Upper Tract Uothelial Carcinoma (UTUC)

Question 1

Risk factors for UTUCs:

Answer 1

Smoking
Aromatic amines
Phenacetin
Balkan endemic nephropaty
Endemic in sothwest Taiwan: aristolochoic acid
Polymorphisms: SULT1A1 reduction of sulfotransferase activity
Hereditary linked to HNPCC (lynch syndrome)

Question 2

What types of cancers can individuals with HNPCC (lynch syndrome) get?

Answer 2

Endometrial
Stomach
UTUCs
Biliary ducts
Ovarian
Small intestines
Skin Brain

Question 3

When should Lynch syndrome be suspected?

Answer 3

UTUC in patient <60 years and
personal history of HNPCC-type cancer
or
First degree relalitve <50 years old with HNPCC-type cancer
or
Two first degree relatives with HNPCC-type cancer

Question 4

What is the recommended investigation for suspected UTUC?

Answer 4

Urinary cytology
Cystoskopy to rule out concomittant bladder tumour
CT urography

Question 5

The sensivity for cytology in UTUCs is less or greater than bladder cancer?

Answer 5

less sensitive

Question 6

With how much does NBI (narrow band imaging) increase detection rate of UTUCs?

Answer 6

23%

Question 7

What can you use Optical Coherence Tomography for?

Answer 7

Staging of UTUCs

Question 8

What share of biopsies from the urether are non diagnostic for UTUC?

Answer 8

20%

Question 9

Pre-operative prognostic factors for UTUCs (12):

Answer 9

Tumour focality
Tumour location
Grade (biopsy, cytology)
Age
BMI
Tobacco comsumption
ECOG
ASA score
systemic symptoms
hydronephrosis
Delayed surgery >3 months
Neutrophil-to-lymphocyte ratio

Question 10

Intra- and post-operative prognostic factors for UTUCs (10):

Answer 10

Stage
Grade
CIS
Lymphovascular invasion
Lympnode involvement
Tumour architecture
Positive surgical margins
Tumour necrosis
Variant histology 
Distal urether management

Question 11

What share of patients with a diagnos of a G1 tumour from URS biopsies where upgraded?

Answer 11

96%

Question 12

What are the criterias for Low-risk UTUCs?

Answer 12

Unifocal disease
Tumour size < 2cm
Low-grade cytology
Low-grade URS biopsy
Non invasive on CT-urography

OBS all criteria must be present

Question 13

What are the criterias for High-risk UTUCs?

Answer 13

Multifocal disease
Tumour size > 2cm
High-grade cytology
High-grade URS biopsy
Hydronephrosis
Previous radical cystectomy for bladder cancer

Question 14

Which are the factors that are best in predicting ≥ pT2 disease in UTUCs?

Answer 14

High grade cytology or biopsy

Tumour size > 2 cm

Question 15

After endoscopic treatment of a UTUC, when should you perform a second look?

Answer 15

within 2 months

Question 16

When using laser vaporisation of a UTUC, what is the correct surgical technique?

Answer 16

Laser settings: 10Hz/1J
Don’t touch the tumour
Apnoe

Question 17

What are the criterias for Segmental Distal Ureterectomy?

Answer 17

Solitary tumour
Lower 1/3 of the ureter
Stage ≤ p T2

Question 18

Is there a difference between renal pelvis & ureteral tumours with regards to bladder recurrence, overall recurrence, cancer-specific or overall survival?

Answer 18

No

Question 19

Which is the superior technique for radical nefroureterectomy, open or laprascopic?

Answer 19

They are comparable when it comes to recurrence and disease-specific survival

Question 20

What technique is not recommended for the management of the bladder cuff in a radical nephroureterectomy?

Answer 20

Extravesical approach
Intravesical approach
(or a combination of extravescal and intravesical)
Endoscopic approach

Question 21

What technique is recommended for the management of the bladder cuff in a radical nephroureterectomy?

Answer 21

Transvesical approach

Question 22

What are the benefits of performing a Lymph node dissection at the time of a radical nephroureterectomy?

Answer 22

Staging

Therapeutic benefit

Question 23

When is Lymph node disseiction recommended in UTUCs?

Answer 23

Muscle-invasive UTUCs

Question 24

In patients with high-risk upper tract urothelial carcinoma which of the following statements is true?

1. Adjuvant chemotherapy after radical nephroureterectomy iproves progression-free survival
2. Singe dose intravesical chemotherapy after radical nephroureterectomy lower intravesical recurrence rate
3. The open approach is preferred to the laparascopic in clinicallay non organ confined disease
4. Lymphadenectomy should be performed in all invasive cases
5. All of the above

Answer 24

5. All of the above