered before surgery with the goal of shrinking the tumor, making it easier to remove, and potentially killing any cancer cells that may have spread beyond the ureter. Adjuvant chemotherapy is given after surgery to destroy any remaining cancer cells and reduce the risk of recurrence, particularly for patients whose cancer had spread to lymph nodes or grown deeply into the ureter wall.^[12][15]

Doctors typically use combinations of chemotherapy drugs rather than single agents because multiple drugs working together are more effective at killing cancer cells. The specific drugs your oncologist recommends depend on your kidney function, overall health, and the characteristics of your cancer. Treatment is usually given in cycles—periods of treatment followed by rest periods to allow your body to recover—over several weeks or months.^[12]

Chemotherapy can also be delivered directly into the affected area rather than throughout your entire body. For patients with early-stage, low-grade tumors who cannot undergo or wish to avoid major surgery, doctors may administer chemotherapy drugs directly into the ureter and kidney. This can be done by threading a catheter up through the bladder into the ureter or by inserting a tube through the skin into the kidney. This localized approach minimizes side effects on the rest of your body while delivering high concentrations of medication where it’s needed most.^[16]

Chemotherapy affects rapidly dividing cells, which includes not only cancer cells but also healthy cells in your hair follicles, digestive tract, and bone marrow. Common side effects include fatigue, nausea and vomiting, loss of appetite, mouth sores, and increased risk of infection as your white blood cell counts drop. Hair loss may occur depending on which drugs you receive. Most side effects resolve after treatment ends, though some may persist longer. Your healthcare team can prescribe medications to help manage these side effects and will monitor your blood counts closely during treatment.^[12]

Immunotherapy

For certain patients, particularly those with high-grade disease who undergo kidney-sparing procedures, doctors may recommend instilling Bacillus Calmette-Guérin (BCG) directly into the affected ureter and kidney. BCG is a weakened form of bacteria related to tuberculosis that stimulates your immune system to attack cancer cells. It has been used successfully for decades in treating bladder cancer and shows promise for upper urinary tract cancers as well. However, BCG carries a small risk of causing systemic infection, so it should not be used if you have visible blood in your urine or certain immune system disorders.^[16]

Another immunotherapy agent that can be instilled locally is mitomycin C, a chemotherapy drug that works by interfering with cancer cell DNA. In 2020, a formulation specifically designed for upper tract cancers called mitomycin pyelocalyceal (brand name Jelmyto) was approved for treating low-grade ureteric cancer. This gel-like formulation is instilled through a catheter into the kidney and ureter once weekly for six weeks. In clinical studies, more than half of patients achieved complete disappearance of their tumors after this treatment. Those who responded continued with monthly treatments for up to a year to help prevent recurrence.^[16]

For patients with advanced ureteric cancer that has spread to other parts of the body, systemic immunotherapy may be an option. The drug nivolumab is now approved for certain patients after surgery who are not candidates for standard chemotherapy. Nivolumab works by blocking proteins that prevent your immune system from attacking cancer cells, essentially releasing the brakes on your immune response. This type of therapy represents a newer approach to treating ureteric cancer and is typically reserved for specific situations based on the cancer’s characteristics and the patient’s overall condition.^[7]

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells. While it is not typically the primary treatment for ureteric cancer, radiation may be recommended in certain situations. Some patients receive radiation therapy in combination with surgery and chemotherapy, particularly if the cancer has grown extensively or if not all cancer could be removed during surgery. Radiation can also help control symptoms in patients with advanced cancer that has spread to bones or other organs, providing pain relief and improving quality of life.^[6][15]

During radiation therapy, you lie still on a table while a machine directs precisely targeted beams at the cancer site. Each treatment session lasts only a few minutes, though you’ll typically undergo treatment five days a week for several weeks. The procedure itself is painless, though side effects can develop as treatment continues. These may include fatigue, skin irritation in the treated area, urinary urgency and discomfort, and digestive symptoms if nearby intestines are exposed to radiation. Most side effects gradually improve after treatment concludes.^[6]

Emerging Treatments in Clinical Trials

While standard treatments have helped many patients with ureteric cancer, researchers continue to develop new approaches that may improve outcomes. Clinical trials are research studies that test whether new treatments are safe and effective before they become widely available. Participating in a clinical trial gives you access to cutting-edge therapies while contributing to medical knowledge that may help future patients.^[8]

