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Treatment of Ureteral Cancer

Due to the difficulties associated with the organization of treatment in Turkey, Switzerland, South Korea and India, we are not currently processing requests to these regions.

If you are interested in treatment in Germany, please leave a request and our specialists will contact you as soon as possible.

 

Cost for treatment

Diagnostic tests for ureteral cancer
 from  1146
Surgical ureteral cancer treatment with transurethral tumor excision
 from  5658
Treatment of ureteral cancer with chemotherapy
 from  1671

University Hospital of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of Adult and Pediatric Urology

According to the Focus magazine, the University Hospital of Ludwig Maximilian University of Munich is regularly ranked among the best medical institutions in Germany! The hospital is the largest multidisciplinary medical facility, as well as a leading research and training center in Germany and Europe. The hospital is proud of i
Diagnostic tests for ureteral cancer
3002
Surgical ureteral cancer treatment with transurethral tumor excision
11088
Treatment of ureteral cancer with chemotherapy
5784

University Hospital Ulm

8.7/10
location_onGermany, Ulm

Department of Adult and Pediatric Urology

The University Hospital Ulm started its activities 35 years ago and during this time it has become one of the most prestigious medical institutions in Europe. The hospital is famous for its numerous discoveries and the world-class achievements in medicine and pharmaceuticals. The medical facility has 29 specialized departments a
Diagnostic tests for ureteral cancer
2904
Surgical ureteral cancer treatment with transurethral tumor excision
10735
Treatment of ureteral cancer with chemotherapy
5570

Urology Hospital Munich-Planegg Munich

10/10
location_onGermany, Munich

Department of Adult and Pediatric Urology

According to Focus magazine, the Urology Hospital Munich-Planegg Munich ranks among the top specialized German hospitals! The hospital was founded in 1970 by Dr. Rudolf Castringius. During this time, it became the leading provider of male health care in Germany. In addition, the hospital has the status of one of the best medical
Diagnostic tests for ureteral cancer
3323 help2823
Surgical ureteral cancer treatment with transurethral tumor excision
9965
Treatment of ureteral cancer with segmental ureterectomy with uretero-cysto-anastomosis
19154

University Hospital Frankfurt am Main

10/10
location_onGermany, Frankfurt am Main

Department of Urology

According to the reputable Focus magazine, the University Hospital Frankfurt am Main ranks among the top German medical facilities! The hospital was founded in 1914 and today is a well-known German medical facility, which combines rich traditions and scientific innovations. A medical team of more than 6,500 employees cares about
Diagnostic tests for ureteral cancer
2804
Surgical ureteral cancer treatment with transurethral tumor excision
10141
Treatment of ureteral cancer with chemotherapy
5293

Charite University Hospital Berlin

9/10
location_onGermany, Berlin

Department of Adult and Pediatric Urology

According to the authoritative Focus magazine, the Charite University Hospital Berlin occupies the first place in the rating of the top German medical facilities! The hospital is one of the largest and leading university medical complexes in Europe. The hospital in Germany provides modern diagnostics and treatment of patients, a
Diagnostic tests for ureteral cancer
3702
Surgical ureteral cancer treatment with transurethral tumor excision
14718
Treatment of ureteral cancer with chemotherapy
4999

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

Department of Adult and Pediatric Urology

According to the Focus magazine, the University Hospital Heidelberg ranks among the top five hospitals in Germany! The hospital is one of the most advanced and reputable medical institutions not only in Germany, but throughout Europe. There are more than 43 specialized departments and 13 medical institutes, which cover all field
Diagnostic tests for ureteral cancer
0
Surgical ureteral cancer treatment with transurethral tumor excision
0
Treatment of ureteral cancer with chemotherapy
0

University Hospital Jena

8.9/10
location_onGermany, Jena

Department of Adult and Pediatric Urology

According to the prestigious Focus magazine, the University Hospital Jena regularly ranks among the top German medical facilities! The hospital has positioned itself as a multidisciplinary medical facility with a long history of more than 200 years. Since its foundation, the hospital has been constantly developing and modernizin
Diagnostic tests for ureteral cancer
3024
Surgical ureteral cancer treatment with transurethral tumor excision
11052
Treatment of ureteral cancer with chemotherapy
4945

