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Distant metastases Prior to any treatment with curative intent, it is essential to rule out distant metastases. Summary of evidence and guidelines for the my wife wants a wife of UTUC Summary of evidence LE The diagnosis and staging of UTUC is roche h232 done with computed tomography urography and URS.

Strong Perform a computed tomography (CT) urography for diagnosis and staging. Prognostic factors Upper urinary tract UCs that invade the muscle wall usually have a very poor prognosis. Surgical delay A delay between diagnosis of an invasive tumour and its removal may increase the risk of disease progression. Surgical margins Positive soft tissue surgical margin is associated with a higher disease recurrence after RNU.

Molecular markers Because of the rarity of UTUC, the main limitations of molecular studies are their retrospective design and, for most studies, small sample size. Risk stratification for clinical decision making 6. Summary of evidence and guidelines for the prognosis of UTUC Summary of evidence LE Important prognostic factors for risk stratification include tumour multifocality, size, stage, grade, hydronephrosis and variant histology. Kidney-sparing surgery Kidney-sparing surgery for low-risk UTUC reduces my wife wants a wife morbidity associated with radical surgery (e.

Ureteral resection Segmental ureteral resection dsm wide margins provides adequate pathological specimens for staging and grading while preserving the ipsilateral kidney. Guidelines for kidney-sparing management of UTUC Recommendations Strength rating Offer kidney-sparing management as primary treatment option to patients with low-risk tumours.

Strong Offer kidney-sparing management (distal ureterectomy) to patients with high-risk tumours limited to the distal ureter. Management of high-risk non-metastatic UTUC 7. Several precautions may lower the risk of my wife wants a wife spillage: 1. Laparoscopic RNU is safe in experienced hands when adhering to strict oncological principles.

Adjuvant radiotherapy after radical nephroureterectomy Adjuvant radiation therapy has been suggested to control loco-regional disease after surgical removal. Summary of evidence and guidelines for the management of high-risk non-metastatic UTUC Summary of evidence LE Radical nephroureterectomy is the standard treatment for high-risk UTUC, regardless of tumour location.

Strong Perform open RNU in non-organ confined UTUC. Weak Remove the bladder cuff in its entirety. Strong Perform a template-based lymphadenectomy in patients with muscle-invasive UTUC.

Strong Offer post-operative systemic platinum-based chemotherapy to patients with muscle-invasive UTUC. Strong Deliver a post-operative bladder instillation of chemotherapy to lower the intravesical recurrence rate.

Metastasectomy There is no UTUC-specific study supporting the role of metastasectomy in patients with advanced disease. First-line setting Extrapolating from the bladder cancer literature and small, single-centre, UTUC studies, platinum-based combination chemotherapy, especially using cisplatin, is likely to be efficacious as first-line treatment of metastatic UTUC.

Second-line setting Similar to the bladder cancer setting, second-line treatment of metastatic UTUC remains challenging. Summary of evidence and guidelines for the treatment of metastatic UTUC Summary of evidence LE Radical nephroureterectomy may improve quality of life and oncologic outcomes in select metastatic patients.

Weak First-line treatment for cisplatin-eligible patients Use cisplatin-containing combination chemotherapy with GC or HD-MVAC. Strong Do not offer carboplatin or non-platinum combination chemotherapy. My wife wants a wife First-line treatment in patients unfit for cisplatin Offer checkpoint inhibitors pembrolizumab or atezolizumab depending on PD-L1 status.

Weak Offer carboplatin combination chemotherapy if PD-L1 is negative. Strong Second-line treatment Offer checkpoint flu avian (pembrolizumab) to patients with disease progression during my wife wants a wife after phenylpropionate nandrolone combination my wife wants a wife for metastatic disease.

Strong My wife wants a wife checkpoint inhibitor (atezolizumab or nivolumab) to patients with disease progression during or after platinum-based combination chemotherapy for metastatic disease. Strong Only offer vinflunine to patients for metastatic disease as second-line treatment if immunotherapy or combination chemotherapy is not feasible.

Summary of evidence and guidelines for the follow-up of UTUC Summary of evidence LE Follow-up is more frequent and more stringent in patients who have undergone kidney-sparing treatment compared to radical nephroureterectomy. Weak High-risk tumours Perform cystoscopy and urinary cytology at three months. Weak Perform computed tomography (CT) urography and chest CT every six months for two years, and then yearly. Weak After kidney-sparing management Low-risk tumours Equity cystoscopy and CT urography at three and six months, and then yearly for five years.

Weak Perform ureteroscopy (URS) at three months. Weak High-risk tumours Perform cystoscopy, urinary cytology, CT urography and chest CT at my wife wants a wife and six months, and then yearly.

CONFLICT OF INTEREST All members of the Non-Muscle-Invasive Bladder Cancer Guidelines working panel have provided disclosure statements on all relationships that they have that might be perceived to be a potential source of a conflict of interest.

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Post-operative chemotherapy my wife wants a wife disease-free survival. Recommendation Strength rating Offer post-operative systemic platinum-based chemotherapy to patients with muscle-invasive UTUC.

Patients with Lynch syndrome are at risk for UTUC. Recommendations Strength rating Evaluate patient and family history based on the Amsterdam criteria to identify patients with upper tract urothelial carcinoma. Evaluate patient exposure to smoking and aristolochic acid.

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