Upper tract urothelial carcinoma (UTUC), affecting the renal pelvis and ureter, is less common than bladder cancer but biologically similar. Risk factors include smoking, prior bladder cancer, genetic syndromes (like Lynch syndrome), and chronic inflammation.

Symptoms usually include hematuria (most common), flank pain, and occasionally obstruction leading to hydronephrosis. Diagnosis involves CT urography, ureteroscopy, and biopsy.

Treatment depends on grade and location. For high-risk or invasive tumors, the gold standard is radical nephroureterectomy (removal of the kidney, ureter, and bladder cuff). This can be performed laparoscopically or robotically.

For selected low-grade, localized tumors, endoscopic management using laser ablation or segmental ureterectomy may preserve renal function. Intracavitary instillations of chemotherapy (e.g., mitomycin gel) are emerging as organ-preserving options.

Advanced/metastatic UTUC is treated similarly to bladder cancer, using systemic chemotherapy and immunotherapy.

Surveillance is critical, as recurrence in the bladder or contralateral tract is common. Modern minimally invasive techniques and organ-preserving strategies are improving outcomes.