The patient had persistent lower back pain and, upon examination, was found to have kidney cancer.

According to the patient, he frequently experienced lumbar pain but was subjective about it, assuming it was due to aging and heavy labor. For many years, he did not undergo general health check-ups or routine ultrasounds. When the pain gradually worsened and was accompanied by fatigue, his family took him to the hospital.

According to MSc., Dr. Trần Quốc Phong, Head of the Urology Unit at An Bình Hospital, ultrasound revealed an abnormal structure in the left kidney. A CT scan later confirmed a tumor occupying nearly the entire renal pelvis, causing mild dilation of the calyces and hydronephrosis.

“The initial diagnosis was suspected urothelial carcinoma originating from the renal pelvis lining — a rare type of cancer often associated with long-term smoking. Based on these findings, the patient was indicated for radical nephroureterectomy using a retroperitoneal laparoscopic approach,” Dr. Phong said.

Dr. Phong added that this was a challenging surgery. The entire left kidney and ureter were covered by fibrotic tissue, making dissection far more difficult than typical renal cancer cases. The retroperitoneal space was narrow, and severe inflammatory adhesions altered the anatomical structures, forcing the team to proceed cautiously, millimeter by millimeter, to avoid damaging major blood vessels and nearby organs.

The surgery lasted five hours. Ultimately, the team removed the entire left kidney, the full length of the ureter, and part of the bladder wall — in accordance with radical treatment principles for upper urinary tract transitional cell carcinoma. The procedure was successful; the patient was transferred to recovery and began stabilizing.

Unexpected findings emerged after the tumor was sent to the pathology department. Histology revealed that the patient not only had transitional cell carcinoma (TCC), commonly found in the renal pelvis and ureter, but also squamous cell carcinoma (SCC) within the same tumor.

This is a rare occurrence, as SCC in the upper urinary tract is typically linked to long-term chronic irritation such as stones, infections, or heavy smoking. The simultaneous presence of both malignancies in the same renal pelvis tumor has been reported at very low rates in medical literature.

Smoking risk and urinary–renal cancer

Dr. Trần Quốc Phong emphasized that this case serves as a major warning for the community. He noted that the most significant risk factor for upper urinary tract cancer is smoking, because toxins in cigarette smoke are excreted through the urinary system, continuously irritating the lining of the renal pelvis and ureter. Over many years, this can lead to cellular changes and cancer development. Smoking also increases the risk of bladder cancer and many other cancers.

The patient’s lack of regular check-ups allowed the tumor to progress silently until symptoms appeared. According to Dr. Phong, if detected earlier, treatment would have been simpler, the possibility of preserving kidney tissue higher, and survival prognosis better. Even after radical surgery, the patient will require long-term monitoring because urinary tract cancers can recur or appear in other locations.

From this case, doctors recommend that the public — especially middle-aged individuals and long-term smokers — undergo annual general health examinations and abdominal ultrasounds. These simple tests can detect many dangerous urological conditions early, such as kidney stones, ureteral strictures, hydronephrosis, or suspected malignant lesions.

Dr. Phong stressed that persistent back pain should never be ignored, especially when accompanied by hematuria, cloudy urine, unexplained weight loss, or prolonged fatigue. These symptoms are easily mistaken for musculoskeletal problems or aging, leading to delayed medical evaluation and missed early treatment opportunities. Upper urinary tract cancers often progress silently and are difficult to detect early unless patients proactively seek medical care.

“People need to build the habit of annual health check-ups. This is not only a way to protect personal health but also helps reduce the treatment burden on families and society,” Dr. Phong added.