1. What is an upper urinary tract epithelial neoplasm? Upper urinary tract tumor can be defined as a neoplastic neoplasm involving the urinary tract between the calyces and the distal ureter; and the final pathological findings of most upper urinary tract tumors are mostly uroepithelial carcinoma (hereinafter referred to as UTUC). What is the correlation between the onset of UTUC and the tumor in Shanghai Renji Hospital, Department of Urology, Huang Jiwei 2. UTUC is mostly concentrated in the age of 70 to 90 years and is more frequent in men; female patients have less tumor malignancy compared to male patients, etc. For upper urinary tract tumors, smoking is the most important modifiable risk factor; incidence is three times higher in smokers than in non-smokers and correlates with the amount of smoking; incidence is 7.2 times higher than normal in long-term smokers (more than 45 years); other associated factors include: analgesic abuse, occupational exposure (chemical, oil and plastic industries), chronic inflammation (urinary tract stones and obstruction-related chronic bacterial infections ). Notably, in the Chinese population, the occurrence of UTUC is mainly associated with the use of herbal medicines containing aristolochic acid.3. What are the symptoms of UTUC? The most common clinical sign of hematuria, including visual or microscopic hematuria, is a heterogeneous or even neoplastic lesion of the urinary epithelium, followed by low back pain, usually dull, probably due to progressive urinary tract overgrowth and expansion of hydronephrosis. The presence of a lump in the lower back and abdomen, weight loss over a short period of time, anorexia and bone pain often suggest that the disease has progressed to an advanced stage. Therefore, it is important for elderly men to seek prompt medical attention once they develop abnormal urine color.4. What ancillary tests are needed after suspicion of UTUC? 1) Ultrasound: As a non-invasive test, it can detect separation and dilatation of the renal pelvis and calyces or ureter, and often reveals hypoechoic solid masses.2) CTU or MRU: It can provide three-dimensional imaging of the upper urinary tract; it is useful in determining the extent of tumor infiltration, associated masses outside the collecting system, and the presence of lymph nodes. 3) Cystoscopy: Since upper urinary tract tumors are often associated with bladder cancer, cystoscopy can clarify whether there is a combination of bladder tumors. 4) Ureteroscopy: Tumors can be directly observed, and biopsies of suspicious lesions can also be performed directly through ureteroscopy. However, it is worth mentioning that biopsy often takes small samples and it is difficult to finalize the tumor stage accurately. 5 How to treat UTUC? Radical ureterectomy and cystectomy remain the “gold standard” of treatment for UTUC; the procedure can be done openly or laparoscopically. Renal conservation is also traditionally considered necessary in cases of isolated kidney, chronic renal insufficiency, and other conditions that require renal transplantation or long-term dialysis treatment after nephrectomy. Increasingly, studies have shown that endoscopic treatment or partial nephrectomy can be performed in some cases with small, low-grade tumors and normal contralateral kidneys. In patients with advanced UTUC, chemotherapy is mostly administered based on experience with bladder cancer, but clinical evidence is insufficient.6. What is the prognosis for UTUC? Similar to other tumors, the most important factor in predicting the survival of patients with upper urinary tract uroepithelial tumors is still the stage of the tumor, and the most common staging system is TMN stage; the more advanced the stage, the worse the prognosis; the survival rate of patients with stage T3 tumors that penetrate the perinephric and periureteral fat is significantly lower; the prognosis of pelvic tumors and ureteral tumors is inconclusive. The prognosis of UTUC is also influenced by the tumor grade, the presence of carcinoma in situ, lymphovascular invasion, and the presence of combined bladder cancer. This article is published with permission from Dr. Jiwei Huang.