Last updated: 18-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 85 Google reviews (Gota clinic) · 5.0 from 28 (Apollo, Bhat)
IN SHORT
The usual operation for high-risk cancer removes the kidney, whole ureter and a bladder cuff. With only one working kidney, that would mean dialysis, so the plan changes.
Kidney-sparing treatment keeps the kidney, but the cancer can come back. It needs a second camera test within eight weeks, then checks for life.
Every ureter and renal pelvis cancer is tested for a Lynch syndrome link. A positive result changes checks for the whole family, not only the patient.
This page is one part of a larger guide. For how ureter and renal pelvis cancer is treated, start with our nephroureterectomy guide. For the wider picture of kidney cancer surgery, see our kidney cancer surgery guide.
For most people, the plan follows the risk group. High-risk cancer is treated by removing the kidney, the whole ureter and a small cuff of the bladder. This operation is called nephroureterectomy. Low-risk cancer can be treated while keeping the kidney.
Some situations change that plan. Each one is discussed at a meeting of the treating doctors before treatment starts. A kidney physician joins whenever kidney function is at stake.
| Situation | Why it matters | What usually changes |
|---|---|---|
| Only one working kidney. | Removing it would mean dialysis. | Kidney-sparing treatment is offered, even for higher-risk cancer. |
| Cancer on both sides. | Both kidneys cannot be removed. | Kidney-sparing treatment on each side. |
| Weak kidneys before surgery. | Function falls further after the operation. | A kidney physician plans with the surgeon. Chemotherapy timing is rethought. |
| Lynch syndrome found or suspected. | Relatives carry a higher cancer risk. | Genetics referral and checks for relatives. |
| Earlier bladder cancer. | The whole lining is at risk. | The bladder is checked first. The risk group may rise. |
| Fever with a blocked kidney. | Infection comes before cancer decisions. | The kidney is drained first. |
Some people have only one kidney. Others have two, but one works poorly. Doctors call this a functionally single kidney. In both cases, removing the kidney with the cancer would mean dialysis for life.
So kidney-sparing treatment is offered instead, even when the cancer is high grade. This is a joint decision. You accept a higher chance of the cancer coming back, to stay off dialysis.
When the other kidney is weak, a nuclear kidney scan comes first. It measures how much work each kidney does. That number is known before any decision to remove a kidney.
Kidney-sparing treatment is offered only where the laser equipment and the second-look camera test are available. A laser treatment without the second look is incomplete treatment.
The method depends on where the tumour sits.
| Where the tumour is | What is done | Point to know |
|---|---|---|
| Inside the kidney’s drainage space, or the upper ureter. | Laser through a thin camera passed up the urine passage. | No cut on the skin. |
| Lower ureter, near the bladder. | The lower ureter is removed and rejoined to the bladder. | Gives a full tissue report. Preferred for tumours here. |
| Middle of the ureter. | That segment is removed and the two ends joined. | The kidney stays. |
| A large tumour low in the kidney’s drainage space. | Treatment through a small tunnel in the back. | A small risk of cancer cells seeding along the tunnel. |
A medicine can also be placed in the upper urinary tract through a tube. Mitomycin gel is one choice. BCG is used for a flat early form called CIS, when it can be found; it has been in short supply. The proof for these is modest. They add to the checks. They do not replace them.
Sometimes cancer appears in both ureters, or in the drainage space of both kidneys. Removing both kidneys would mean dialysis. So each side is usually treated with kidney-sparing methods. The decision is made with a kidney physician. Checks then cover both sides, for life.
Kidney function falls after nephroureterectomy and stays lower. If it is already low, the drop matters more. A kidney physician helps plan the surgery. Blood pressure and diabetes are brought under control before the operation.
Weak kidneys also affect chemotherapy. For deeper cancers, chemotherapy is advised after surgery. The stronger drug, cisplatin, needs good kidney function. After the operation, it may no longer be possible.
With high-risk cancer and borderline kidney function, chemotherapy before surgery may be discussed. It is a case-by-case choice and is not yet proven for this cancer.
Risks of the operation are higher in older people and in those with weak kidneys. These are explained to you in person.
This cancer can be the first sign of Lynch syndrome. Lynch is an inherited condition. It raises the risk of bowel, womb, stomach, ovary and small bowel cancers in a family.
So every tumour is tested for Lynch, with a special stain on the tissue. You are also asked three questions.
If the tissue test points to Lynch, you are referred to genetics. A blood test can confirm it. Relatives can then be tested too. Those who carry it start bowel camera checks from age 25. Women relatives also need womb and ovary checks. Each relative’s testing is followed until it is done.
The kidney’s drainage space, the ureter and the bladder share one continuous lining. A cancer in one part can appear in another. So the bladder is never assumed to be clear. A bladder camera test is done before any treatment of the ureter.
Some people had their bladder removed earlier for a high-grade bladder cancer. If a ureter cancer appears later, it is treated as high risk.
Some newer medicines after surgery, such as nivolumab, cost more than most families can manage. Cost is raised at the first talk, not after the first dose. The benefit is stated plainly. It delays the return of the cancer, but a longer life is not yet proven.
Usually, yes. Kidney-sparing treatment is offered when removing the kidney would mean dialysis. It needs a second-look test and lifelong camera checks.
It keeps the kidney, but the cancer is more likely to come back. Some people later need the full operation. This trade-off is decided with you.
This cancer can be the first sign of Lynch syndrome in a family. A positive test means relatives can be checked early.
Yes. The bladder is checked before any treatment. After a bladder removal for high-grade cancer, a new ureter cancer is treated as high risk.
The kidney is drained first, usually by a thin tube through the back. Cancer treatment is planned once the infection settles.
The standard operation is explained on the radical nephroureterectomy page. Early signs and the first tests are on the ureter and renal pelvis cancer signs page. To discuss your situation, call +91-63590-11009. Gota OPD, Gota, Ahmedabad. The wider picture of kidney cancer surgery is in the kidney cancer surgery guide.
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
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