Ureteral Cancer: Symptoms, Causes, Diagnosis, and Treatment Explained
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Editorial note: This article is provided for educational purposes only. It is not medical advice. Always consult a qualified healthcare professional for diagnosis and treatment of any condition.
Quick Answer: What Is Ureteral Cancer?
Ureteral cancer is a growth of cells that starts in the ureters, the tubes carrying urine from the kidneys to the bladder [1]. It is uncommon and occurs most often in older adults and people who have had bladder cancer [1]. Because ureter and bladder linings share a cell type, patients are usually checked for bladder cancer [1]. Treatment typically involves surgery [2].
What the research says
Chemotherapy after surgery improved outcomes in advanced disease. In the POUT trial of 261 patients with locally advanced upper tract urothelial carcinoma (the cancer type that includes ureteral cancer), gemcitabine–platinum chemotherapy started within 90 days of nephroureterectomy cut the risk of recurrence or death (hazard ratio 0.45; 95% CI 0.30–0.68). Three-year event-free survival was 71% with chemotherapy versus 46% with surveillance alone. Serious (grade 3 or worse) side effects occurred in 44% of those who started chemotherapy (Birtle et al., The Lancet, 2020) [3].
Surgery can control disease, and certain tumor features predict outcome. In 1,363 patients who had radical nephroureterectomy at 12 academic centers, 5-year recurrence-free survival was 69% and cancer-specific survival was 73%. High tumor grade, advanced stage and lymph node spread were linked to a worse outlook, and 28% had a recurrence outside the bladder (Margulis et al., Cancer, 2009) [4].
What Is Ureteral Cancer?
Ureteral cancer is a growth of cells that starts in the ureters. The ureters are tubes that connect the kidneys to the bladder, and they are part of the urinary tract [1]. They carry urine produced by the kidneys to the bladder.
The urinary system includes the kidneys, ureters, bladder, and urethra. Its job is to remove waste from the body through urine. The kidneys sit toward the back of the upper belly, where they filter waste and fluid from the blood and make urine [1]. Urine then moves through the narrow ureter tubes to the bladder, which stores urine until it is time to urinate. Urine finally leaves the body through a small tube called the urethra [1]. See our guide to Understanding the Bladder: Anatomy, Function, and Care for more.
Ureteral cancer is not common [1]. When it happens, it occurs most often in older adults and in people who have had bladder cancer. It is closely related to bladder cancer: the cells that line the ureters are the same type of cells that line the inside of the bladder [1]. Because of this shared cell type, people diagnosed with ureteral cancer have an increased risk of bladder cancer. For that reason, people with ureteral cancer are usually tested for signs of bladder cancer [1].
Ureteral Cancer vs. Kidney Cancer and Bladder Cancer
Because the urinary tract is one connected system, people often confuse cancers of its different parts. These three related cancers are different in where they begin. Learn more in our Kidney Cancer: Symptoms, Causes & Treatment Guide.
Cancer type | Where it starts |
Kidney cancer | In the kidney itself, where blood is filtered and urine is made |
Ureteral cancer | In the ureters, the tubes connecting the kidneys to the bladder |
Bladder cancer | In the bladder, which stores urine before it leaves the body |
What Does Ureteral Cancer Feel Like? (Symptoms)
Signs and symptoms of ureteral cancer include:
When to See a Doctor
Make an appointment with a doctor or other healthcare professional if you have any persistent symptoms that worry you [1]. Blood in the urine — especially when it is painless — is the warning sign that most often leads to diagnosis, and it should never be ignored even if it happens only once. Our guide to Microhematuria Explained: Causes, Symptoms, and Diagnostic Steps explains how blood in the urine is evaluated.
What Causes Ureteral Cancer?
It is not clear what causes ureteral cancer [1]. Ureteral cancer starts as a growth of cells in a ureter.
Ureteral cancer happens when cells in a ureter develop changes in their DNA [1]. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate, and it also tells the cells to die at a set time [1].
In cancer cells, the DNA changes give other instructions. The changes tell the cancer cells to grow and multiply quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells [1].
The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it is called metastatic cancer [1].
