Editing Upper Urinary Tract Urothelial Cancer (section)

===Survivorship===
*Discuss disease-related stresses and risk factors and encourage patients with urothelial cancer to adopt healthy lifestyle habits, including smoking cessation, exercise, and a healthy diet, to promote long-term health benefits and quality of life.
**UTUC is associated with metabolic syndrome and obesity, with obesity adversely impacting disease-specific outcomes among patients undergoing RNU.
**Clinicians should work with patients and their primary care providers to ensure that comorbidities are optimally managed throughout the course of care for UTUC and during surveillance to maximize quality of life during survivorship.
<h2>Questions</h2>
  <ol>
   <li>What are the risk factors for upper tract urothelial carcinoma (UTUC)?</li>
   <li>Which other malignancies are associated with Lynch syndrome?</li>
   <li>In patients with bladder cancer, what is the risk of subsequent UTUC? In patients with UTUC, what is the risk of subsequent bladder cancer?</li>
   <li>in patients that have undergone cystectomy for bladder cancer, which of the following is not a risk factor for subsequent UTUC?</li>
   <li>What is the most important predictor of developing metastasis?</li>
   <li>What is the differential diagnosis of a filling defect in the collecting system?</li>
   <li>What is the most important prognostic factor for survival in UTUC?</li>
   <li>What are the indications for nephroureterectomy? Segmental ureterectomy?</li>
  </ol>
	<h2>Answers</h2>
  <ol>
   <li>What are the risk factors for upper tract urothelial carcinoma (UTUC)?</li>
   <ol>
    <li>Smoking</li>
    <li>Occupational exposure</li>
    <li>Chronic inflammation</li>
    <li>Cyclophosphamide exposure</li>
    <li>Analgesic abuse</li>
    <li>Lynch syndrome</li>
    <li>Exposure to aristolocholic acid (Balkan nephropathy)</li>
    <li>Exposure to arsenic</li>
   </ol>
   <li>Which other malignancies are associated with Lynch syndrome?
    <ul>
     <li>Colonic (most common), endometrial (second most common), prostate, urothelial, adrenal, gastric, pancreatic, uterine, ovarian, and sebaceous carcinomas </li>
    </ul>
   </li>
   <li>In patients with bladder cancer, what is the risk of subsequent UTUC? In patients with UTUC, what is the risk of subsequent bladder cancer?
    <ul>
     <li>2-4% patients with bladder cancer will subsequently develop UTUC,</li>
     <li>≈30% patients with UTUC will subsequently develop bladder cancer after nephroureterectomy or nephron-sparing procedures</li>
    </ul>
   </li>
   <li>In patients that have undergone cystectomy for bladder cancer, which of the following is not a risk factor for subsequent UTUC?</li>
   <ol>
    <li>Presence of CIS</li>
    <li>N0 status</li>
    <li><u>High-grade tumours</u></li>
    <li>Involvement of male prostatic urethra or female urethra</li>
   </ol>
   <li>What is the most important predictor of developing metastasis?
    <ul>
     <li>T stage &gt; 2</li>
    </ul>
   </li>
   <li>What is the differential diagnosis of a filling defect in the collecting system?</li>
   <ol>
    <li>Tumour</li>
    <li>Blood clot</li>
    <li>Stone</li>
    <li>Sloughed papilla</li>
    <li>Fungus ball</li>
    <li>Overlying bowel gas</li>
    <li>External compression</li>
   </ol>
   <li>What is the most important prognostic factor for survival in UTUC?
    <ul>
     <li>Stage; recall in bladder grade has stronger association with progression of NMIBC than stage</li>
    </ul>
   </li>
   <li>What are the indications for nephroureterectomy? Segmental ureterectomy?
    <ul>
     <li>Nephroureterectomy: high-grade or pT2</li>
     <li>Segmental ureterectomy: 
      <ul>
       <li>Low-grade, low-stage tumors that are not able to be removed endoscopically because of tumor size or multiplicity </li>
       <li>High-grade or invasive tumors when preservation of renal unit is necessary </li>
      </ul>
     </li>
    </ul>
   </li>
   </ol><h2>References</h2>
   <ul>
    <li>Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, vol 1, chap 58</li><li>[https://pubmed.ncbi.nlm.nih.gov/37096584/ Coleman, Jonathan A., et al. "Diagnosis and Management of Non-Metastatic Upper Tract Urothelial Carcinoma: AUA/SUO Guideline." ''The Journal of Urology'' 209.6 (2023): 1071-1081.]
</li>
   </ul>