University Hospital Erlangen

9.1/10
location_onGermany, Erlangen

Department of Adult and Pediatric Urology, Andrology

According to the Focus magazine, University Hospital Erlangen ranks among the best medical facilities in Germany! The hospital is one of the leading healthcare facilities in Bavaria and offers top-class medical care distinguished by the close intertwining of clinical activities with research and training of medical students. The
Diagnostic tests for ureteral cancer
2910
Surgical ureteral cancer treatment with transurethral tumor excision
10621
Treatment of ureteral cancer with chemotherapy
5486

University Hospital Halle (Saale)

9.6/10
location_onGermany, Halle

Department of Urology

According to the prestigious Focus magazine, the University Hospital Halle (Saale) ranks among the top German medical facilities! The history of the hospital has more than 300 years, and during this time it managed to earn an excellent reputation not only in Germany, but throughout the world. The hospital positions itself as a s
Diagnostic tests for ureteral cancer
2861
Surgical ureteral cancer treatment with transurethral tumor excision
9796
Treatment of ureteral cancer with chemotherapy
4929

University Hospital Hamburg-Eppendorf

9.2/10
location_onGermany, Hamburg

Department of Adult and Pediatric Urology

According to the Focus magazine, the University Hospital Hamburg-Eppendorf ranks among the top ten hospitals in Germany! Since its foundation in 1889, the hospital has taken a leading position in the European medical arena and still occupies it until today. A highly competent medical team of more than 11,000 employees takes care
Diagnostic tests for ureteral cancer
3485
Surgical ureteral cancer treatment with transurethral tumor excision
12956
Treatment of ureteral cancer with chemotherapy
5087

University Hospital Würzburg

9.2/10
location_onGermany, Würzburg

Department of Adult and Pediatric Urology

According to the Focus magazine in 2019, the University Hospital Würzburg ranks among the top national German hospitals! The hospital is one of the oldest medical facilities in Germany. The centuries-old traditions of first-class treatment are combined with the very latest achievements of modern evidence-based medicine and
Diagnostic tests for ureteral cancer
2774
Surgical ureteral cancer treatment with transurethral tumor excision
9813
Treatment of ureteral cancer with chemotherapy
4999

University Hospital Rechts der Isar Munich

9.8/10
location_onGermany, Munich

Department of Adult and Pediatric Urology

According to the prestigious FOCUS magazine, the University Hospital Rechts der Isar Munich ranks among the Germany's top medical institutions! Founded in 1834, the hospital combines long traditions and the very latest achievements of modern medicine. The medical facility includes 33 specialized departments, 20 interdiscipli
Diagnostic tests for ureteral cancer
3090
Surgical ureteral cancer treatment with transurethral tumor excision
10972
Treatment of ureteral cancer with chemotherapy
5746

University Hospital RWTH Aachen

8.7/10
location_onGermany, Aachen

Department of Adult and Pediatric Urology

According to the prestigious Focus magazine, the University Hospital RWTH Aachen ranks among the top German hospitals! As a maximum care university medical facility, the hospital guarantees patients first-class medical services combined with a respectful and human attitude. The hospital integrates all the modern options for the
Diagnostic tests for ureteral cancer
3056
Surgical ureteral cancer treatment with transurethral tumor excision
11300
Treatment of ureteral cancer with chemotherapy
5904

University Hospital Duesseldorf

9.5/10
location_onGermany, Duesseldorf

Department of Adult and Pediatric Urology

According to the authoritative Focus magazine, the University Hospital Duesseldorf ranks among the top Germany hospitals! The hospital is an excellent example of a combination of high-quality health care, research and teaching activities. With more than 50,000 inpatients and about 300,000 outpatients every year, the hospital is
Diagnostic tests for ureteral cancer
3014
Surgical ureteral cancer treatment with transurethral tumor excision
11181
Treatment of ureteral cancer with chemotherapy
4994

