Causes and Risk Factors for Ureter Cancer

• Ureter cancer develops from a combination of genetic changes and impaired DNA repair in the cells lining the ureter.
• Smoking is the strongest and most well-documented risk factor for ureter cancer, a risk it shares with the more common bladder cancer.
• Workplace exposure to certain industrial chemicals and long-term arsenic exposure in drinking water have both been linked to a higher risk.
• People with Lynch syndrome, a hereditary DNA-repair gene condition, face elevated odds of multiple cancer types, urinary tract cancers among them.
• Age, sex, and race all play a role, and exposure to aristolochic acid in certain herbal remedies has been tied to a markedly higher risk in specific regions.

Understanding Ureter Cancer Causes

Ureter cancer develops when cells lining the ureter begin to grow and divide abnormally, eventually forming a tumor. As with other cancers, this process usually results from a mix of inherited traits and outside exposures that damage the DNA inside these cells over time.

Genetic and Epigenetic Changes

At the cellular level, ureter cancer is driven by changes in the genes that normally control how cells grow and divide. Some of these are mutations in the DNA sequence itself, which can silence tumor-suppressor genes or switch on genes that push cell growth forward. Others are epigenetic changes — shifts in how genes are turned on or off without altering the underlying DNA sequence — that can have a similar effect. Together, these changes allow cells in the urothelium, the tissue lining the ureter, to grow without the usual controls.

DNA Damage and Repair Mechanisms

Cells face DNA-damaging exposures throughout life, both from normal metabolism and from outside sources such as tobacco smoke or industrial chemicals. Healthy cells normally repair this damage, but when repair systems are overwhelmed or impaired, errors can accumulate and eventually contribute to cancer. This is one reason ongoing exposure to carcinogens is considered central to ureter cancer risk.

Lifestyle Risk Factors for Ureter Cancer

Several of the clearest risk factors for ureter cancer involve substances the body filters through the kidneys and eliminates in urine, bringing them into direct contact with the ureter’s lining.

Smoking and Tobacco Use

Smoking is the strongest and most consistently documented risk factor for cancers of the urothelium — the tissue lining the bladder, ureters, and renal pelvis — a risk that ureter cancer shares with the more common bladder cancer. Carcinogens in tobacco smoke enter the bloodstream and pass through the kidneys before being concentrated in urine, exposing the urothelium to repeated chemical injury. The National Cancer Institute lists tobacco use as a major, modifiable risk factor for these urinary tract cancers, and quitting can help lower that risk over time.

Chemical and Occupational Exposures

Workplace exposure to certain industrial chemicals is another recognized contributor to ureter cancer risk. On-the-job exposure to industrial dyes, paints, certain metals, or petroleum-based products is a separately recognized risk factor for cancers of the urothelium. Aromatic-amine dye chemicals, historically used in textile, leather, and dye manufacturing, are a well-known example of this kind of occupational exposure. Long-term use of well water with elevated arsenic levels has, on its own, been linked to a higher risk of bladder cancer, a comparable exposure route for the ureter’s urothelial lining.

Exposure	Common Setting	Associated Risk
Paints, dyes, metals, or petroleum products	Manufacturing and industrial workplaces	Recognized occupational risk factor for cancers of the urothelium
Arsenic	Contaminated well water, long-term use	Linked to a higher risk of bladder cancer with prolonged exposure

Medical Conditions and History Risks

Certain health conditions and a person’s medical history can also affect ureter cancer risk, often by contributing to ongoing irritation of the urinary tract lining or to inherited genetic vulnerability.

Chronic Kidney Disease and Stones

Long-standing irritation from recurrent kidney stones has drawn research interest as a possible contributor to ureter cancer. A recent case series identified a small group of ureter cancer patients with a history of recurrent stones and proposed that ongoing, stone-related inflammation of the urinary tract lining may play a role in how these cancers develop. The researchers were clear that this connection is still under-studied and needs confirmation in larger groups of patients, so it should be viewed as an area of active research rather than a firmly established cause.

Hereditary Syndromes (e.g., Lynch)

Inherited genetic conditions can also raise ureter cancer risk. The best-documented example is Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, which is caused by inherited changes in one of several DNA mismatch-repair genes — MLH1, MSH2, MSH6, PMS2, or EPCAM — that normally correct errors made when cells copy their DNA. According to MedlinePlus Genetics, people with Lynch syndrome have an increased risk of several cancers beyond colorectal cancer, including cancers of the urinary tract. Because Lynch syndrome is typically passed down in an autosomal dominant pattern, a family history of colorectal, endometrial, or urinary tract cancer is a reason to discuss genetic counseling and testing with a doctor.

Demographic and Unavoidable Risk Factors

Some factors that influence ureter cancer risk are tied to a person’s demographics or environment rather than to specific behaviors, and are generally outside a person’s control.

Age, Gender, and Ethnicity

As with most cancers, the chance of developing ureter cancer rises with age. Because ureter cancer arises from the same urothelial tissue as bladder cancer, it is generally studied and managed alongside that more common disease, even though large-scale demographic data specific to ureter cancer are limited. In bladder cancer, the National Cancer Institute notes a diagnosis pattern skewed toward male patients and toward White Americans compared with Black Americans, with cases becoming steadily more common as people age.

Geographic and Environmental Influences

Where a person lives can affect ureter cancer risk, mainly through environmental exposure rather than genetics. Arsenic-contaminated well water, discussed above, is one example of a location-based exposure. A more striking example is aristolochic acid, a compound found in some traditional herbal remedies made from Aristolochia plants. Research has linked aristolochic acid exposure to kidney damage and a sharply elevated risk of upper tract urothelial carcinoma, the disease group that includes ureter cancer, with the most clearly documented clusters identified in the Balkan region of Southeastern Europe and in Taiwan, where use of these herbal remedies has historically been more common. Avoiding herbal products that contain aristolochic acid is one of the few environmental exposures a person can directly control.

Frequently Asked Questions

Can diet influence ureter cancer risk?

While no particular eating pattern has been shown to prevent ureter cancer specifically, leaning on plant-based staples like produce and whole grains benefits overall health and may contribute to lower cancer risk broadly. Avoiding herbal products that contain aristolochic acid is more directly relevant to ureter cancer risk than any single food choice.

Is ureter cancer hereditary?

Most cases are not inherited, but some are. Lynch syndrome is the clearest example: mismatch-repair gene changes passed down in families push up the odds of several cancer types, with the urinary tract among the sites affected. A strong family history of colorectal, endometrial, or urinary tract cancer is a reason to talk with a doctor about genetic counseling and testing.

How can I reduce my risk of ureter cancer?

Not smoking, or quitting if you currently do, is the clearest step, since tobacco use is the leading modifiable risk factor. Limiting workplace exposure to industrial chemicals, avoiding herbal products that contain aristolochic acid, and staying current with medical care for recurrent kidney stones or a family history of Lynch syndrome can also support earlier detection.

Sources

• National Cancer Institute – Bladder Cancer Causes and Risk Factors
• MedlinePlus Genetics – Lynch Syndrome
• National Institutes of Health (PMC) – Toward Clinical Understanding of Aristolochic Acid Upper-Tract Urothelial Carcinoma, Theranostics, 2020
• National Institutes of Health (PMC) – Recurrent Urolithiasis as a Risk Factor for Upper Tract Urothelial Carcinoma, Frontiers in Oncology, 2026