Last updated: 15-Oct-2026
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Urology Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ 4.99 from 84 Google reviews (Gota clinic) · 5.0 from 35 (Apollo, Bhat)
IN SHORT
This cancer grows in the thin lining that carries urine out of the kidney and down the ureter. It is different from the common kidney cancer.
Blood in the urine without pain is its commonest first sign. It is often put down to a stone or an infection and missed for months.
Blood in the urine needs both kidneys, both ureters and the bladder checked. A CT urogram and a cystoscopy are the first key tests.
Urine is made in the kidney. It collects in a funnel inside the kidney called the renal pelvis. From there, a thin tube called the ureter carries it down to the bladder. All of these spaces share one lining, called the urothelium. Cancer of this lining in the kidney or the ureter is called upper tract urothelial cancer.
It is not the same disease as the common kidney cancer, which starts in the kidney’s solid tissue. The signs overlap, but the tests and the treatment differ. The lining of the bladder is the same lining. So the bladder is never assumed to be clear, and it is always looked at too.
Most people notice blood in the urine. A few have side pain. Some have no symptom at all, and the clue comes from a urine test or a scan.
| Sign | What it can mean | What is checked next |
|---|---|---|
| Blood in the urine without pain. | The commonest first sign of this cancer. | A CT urogram and a cystoscopy. |
| A dull ache in the side or back. | A tumour blocking the flow of urine. | A CT urogram. |
| Sharp, colicky side pain. | Blood clots passing down the ureter. | A CT urogram, before calling it a stone. |
| Abnormal cells in a urine test, with a normal bladder. | A source higher up in the kidney or ureter. | The upper tract is examined before saying no cause was found. |
| A swollen kidney or a filling gap on a scan. | Something blocking or lining the drainage system. | A CT urogram with the late urine phase. |
Stones and urine infections are common, so blood in the urine is easily blamed on them. When the bleeding stops on its own, the search often stops too.
A stone that is never actually seen on a scan is not an answer. Nor is an infection that does not show in the urine culture. If blood has been seen even once, the whole urinary tract needs to be checked. That means both kidneys, both ureters and the bladder. A delay of months is the usual story in this cancer, and it is avoidable.
Three questions are asked at diagnosis to screen for Lynch syndrome. Are you under 60? Have you had a Lynch-type cancer yourself? Has a parent, brother, sister or child had one? A yes to any of them leads to more testing. The tumour itself is also tested for Lynch-type changes.
A thin camera passed up the ureter, called ureteroscopy, can take a biopsy. It is not done for everyone, because it can raise the chance of a later bladder tumour.
It is needed when keeping the kidney is being considered, or when the diagnosis is truly unclear. If the CT urogram and high-grade urine cells already show a high-risk tumour, it is skipped. In that case it adds risk without changing the plan.
| What you notice | Why it is urgent |
|---|---|
| Fever with chills and side pain, with a known block in the kidney. | Infection behind a block needs drainage first, usually with a tube through the back. |
| Heavy bleeding with clots, and you cannot pass urine. | Clots are blocking the bladder outlet and need urgent care. |
Once the tests are done, the tumour is placed in a low-risk or a high-risk group. This group decides the treatment, which is explained on the nephroureterectomy page.
| Low risk: all of these | High risk: any of these |
|---|---|
| A single tumour. | More than one tumour. |
| Smaller than 2 cm. | 2 cm or larger. |
| Low-grade cells in urine and biopsy. | High-grade cells in urine or biopsy. |
| No sign of growth into the wall on CT. | Growth into the wall, a swollen kidney, or a rare cell type on testing. |
No. Stones, infection and other causes are more common. But it always needs the kidneys, ureters and bladder checked, because cancer cannot be ruled out without tests.
Yes. Bleeding from this cancer often comes and goes. Stopping on its own does not mean the cause has gone.
No. Common kidney cancer starts in the solid kidney tissue. This cancer starts in the lining that drains urine, the same lining as the bladder.
The bladder has the same lining and can carry a tumour at the same time. It is checked in every patient before any treatment.
It can. These cancers belong to Lynch syndrome, which also raises the risk of this cancer. Tell the doctor about every cancer in the family.
Treatment for this cancer is explained on the nephroureterectomy page. For questions before you travel, call +91-63590-11009.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Urology Cancer Surgeon
Consultation: Gota OPD, Gota, Ahmedabad. Surgery: Apollo Hospital, Bhat, Gandhinagar.
Gota OPD — Gota, Ahmedabad, Gujarat
Apollo Hospital, Bhat, Gandhinagar — Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat
Call: +91-63590-11009 · WhatsApp: +91-63590-11009
Blood in the urine, or a scan showing a swollen kidney or a block in the ureter? The urine reports, scan films and reports can be sent ahead on WhatsApp, so the visit starts with them already read. What they mean for you is decided at the consultation, after examination. Call +91-63590-11009 Send reports before your visit
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