University Hospital Tuebingen

9.2/10
location_onGermany, Tuebingen

Department of Urology

According to the prestigious medical publication Focus, the University Hospital Tuebingen ranks among the top five German hospitals! The hospital was founded in 1805, therefore it is proud of its long history, unique experience, and outstanding achievements in the field of medical care, as well as research and teaching activitie
Diagnostic tests for ureteral cancer
3040
Surgical ureteral cancer treatment with transurethral tumor excision
10611
Treatment of ureteral cancer with chemotherapy
5661

University Hospital Bonn

9.2/10
location_onGermany, Bonn

Department of Adult and Pediatric Urology

According to the authoritative Focus magazine, the University Hospital Bonn ranks among the top ten medical facilities in Germany! The hospital was opened on January 1, 2001, although in fact it inherits the medical facility, which operated at the Faculty of Medicine of the University of Bonn. The hospital in Germany combin
Diagnostic tests for ureteral cancer
3044
Surgical ureteral cancer treatment with transurethral tumor excision
11256
Treatment of ureteral cancer with chemotherapy
5770
| from Booking Health GmbH

Ureteral cancer is a rare but severe oncological disease. Cancer treatment mostly involves the use of surgical techniques. In developed countries, early stages of cancer are often treated with minimally invasive organ-preserving surgery without skin incisions. With an invasive tumor or high-grade cancer, doctors perform surgery to remove the kidney and ureter. Surgeons abroad can perform the surgical procedure with the use of laparoscopic techniques: through short skin incisions. Chemotherapy and radiation therapy are used much less often for cancer treatment: mainly at the advanced stage.

Content

  1. What is ureteral cancer
  2. Diagnostics
  3. Surgical treatment of cancer
  4. Chemotherapy and radiation therapy
  5. Treatment in Europe with Booking Health at an affordable price

What is ureteral cancer

 

The ureters are thin "tubes" that carry urine from the kidneys to the bladder.

Ureteral cancer refers to urothelial cancer. It develops from the urothelial cells, which lines the urinary organs from the inside. Urothelial cancer is common: it ranks fifth among all malignancies after lung, prostate, breast and colon cancers.

Most of the urothelial tumors develop in the bladder. The ureter is much less frequently affected by tumors, and they are much more dangerous. If at the time of diagnosis, only 15% of bladder neoplasms progress to the invasive stage (reach the muscular layer of the organ), then the frequency of invasive forms of ureteral cancer reaches 60%. This type of the pathology is associated with a high risk of metastasis and recurrence, and therefore it requires more radical interventions for the treatment of ureteral cancer.

Risk factors are as follows:

  • Age over 60.
  • Male sex increases the risk of pathology by 3 times.
  • Smoking increases the likelihood of cancer by 7 times.
  • Occupational hazards: paint and varnish, chemical, oil industries increase the risk of disease by 8 times within 7 years due to exposure to benzidine and beta-naphthalene.

All these factors influence the risk of urothelial cancer in general, but its development in the ureters occurs very rarely. In 90% of cases, the tumor is localized in the bladder, in 7% of cases – in the renal pelvis, and only 3% of all cases of urothelial cancer are ureteral tumors.

Diagnostics

 

Blood in urine is the reason for visiting a doctor in 80% of patients. In 30% of cases, there is a flank pain, and in 15% – a palpable mass in the lumbar area.

Urothelial cancer can be suspected based on the results of urine cytology. However, the sensitivity of this examination is low. Cancer cells usually enter the urine after the invasion of the muscle wall of the ureter.

To make a diagnosis, instrumental diagnostic tests are required:

Computed tomography is the best method for imaging the urinary tract. The technique detects 100% of neoplasms over 1 cm, 96% of tumors from 5 to 10 mm, 89% of neoplasms of 3-5 mm in size.

MRI scanning is a less informative method that is used only if there are contraindications to the CT scan. The probability of detecting tumors less than 2 cm is about 75%.

Ureteroscopy is an endoscopic diagnostic method, the most accurate one, which allows the doctors to perform a biopsy and confirm the diagnosis. This is an optional examination. It is carried out mainly in those whose results of histological examination of the material can affect the cancer treatment regimen. For example, for a low-grade tumor, the doctor may opt for organ-preserving therapy instead of removing the kidney with the ureter.

