BackTable / Urology / Podcast / Episode #50

Breaking Down Upper Tract Malignancy

with Dr. Katie Murray

In this episode of BackTable Urology, Dr. Silva interviews Dr. Katie Murray, a urologic oncologist from the University of Missouri, about management of high and low-grade upper tract urothelial cancer.

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JELMYTO
Breaking Down Upper Tract Malignancy with Dr. Katie Murray on the BackTable Urology Podcast)
Ep 50 Breaking Down Upper Tract Malignancy with Dr. Katie Murray
00:00 / 01:04

BackTable, LLC (Producer). (2022, August 17). Ep. 50 – Breaking Down Upper Tract Malignancy [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Katie Murray discusses Breaking Down Upper Tract Malignancy on the BackTable 50 Podcast

Dr. Katie Murray

Dr. Katie Murray is a urologic oncologist with the University of Missouri.

Dr. Jose Silva discusses Breaking Down Upper Tract Malignancy on the BackTable 50 Podcast

Dr. Jose Silva

Dr. Jose Silva is a board certified urologist practicing in Central Florida.

Show Notes

Dr. Murray prefaces the discussion by explaining that historically, upper tract urothelial cancer (UTUC) has been treated similarly to bladder cancer, but the two malignancies are actually very different. For this reason, there are no set guidelines for the management of UTUC in the United States. Then, she describes her typical workup of a UTUC patient. ALthough most of her referrals are from general urologists who already diagnosed UTUC in patients, she sometimes gets referrals for patients with gross/microscopic hematuria that leads to a de novo diagnosis of UTUC. Dr. Murray will perform a routine cystoscopy and a ureteroscopy on her patients; she prefers the Olympus scope with narrow band imaging and a flexible ureteroscope without a ureteral access sheath, respectively. She does not always perform a retrograde pyelogram because her decision depends on the patient’s comorbidities and cytology results.

Then, Dr. Murray explains her surgical techniques for managing UTUC. For low-grade and small tumors, she will perform an endoscopic ablation during the biopsy if the tumor is easy to remove. For larger tumors, she will only perform a biopsy and further evaluate the patient for the next steps. She notes that all biopsies have a risk of spreading the cancer along the ureter, as urothelial cancer can implant anywhere in the tract during the procedure. Additionally, although she does not use balloon dilation during biopsies, she places a stent instead. For visualization, she uses the single action pump system (SAPS). Finally, she explains the importance of intravesical therapy after ablation.

Next, Dr. Murray explains the difference in managing low versus high-grade UTUC. Low grade UTUC has a high recurrence rate (over 50%). For low grade tumors, endoscopic ablation is her first-line treatment. She also recommends a six-week course of JELMYTO, a mitomycin gel as a non-surgical option. She uses a cystoscope or nephrostomy tube to deliver the JELMYTO medication. For patients with a high-grade tumor, Dr. Murray only performs an ablation if the patient has contraindication to every other surgical procedure. For distal high-grade UTUC, she performs a distal ureterectomy with a node dissection and follows with a ureteral implant. For proximal high-grade UTUC in the renal pelvis, she will perform a nephroureterectomy. In all high-grade tumors, she emphasizes the importance of thorough assessment of pelvic nodes and chest/abdomen/pelvis imaging to accurately stage the cancer. When deciding whether to start neoadjuvant chemotherapy before surgery, Dr. Murray recommends collaborating with the oncologist.

Lastly, Dr. Murray explains her approach treating a patient with bilateral UTUC, which is to prioritize surgical management of the worst side first.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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