Risk Factors
Factors that can increase the risk of ureteral cancer include:
Risk factor | Detail |
Increasing age | The risk of ureteral cancer goes up with age; most people diagnosed with this cancer are in their 70s and 80s [1] |
Previous bladder or kidney cancer | People diagnosed with bladder cancer or kidney cancer have a higher risk of ureteral cancer [1] |
Smoking tobacco | Raises the risk of ureteral cancer, as well as kidney cancer and bladder cancer [1] |
Exposure to certain chemicals | Working with certain chemicals is linked to an increased risk [1] |
Family history of cancer | With a strong family history, healthcare professionals may consider genetic testing for inherited cancer syndromes such as Lynch syndrome, which raises the risk of colon cancer and other cancers, including ureteral cancer [1] |
Lynch syndrome also raises the risk of colon cancer — see Colon Cancer: Symptoms, Causes, Diagnosis, Staging and Treatment.
Can Ureteral Cancer Be Prevented?
Although there is no sure way to prevent ureteral cancer, you can take steps to help reduce your risk [1].
Step | How it helps |
Don't smoke | If you don't smoke, don't start. If you smoke, talk with your healthcare professional about a plan to quit; support groups, medicines, and other methods may help [1] |
Take caution around chemicals | If you work with chemicals, follow all safety instructions to avoid harmful exposure [1] |
Choose a variety of fruits and vegetables | The antioxidants in fruits and vegetables may help reduce the risk of certain cancers [1] |
How Is Ureteral Cancer Diagnosed?
To diagnose ureteral cancer, a healthcare professional might start by asking about your symptoms and examining your body [2]. You might have a procedure to see inside your urinary tract to look for signs of cancer. Other tests and procedures include urine tests and imaging tests [2].
Diagnostic step | What it involves |
Physical exam | Questions about symptoms and an examination of the body to better understand the condition |
Urinalysis | A test to analyze the urine |
Urine cytology | A test to look for concerning cells in a urine sample [2] |
Imaging tests | Pictures of the body that help the healthcare team understand the size of the cancer and look for signs it may have spread beyond the ureter [2] |
Ureteroscopy | A thin, lighted tube with a camera is inserted into the urethra and passed through the bladder into the ureters [2], allowing the doctor to inspect the ureters directly |
Biopsy | A tissue sample removed during ureteroscopy and tested in a lab for signs of cancer [2] |
Tests for bladder cancer | Imaging to examine the bladder and cystoscopy (a scope to see inside the bladder), because of the high risk of bladder cancer [2] |
Imaging tests used for ureteral cancer may include the intravenous pyelogram, the computerized tomography urogram (CT urogram), the magnetic resonance urogram (MR urogram), and the positron emission tomography scan (PET scan) [2]. Your healthcare team chooses which imaging tests you need based on your situation.
Staging: What Does the Cancer Stage Tell Us?
Information from the diagnostic procedures is used to assign a stage to the cancer. The stage tells your healthcare team about the extent of the cancer and about your prognosis [2]. Lab tests may also look for changes in the DNA inside the cancer cells, and results from these tests may help your healthcare team make a treatment plan [2].
Why Bladder Cancer Testing Matters
People diagnosed with ureteral cancer have a high risk of bladder cancer. Bladder cancer may occur at the same time as the ureteral cancer or grow soon after treatment [2]. Because the cells that line the ureters are the same type that line the inside of the bladder, ongoing bladder monitoring is a standard part of both diagnosis and follow-up care.
How Is Ureteral Cancer Treated?
Treatment options for ureteral cancer include surgery, chemotherapy, immunotherapy, and targeted therapy [2]. Treatment depends on many factors, including the size and location of the cancer, how aggressive the cells are, and your own goals and preferences [2].
Surgery
Surgery is often recommended to remove ureteral cancer [2]. The kind of surgery used will depend on your cancer.
