Cancer Pathway

Upper Tract (Ureter) Cancer: your pathway, step by step

The upper urinary tract is the kidney’s drainage channel (renal pelvis) and the ureter that carries urine to the bladder. Cancer here is uncommon. It is treated differently from kidney cancer, and the other kidney’s health is central to the plan. This guide explains the steps, one stage at a time.

Book a consultation

Written for patients and reviewed by Dr. Anshuman Singh, Uro-Oncologist, on 7 October 2026.

Start here

What is upper tract (ureter) cancer?

Upper tract urothelial cancer starts in the same type of lining cell as most bladder cancers. Because that lining runs throughout the urinary tract, people with it often also have, or later develop, a bladder cancer.

Removing the kidney and ureter is the usual treatment for aggressive cancers, but small, low-risk cancers can sometimes be treated while keeping the kidney, especially if the other kidney is weak.

How upper tract cancer is usually found

  • Blood in the urine, visible or only seen under a microscope.
  • A dull ache in the side, or a swollen kidney (hydronephrosis) seen on a scan.
  • A scan for another problem that shows a growth in the ureter or kidney drainage channel.
  • Smoking, certain herbal products (aristolochic acid) and an inherited condition called Lynch syndrome are risks.

Step 1

The tests that decide the plan

Treatment is chosen only after these results are put together.

CT urogram
A CT scan with contrast that shows the kidneys, ureters and bladder, including growths and blockages.
Ureteroscopy with biopsy
A thin camera is passed up the ureter under anaesthetic to look at the growth, take a sample and judge its grade. It guides whether the kidney can be spared.
Cystoscopy and urine tests
The bladder is checked at the same time, since a bladder tumour often goes with or follows an upper tract one.
Kidney function and chest scan
Blood tests (creatinine, eGFR) show how well both kidneys work, and a chest scan checks for spread. Testing for Lynch syndrome may be advised.

Step 2

Find what applies to you

Choose your stage and a few details. The page then shows what it means, the options, what to take into account and what to ask, with a checklist you can download.

Living with treatment

Side effects and recovery

These depend on the treatment chosen. Most can be reduced or managed, so ask about them before you decide.

Lower kidney function
Losing a kidney lowers function. The remaining kidney is protected by controlling blood pressure and diabetes and avoiding unnecessary painkillers.
Bladder tumours
New tumours often appear in the bladder afterwards. They are usually small and treated through the urine passage.
Chemotherapy effects
Tiredness, nausea, low blood counts, hearing and nerve changes. Most can be reduced with early reporting.
Wound pain, bleeding or hernia
Usual after an operation. Keyhole surgery lessens them.

After treatment

Follow-up

  • Cystoscopy every three months for the first year or two, then less often, for many years.
  • Scans of the chest and abdomen, and kidney function tests, at set intervals.
  • After kidney-sparing treatment, repeat ureteroscopy is needed, as the cancer often returns.

When to get help quickly

  • Blood or clots in the urine, or being unable to pass urine.
  • Fever with side or back pain.
  • Very little urine over a day.
  • A wound that is red, swollen or leaking.

Common questions

Questions patients ask

How is this different from kidney cancer?

Kidney cancer starts in the kidney tissue; upper tract cancer starts in the lining of the drainage channel and ureter. Treatment, risks and follow-up are different, and it is related to bladder cancer.

Do I need to lose my kidney?

For high-risk cancers, usually yes. Some low-risk cancers can be treated while keeping the kidney, with frequent check-ups.

Will I need dialysis after losing a kidney?

Rarely. Most people stay well with one kidney, unless the other kidney is already weak. Your kidney function is checked before surgery.

Why is the bladder checked so often?

The lining of the urinary tract is exposed to the same causes, so a tumour often appears in the bladder after treatment. Finding it early keeps treatment simple.

What is Lynch syndrome and does it matter?

It is an inherited condition that raises the risk of several cancers, including this one. A test can tell, and if positive, relatives can be advised.

Want to talk through your own reports?

This guide is general information and does not replace a medical opinion. An unhurried one-to-one discussion with Dr. Anshuman Singh, with your family welcome, so that you understand every option before you decide. Bring your reports and scans to a consultation with Dr. Anshuman Singh, in the clinic or by teleconsultation.

Book a consultationUpper Tract (Ureter) Cancer treatment