Surgical treatment of cancer

 

Surgery is the main and often the only cancer treatment option for patients with ureteral neoplasms. The scope and type of surgery depends on the tumor location, the cancer stage and the tumor grade. Other prognostic factors are also taken into account, in the presence of which cancer treatment may be more aggressive. These include:

  • Tumor invasion into the blood vessels.
  • Extensive necrotic zones (more than 10% of the tumor).
  • Tumor on a broad base.
  • Presence of concomitant carcinoma in situ in the urinary tract is associated with a high risk of recurrence.

Organ-preserving surgery

 

The most sparing option for cancer surgery involves removing only the tumor. Not only the kidney is completely preserved, but also the ureter. There are three indications for such surgical interventions:

  • Low stage (non-invasive neoplasms up to 1 cm) and low aggressiveness of ureteral cancer.
  • Patient has only one kidney preserved, the second does not function or is removed.
  • Patient cannot undergo open surgery due to severe concomitant diseases.

After organ-preserving treatment, the patient retains the urinary tract, but the oncological results are worse. Recurrences are more frequent, and in the case of recurrent tumor growth, another more extensive surgery should be performed – with the removal of the kidney and the ureter on the affected side, regardless of the preservation or presence of the second kidney. Therefore, these patients require more intensive follow-up monitoring after surgery. After 3, 6 months, and then annually, they undergo endoscopic diagnostics and computed tomography of the urinary system.

The intervention to remove an early stage ureteral tumor is minimally invasive. It is performed using endoscopic equipment. The doctor removes the part of the ureter with the tumor, including part of the healthy tissue, in order to avoid local recurrence. One of two surgical approaches can be used for this intervention:

  • Percutaneous – through a skin incision.
  • Ureteropyeloscopic – through the urinary tract, without skin incisions.

The percutaneous approach (laparoscopic) is used when the neoplasm is located in the upper part of the ureter, if the cancer has spread to the lower calyxes. They can be difficult to reach through the urinary tract.

Ureteropyeloscopy is the main surgery that is used more often. It helps to remove the neoplasm without skin incisions: instruments are inserted into the ureter through the urethra and bladder. Developed countries use more advanced state-of-the-art ureteropyeloscopes, which have better technical capabilities, and therefore they can remove ureteral tumors of any localization.

When performing the operation, the doctor inserts a flexible, thin ureteropyeloscope into the bladder and ureter. The specialist thoroughly examines the organs from the inside, and with suspicious changes on the walls, he samples tissue for the further histological examination (performs a biopsy). The tumor itself can be removed using one of the following methods:

  • Electroresection.
  • Coagulation and electrovaporization of the tumor base.
  • Laser vaporization.

The neoplasm is excised with an electrosurgical instrument or its base is evaporated with a laser.

Ureteropyeloscopy is not only a more sparing treatment method than percutaneous approach, but also a more effective one. The integrity of the urinary system is not violated. This means that cancer cells do not spread outside of it during the operation, so the risk of recurrence is reduced.

For small, non-invasive, low-grade malignant tumors, ureteropyeloscopy is as effective as open surgery to remove the kidney, ureter, and part of the bladder. It provides the same survival rates. The only drawback is the higher risk of cancer recurrence from the bladder. If it develops, the patient will need additional treatment: transurethral resection of the bladder, intravesical chemotherapy, immunotherapy. Intravesical instillation of drugs is also used for prophylactic purposes: to reduce the risk of recurrence after endoscopic tumor removal.

Some doctors prefer percutaneous surgery, because after performing such an intervention, a nephrostomy drainage (tube) can be left, and postoperative chemotherapy and immunotherapy can be carried out through it. However, such an approach is usually not used in Europe. So far, there is no conclusive evidence that the use of local drugs after organ-preserving surgery improves patient survival rates. In addition, postoperative therapy is also technically possible after ureteropyeloscopy: drugs are injected through a ureteral stent.

Segmental resection of the ureter

 

This is a rare surgical procedure used for the treatment of low-grade cancers without signs of invasion, if the tumor is located in the lower third of the ureter. Doctors remove this part of the organ and attach the end to the bladder for normal urine outflow.