Situation | Surgical approach |
Small cancer that hasn't spread beyond the ureter | Surgery may remove only a portion of the ureter [2] |
Cancer that grows larger or spreads beyond the ureter | The surgeon may remove the affected ureter, its associated kidney, and part of the bladder — a procedure sometimes referred to as a nephroureterectomy [2] |
Chemotherapy
Chemotherapy treats cancer with strong medicines. It is sometimes used before surgery to shrink the cancer, which can make it easier to remove during surgery [2]. It may also be used after surgery to kill any cancer cells that may remain [2]. For advanced ureteral cancer, chemotherapy may be used to control symptoms of the cancer [2].
Immunotherapy
Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells [2]. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
Immunotherapy might be an option for treating advanced ureteral cancer that spreads to nearby lymph nodes or other parts of the body [2]. It is sometimes used in combination with targeted therapies [2].
Targeted Therapy
Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die [2]. Your cancer cells may be tested to see if targeted therapy is likely to be effective. Targeted therapy may be used for treating advanced ureteral cancer [2].
Follow-Up Care
After treatment, your healthcare team may create a schedule of follow-up exams. During these exams, the team checks for signs that your cancer has returned and looks for signs of bladder cancer [2], since people diagnosed with ureteral cancer have an increased risk of bladder cancer.
The tests you have and the schedule of exams depend on your situation. Most people see their care teams every few months for the first year [2]. After that, visits may be less frequent.
Preparing for Your Appointment
If you have any symptoms that worry you, make an appointment with a doctor or other healthcare professional. If you are diagnosed with ureteral cancer, you will likely be referred to a urologist or oncologist [2]. A urologist is a doctor who specializes in conditions that affect the urinary system. An oncologist is a doctor who specializes in treating cancer.
Before your appointment, note the symptoms you are experiencing, including when you first noticed them and whether they have changed over time. Make a list of all your medicines, including prescriptions, over-the-counter medicines, vitamins, supplements, and herbal remedies [2]. Take a family member or friend along [2], because it can be difficult to remember all the information provided during an appointment.
Questions to ask at your initial appointment include: What may be causing my symptoms or condition? Are there any other possible causes? What kinds of tests do I need? What do you recommend for next steps in determining my diagnosis and treatment? Are there any restrictions that I need to follow in the meantime?
Questions to consider if referred to a specialist include: Do I have ureteral cancer? What are the goals of treatment in my case? What treatment do you recommend? Do I need to start treatment right away? I have other health conditions — how can I best treat them together? What are the possible side effects of treatment? If the first treatment isn't successful, what can we try next? What is the outlook for my condition?
Your healthcare team is likely to ask you questions, too: What are your symptoms? When did they begin? How have they changed over time? Have you been diagnosed or treated for any other medical conditions? What medicines are you taking?
Conclusion: What to Do Next
Ureteral cancer is rare, but its most common warning sign — blood in the urine — is something you can notice at home. If you see urine that looks red, pink, or cola colored, or if you have persistent back pain, pain when urinating, unexplained weight loss, or fatigue, make an appointment with a healthcare professional. Persistent symptoms that worry you deserve evaluation, and early diagnosis gives your care team the most treatment options.
If you have already been diagnosed, know that your care team will likely recommend surgery, and that chemotherapy, immunotherapy, and targeted therapy may be available depending on the size, location, and aggressiveness of your cancer. Because ureteral cancer and bladder cancer are closely related, expect regular follow-up exams — typically every few months during the first year — to check for cancer return and to screen for bladder cancer.
Talk to your doctor about blood in your urine today. Even a single episode of visible blood in the urine should be evaluated rather than ignored.
Frequently Asked Questions
1. What is ureteral cancer?
Ureteral cancer is a growth of cells that starts in the ureters, the tubes that connect the kidneys to the bladder and carry urine from the kidneys to the bladder. It is not common and is part of the urinary tract.
2. Is ureteral cancer the same as bladder cancer?
No, but they are closely related. The cells that line the ureters are the same type of cells that line the inside of the bladder. Because of this, people diagnosed with ureteral cancer have an increased risk of bladder cancer and are usually tested for signs of it.
3. What are the signs of ureteral cancer?
The most common sign is blood in the urine, which may make the urine look red, pink, or cola colored. Other signs include back pain, pain when urinating, losing weight without trying, and feeling very tired.
