eventually leads to blockage of the ureter and possibly other body parts if left untreated. The risk of developing ureteral cancer increases with age. In addition to increasing age, previous bladder or kidney cancer diagnoses may also increase the risk of developing ureteral cancer. HNPCC (hereditary nonpolyposis colorectal cancer), also known as lynch syndrome, leads to an increased risk of developing ureteral cancer, as well as various other cancers such as colon cancer. Aside from genetic factors and predisposition to developing cancer, there are also a few environmental factors and lifestyle choices that may significantly escalate the chances of being diagnosed with ureteral cancer. For example, taking an overabundance of pain medications such as phenacetin, a probable carcinogen, can lead to an increased risk. Exposure to certain chemicals used to produce leather goods, plastics, rubber, etc. have also been proven to influence the likeliness of developing ureteral cancer. As with many other types of cancer, tobacco smoking is also associated with an increased risk of ureteral cancer. Diagnosis Diagnosis may include a fluorescence in situ hybridization (FISH) test, computed tomography urography (CTU), magnetic resonance urography (MRU), intravenous pyelography (IVP) x-ray, ureteroscopy, or biopsy. Before a diagnosis is made, a physical examination and health history will be conducted. This includes questions related to current signs and symptoms, which are used to better understand the presenting condition. Imaging tests such as CTU and IVP are also frequently used, as well as MRU, which is used if CT imaging is not available or suitable for the patient. A procedure called a ureteroscopy is also used to inspect the ureters. During this procedure a thin, lighted tube equipped with a camera is inserted through the urethra and into the bladder, ureter, and renal pelvis. This can also include a biopsy (small sample of tissues collected), which will then be inspected in the laboratory. Less invasive common testing methods include a urine test, a urine cytology test to look for abnormal cells, as well as a urinalysis to check the color of urine and its contents. Pathology and staging There are multiple stages of ureteral cancer: 0, I, II, III, and IV. Stage 0 can be divided into stages 0a and 0is and occurs when abnormal cells appear in the tissue lining the inside of the ureter. Stage 0a (noninvasive papillary carcinoma) is when long, thin growths extend from the tissue lining the ureter. Stage