Case: Causation vs. correlation: Naturopathic medicine vs. natural history of a disease.

Abstract

Urothelial carcinoma (UC) is the fourth most common type of cancer and arises from the urogenital epithelial. Between 5% and 10% of primary UC originate from renal pelvis and ureters and are collectively called upper tract urothelial carcinoma (UTUC). The estimated annual incidence of UTUC in Canada is 1–2/100 000.1 It most commonly affects patients in the sixth and seventh decade of life with a male predominance. In developed countries, tobacco smoking is the greatest risk factor. UTUC is often multifocal, as the entire urothelial surface is affected by the same carcinogen. 2 The gold standard treatment of localized UTUC is a radical nephroureterectomy due to the frequent occurrence of synchronous or metachronous tumours. For patients with high-risk disease (i.e., T3–T4 and/or patients with positive lymph nodes), adjuvant chemotherapy is also suggested.2 Postoperative recurrences are common. In general, bladder recurrence occurs in 22–47%, while extravesical recurrences occur in 0–12% of patients with UTUC.1 Naturopathic treatments have frequently been mentioned in the context of “curing” cancer. However, there are limited studies that follow up on these numerous treatment options and the studies that are available often are unreliable or invalid.3 Therefore, many of these rare cases are generally attributed to the spontaneous regression of cancer. We present a case of a patient with UTUC who had a local recurrence following definitive therapy and experienced resolution of cancer following a naturopathic treatment option.