Upper Urinary Tract Urothelial Cancer

Aetiology Smoking – increased RR x7 Analgaesic abuse Phenacetin most commonly described – increased RR 3.6x. Also associated with codeine, paracetamol and salyicylates Associated papillary necrosis on imaging associated with risk increase x7, which is synergistic with phenacetin abuse (20x) Characteristic finding of thickened basement membrane on histology – should alert physician to need for careful surveillance of contralateral kidney. Occupation Chemical/petroleum/plastics/coal/tars/asphalt/aniline dyes – increased RR x4-5 Heredity Lynch syndrome – young women; familial non-polyposis colon tumours/extracolonic lesions including UUT tumours Balkan nephropathy Familial but not obviously inherited In some families increased RR x 100+ Degenerative interstitial nephropathy and UUT TCC Tumours typically low-grade, bilateral and multifocal