Upper tract urothelial cancer

Upper tract urothelial carcinoma is a relatively uncommon yet aggressive malignancy. It accounts for roughly 5–10% of all urothelial carcinomas. Contrasted to bladder cancer, UTUC is more frequently diagnosed at an advanced stage, contributing to poorer prognostic outcomes. Guided predominantly by risk stratification, management of low-risk cancer generally favours kidney-sparing interventions, whereas high-risk patients typically require radical nephroureterectomy with bladder cuff excision.

The impact of perioperative systemic therapies including neoadjuvant chemotherapy and adjuvant immunotherapy on survival outcomes is being explored. Additionally, emerging diagnostic modalities such as urinary biomarkers or narrow-band imaging are showing promise in early detection and risk assessment. However, agreement on optimal surveillance strategies is yet to be established, particularly in cases with hereditary predispositions, such as those with Lynch syndrome. This review provides a comprehensive overview of the contemporary developments in the management of UTUC.