Team:CSMU Taiwan/Description
Description
Upper Tract Urothelial Carcinoma
Upper Tract Urothelial Carcinoma [1] (UTUC) is a subset of urothelial carcinoma that arise in the lining of the renal pelvis or the ureter. Haematuria (the presence of blood or red blood cells in the urine) and hydronephrosis (the swelling of a kidney due to a build-up of urine) are the common first signs of UTUC. Delay in detection and treatment [2] could cause severe urinary tract infections and cancer metastasis. General risk factors for UTUCs include old age, exposure to certain chemicals over time, family history of UTUC or diabetes, prior chemotherapy or radiation therapy for another cancer, or undergoing dialysis therapy [3]. In particular, dialysis patients show a higher rate of developing UTUC. Some urologists suggested that chronic kidney disease and upper tract urothelial carcinomas have a bidirectional relationship. The dialysis rate in Taiwan is the largest worldwide, which puts the Taiwan population in a position of elevated risk to UTUC. Sad to say, UTUC is difficult to be diagnosed in its early stages. Thus, it is usually only detected in the terminal stages. Moreover, current UTUCs medical diagnosis has problems such as low accuracy and intrusiveness.
Current Diagnostic Problem
Current diagnostic method of UTUCs are CT, MRI and Urethroscopy(URE). These three methods have low accuracy and highly risk problem. Detection through CT scan is highly dependent on the size of the tumor, so it may not be able to show flat or small tumors. This limitation leads to difficulty of early detection and reduced chances of treatment. The accuracy of MRI is slightly higher than CT but it has a serious problem about Gadolinium [4] in contrast agents. This element has a negative influence over patients with chronic kidney disease more likely to develop Nephrogenic systemic fibrosis. URE is currently the most accurate way to detect UTUC. However, general anesthesia is the necessary and risky process to patients in URE, and urologists would only offer this detection while the symptoms are obvious. Therefore, detection methods mentioned above are not ideal for examination of early stage UTUC.
Micro RNA is a new target of cancers detected in blood or urine, and the amount of micro RNA can be inferred to the status of tumor development.[5] When metastasis or hyperplasia of malignant tumors occur, the level of specific micro RNA would increase rapidly. Based on this mechanism, measuring the concentration of targeted micro RNA and analyzing the fold change compared to normal value can lead to the stage of cancer.
How we solve the problem?
This year, we designed a detection kit called GotCha based on the specificity of micro RNA. It effectively analyzes the risk of UTUC before the last stage through the amount of micro RNA measured from blood test. The accessibility of blood sample shows a great potential to other UTUC detections, and we expected that GotCha can bring a breakthrough of UTUC early diagnostic method and lower the occurrence of treatment delay and misdiagnosis of UTUC.
References
- Soria, F., Shariat, S. F., Lerner, S. P., Fritsche, H. M., Rink, M., Kassouf, W., Spiess, P. E., Lotan, Y., Ye, D., Fernández, M. I., Kikuchi, E., Chade, D. C., Babjuk, M., Grollman, A. P., & Thalmann, G. N. (2017). Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World journal of urology, 35(3), 379–387.
- Rouprêt, M., Babjuk, M., Compérat, E., Zigeuner, R., Sylvester, R. J., Burger, M., Cowan, N. C., Gontero, P., Van Rhijn, B., Mostafid, A. H., Palou, J., & Shariat, S. F. (2018). European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2017 Update. European urology, 73(1), 111–122.
- Wang, L. J., Lee, S. Y., Teh, B. T., Chuang, C. K., & Nortier, J. (2014). Upper tract urothelial carcinomas in patients with chronic kidney disease: relationship with diagnostic challenge. BioMed research international, 2014, 989458.
- Weinreb, J. C., Rodby, R. A., Yee, J., Wang, C. L., Fine, D., McDonald, R. J., Perazella, M. A., Dillman, J. R., & Davenport, M. S. (2021). Use of Intravenous Gadolinium-based Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Radiology, 298(1), 28–35.
- Chen, L., Heikkinen, L., Wang, C., Yang, Y., Sun, H., & Wong, G. (2019). Trends in the development of miRNA bioinformatics tools. Briefings in bioinformatics, 20(5), 1836–1852.