Radical nephroureterectomy

 

Radical nephroureterectomy is a classic surgical procedure for the treatment of ureteral cancer. It involves the total removal of the kidney, ureter, as well as partial removal of the bladder wall along with the orifice (the place where the ureter enters). This intervention was first described by J. Albarran in 1907, and since then has remained the most common treatment for ureteral cancer.

The surgical intervention is performed through a large skin incision. Doctors strive to remove the urinary organs, avoiding the dissemination of tumor cells outside of it.

The operation is usually complemented by the removal of regional lymph nodes. This manipulation allows the doctors to accurately establish the stage of the disease in order to plan postoperative treatment. It may also reduce the risk of regional recurrence, although there is still no evidence of an effect of lymphadenectomy on patient survival rates. Lymph node dissection is considered optional only at the early stages of ureteral cancer.

In developed countries, laparoscopic operations are increasingly being performed for ureteral cancer treatment. Doctors make several small skin incisions instead of one big incision. Such interventions are less traumatic, less likely to cause complications, after which patients recover faster. Some hospitals perform robot-assisted tumor removal surgery.

When performing laparoscopic surgery, doctors strive to achieve the following goals:

  • Avoid violation of the integrity of the urinary tract in order to avoid the spread of cancer cells outside of it.
  • Avoid direct contact of the instrument with the tumor.
  • Removed tissues are extracted inside a special container.
  • All organs are removed using en bloc resection.

European specialists have sufficient experience and skills to fulfill these conditions. After the well-performed surgery, many patients are completely cured of ureteral cancer and do not require any additional treatments.

Large tumors and multiple tumor foci are considered limitations for laparoscopic interventions. In such cases, doctors have to perform classic open surgery through the large skin incision.

Chemotherapy and radiation therapy

 

Systemic chemotherapy and radiation therapy are used only at the advanced stage of cancer. They help the doctors to restrain the progression of the disease.

Radical nephroureterectomy can only be performed for palliative purposes (for symptom relief and prevention of severe complications). It does not significantly increase the life expectancy of patients.

Chemotherapy is the main treatment option. It is carried out with the inclusion of platinum drugs in the regimen.

Systemic chemotherapy is used much less frequently before surgery or after surgery for ureteral cancer without metastases. So far, there is no convincing evidence that such an approach significantly affects patient survival rates. Therefore, chemotherapy is used after radical nephroureterectomy, only for metastases detected in the distant lymph nodes.

Radiation therapy is not used either before or after surgery. There is no evidence that it helps prevent recurrences or improve patient survival rates. Therefore, radiation therapy is used only at the advanced stage of cancer for palliative purposes.

Treatment in Europe with Booking Health at an affordable price

 

To undergo ureteral cancer treatment in one of the European hospitals, you can use the services of the Booking Health company. On our website, you can see the cost of treatment and compare prices in different hospitals in order to book a medical care program at a favorable price. Treatment in a European hospital will be easier and faster for you, and the cost of treatment will be lower.

You are welcome to leave your request on the Booking Health website. Our specialist will contact you and provide a consultation on treatment in Europe. Booking Health will fully organize your trip abroad. We provide the following benefits for you:

  • We will select the best European hospital, whose doctors specialize in the treatment of ureteral cancer.
  • We will help you overcome the language barrier, and establish communication with the doctor of the European hospital.
  • We will reduce the waiting time for the medical care program. You will undergo treatment on the most suitable dates.
  • We will reduce the price. The cost of treatment in Europe will be reduced due to the lack of overpricing and additional coefficients for foreign patients.
  • We will take care of all organizational issues: we will draw up documents, meet you abroad and take you to the hospital, book a hotel, and provide interpreting services.
  • We will prepare a program and translate medical records. You do not have to repeat the previously performed diagnostic procedures.
  • We will help you keep in touch with doctors after the completion of treatment in Europe.
  • We will organize additional examinations and treatment in the European hospital.
  • We will buy medicines abroad and forward them to your native country.

Your health will be in the safe hands of the world's leading doctors. The Booking Health specialists will help you reduce the cost of treatment, organize your trip to the European hospital, and you will only have to focus on restoring your health.

Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko




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