4. Who gets ureteral cancer?
It occurs most often in older adults and in people who have had bladder cancer. Most people diagnosed with it are in their 70s and 80s, and the risk goes up with age.
5. Does smoking cause ureteral cancer?
Smoking tobacco raises the risk of ureteral cancer. It also raises the risk of other urinary tract cancers, including kidney cancer and bladder cancer.
6. Can ureteral cancer run in families?
A strong family history of cancer can be a risk factor. In some cases, healthcare professionals may consider genetic testing for inherited cancer syndromes such as Lynch syndrome, which raises the risk of colon cancer and other cancers, including ureteral cancer.
7. What is a nephroureterectomy?
It is a surgery sometimes used for ureteral cancer that grows larger or spreads beyond the ureter. The surgeon removes the affected ureter, its associated kidney, and part of the bladder.
8. Is surgery always needed?
Surgery is often recommended to remove ureteral cancer, but not always in the same form. For a small cancer that hasn't spread beyond the ureter, surgery may remove only a portion of the ureter.
9. When is chemotherapy used?
Chemotherapy is sometimes used before surgery to shrink the cancer and make it easier to remove, after surgery to kill remaining cancer cells, or to control symptoms in advanced ureteral cancer.
10. What is immunotherapy for ureteral cancer?
Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. Cancer cells survive by hiding from the immune system; immunotherapy helps immune cells find and kill them. It might be an option for advanced ureteral cancer that spreads to nearby lymph nodes or other parts of the body.
11. How does targeted therapy work?
Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, the treatment can cause cancer cells to die. Your cancer cells may be tested first to see if targeted therapy is likely to be effective.
12. Why do I need bladder cancer testing after a ureteral cancer diagnosis?
People diagnosed with ureteral cancer have a high risk of bladder cancer, which may occur at the same time as the ureteral cancer or grow soon after treatment. Imaging tests and cystoscopy (a scope to see inside the bladder) may be used to examine the bladder.
13. How often will I need follow-up after treatment?
Most people see their care teams every few months for the first year after treatment. After that, visits may be less frequent. Follow-up exams check for signs the cancer has returned and for signs of bladder cancer.
14. What tests confirm the diagnosis?
Urine tests (urinalysis and urine cytology), imaging tests (such as a CT urogram or MR urogram), and ureteroscopy — a thin, lighted tube with a camera passed through the bladder into the ureters — with a biopsy to test a tissue sample in the lab.
15. Is blood in the urine always a sign of cancer?
No — blood in the urine has many possible causes, including infections and kidney stones. But because it can signal ureteral, bladder, or kidney cancer, persistent or painless blood in the urine should always be evaluated by a healthcare professional.
Related Reading
Transitional Cell Cancer: A Comprehensive Guide to Urothelial Carcinoma explains the cell type behind most ureteral and bladder cancers.
Nephroureterectomy: Procedure, Recovery, and Outcomes describes surgery to remove the kidney and ureter together.
Ureteroscopy: Procedures, Stone Treatment, and Recovery Guidelines explains the scope used to look inside and treat the ureter.
CT Urogram: What It Is, Why It's Done, How to Prepare and What to Expect describes the CT scan that images the kidneys, ureters and bladder.
References
Mayo Clinic Staff. Ureteral cancer - Symptoms and causes. Mayo Clinic. Accessed October 7, 2026. https://www.mayoclinic.org/diseases-conditions/ureteral-cancer/symptoms-causes/syc-20360721
Mayo Clinic Staff. Ureteral cancer - Diagnosis and treatment. Mayo Clinic. Accessed October 7, 2026. https://www.mayoclinic.org/diseases-conditions/ureteral-cancer/diagnosis-treatment/drc-20360722
Birtle A, Johnson M, Chester J, et al. Adjuvant chemotherapy in upper tract urothelial carcinoma (the POUT trial): a phase 3, open-label, randomised controlled trial. The Lancet. 2020;395(10232):1268-1277. PMID 32145825. https://doi.org/10.1016/S0140-6736(20)30415-3
Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009;115(6):1224-1233. PMID 19156917. https://doi.org/10.1002/cncr.24135
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