Targeted Therapy with FGFR Inhibitors

Scientists have discovered that some ureteric cancers have mutations in a gene called FGFR3 (fibroblast growth factor receptor 3). These mutations cause cells to grow and divide uncontrollably. Researchers are now testing drugs called FGFR inhibitors that specifically block the abnormal signals from mutated FGFR3 proteins, potentially stopping cancer growth without harming normal cells. These targeted oral medications are being studied in clinical trials for patients after surgery to determine whether they can prevent cancer from returning. Unlike traditional chemotherapy that affects all rapidly dividing cells, these drugs are designed to target only cells with the specific mutation, potentially resulting in fewer side effects.^[7][16]

Novel Surgical Techniques

Clinical trials are also evaluating new surgical approaches that aim to remove cancer while preserving as much normal tissue as possible. Researchers are testing different endoscopic techniques, including fulguration—a procedure that uses electric current delivered through a small wire loop to burn away tumor tissue—and laser surgery that precisely vaporizes cancer cells. These minimally invasive approaches are particularly being studied for patients with early-stage cancers or those who cannot tolerate major surgery due to other health conditions.^[7]

Another approach being investigated is segmental resection of the renal pelvis, which removes only the cancerous portion of the kidney’s collecting system rather than the entire kidney and ureter. This experimental procedure attempts to cure cancer while maximizing preservation of kidney function, though it requires careful patient selection and long-term studies to determine its effectiveness compared to standard surgery.^[7]

Regional Chemotherapy and Immunotherapy

For patients with low-grade ureteric cancers, researchers are exploring whether delivering chemotherapy or immunotherapy directly into the affected ureter and kidney immediately after tumor removal can prevent recurrence. These regional therapy approaches aim to kill any remaining microscopic cancer cells while minimizing exposure of the rest of your body to these powerful medications. Studies are testing various drugs, treatment schedules, and delivery methods to determine the most effective and safest protocols.^[16]

Understanding Clinical Trial Phases

Clinical trials progress through distinct phases, each designed to answer specific questions. Phase I trials are the first step in testing a new treatment in humans. They involve small numbers of patients and focus primarily on determining safe dosing and identifying side effects. Researchers carefully monitor participants to understand how the body processes the drug and what dose can be given safely.^[8]

Phase II trials enroll more patients and aim to determine whether the new treatment actually works against the cancer. Researchers measure how many patients respond to treatment, how long responses last, and continue to monitor for side effects. If a treatment shows promise in Phase II, it advances to Phase III.^[8]

Phase III trials involve large numbers of patients and compare the new treatment directly to the current standard of care. These trials provide the strongest evidence about whether a new approach is better than existing treatments. If results show significant benefit, the treatment may receive regulatory approval and become available to all patients.^[8]

Clinical trials for ureteric cancer are conducted at medical centers around the world, including in the United States, Europe, and other regions. Eligibility criteria vary by study but typically consider factors such as cancer stage, previous treatments received, kidney function, and overall health status. Your oncologist can help determine whether you might qualify for any current trials and discuss whether participation might benefit you.^[8]

Most Common Treatment Methods

• Surgical Treatments
  • Radical nephroureterectomy: removal of kidney, entire ureter, and bladder cuff—the most common surgery for ureteric cancer
  • Segmental ureter resection: removes only the cancerous section of ureter with healthy margins, preserving kidney function
  • Endoscopic surgery: minimally invasive tumor removal through ureteroscopy or percutaneous approach using laser or cutting tools
  • Retroperitoneal lymph node dissection: removal of nearby lymph nodes to check for cancer spread
  • Laparoscopic techniques: minimally invasive approach using small incisions for faster recovery
• Chemotherapy
  • Neoadjuvant chemotherapy: given before surgery to shrink tumors
  • Adjuvant chemotherapy: administered after surgery to kill remaining cancer cells and prevent recurrence
  • Systemic chemotherapy: intravenous drug combinations for metastatic disease
  • Regional chemotherapy: direct instillation into ureter and kidney for localized early-stage cancers
• Immunotherapy
  • Bacillus Calmette-Guérin (BCG): instilled into ureter to stimulate immune response against cancer cells
  • Mitomycin pyelocalyceal (Jelmyto): gel formulation instilled weekly for low-grade upper tract cancers
  • Nivolumab: systemic immunotherapy for patients after surgery who cannot receive chemotherapy
• Radiation Therapy
  • External beam radiation: targeted high-energy beams to kill cancer cells, often combined with surgery and chemotherapy
  • Palliative radiation: to relieve symptoms in advanced cancer that has spread to other organs
• Targeted Therapy (Clinical Trials)
  • FGFR inhibitors: oral medications targeting specific genetic mutations in cancer cells
  • Novel endoscopic techniques: fulguration and laser surgery for early-stage disease
  • Regional biological therapy: direct delivery of immunotherapy agents to affected areas