Transitional cell carcinomas

ALSO KNOWN AS: Transitional cell cancer, bladder cancer, renal pelvic tumors, TCCs, papillary urothelial carcinoma

RELATED CONDITIONS: Bladder cancer, kidney cancer, renal cell carcinoma

DEFINITION: Transitional cell carcinoma is a cancer that forms in transitional cells in the lining of the bladder, kidney, or ureter (tube connecting the kidney to the bladder).

Risk factors: Common risk factors for this disease include smoking, misusing certain pain medicines for an extended period of time, and exposure to some chemicals and dyes used in the textile, leather, plastic, and rubber industries.

Etiology and the disease process: The lining of the bladder, ureter, and kidney contain transitional cells, which can change shape and stretch without breaking apart as needed in organs that expand in the urinary tract. Transitional cell carcinoma begins in these cells and can move from the lining of the organs to invade the internal areas of the organ, as well as other nearby organs.

Transitional cell carcinoma that begins as a superficial tumor may grow through the lining and into the muscular wall of the bladder, kidney, or ureter. This invasive cancer may extend into a nearby organ such as the uterus, vagina, or prostate gland or to nearby lymph nodes, in which case cancer cells may have spread to other or other sites, such as the lungs, liver, or bones.

Incidence: The incidence of transitional cell carcinoma is equivalent to that of bladder and kidney cancer, though between 90 and 95 percent of bladder and ureter cancers are caused by transitional cell carcinoma. According to the American Cancer Society's statistics for 2024, bladder cancer is the fourth most common type of cancer in men, and the eleventh most common in women. The statistics vary with geographical location. White people get bladder cancer twice as often as Black people and those of Hispanic descent. People with family members who have bladder cancer are more likely to get the disease, as well as people who have previously had bladder cancer.

Symptoms: The most common symptom is blood in the urine (hematuria). Some patients experience pain or burning during urination or a change in urinary habits, such as painful urination or a frequent urge to urinate. Other symptoms include back pain, lethargy, fatigue, flank pain, and weight loss.

Screening and diagnosis: Diagnosis of transitional cell carcinoma is confirmed with a physical exam, urinalysis, and urine cytology tests. The urinalysis determines if abnormalities such as blood, protein, sugar, and solids exist in the urine. Urine cytology is a microscopic examination of urine to detect any abnormal cells that have sloughed off the walls of the bladder or kidney and been released in the urine. If necessary, cytoscopy is performed; a very narrow tube with a light and camera is inserted through the urethra to examine the inside of the bladder and ureter. Further imaging studies can help determine if the cancer has spread to other layers of the organs, as well as outside the urinary tract. If bladder or kidney cancer is suspected, a physician may order a computed tomography (CT) scan, pyelography, or biopsy. The CT scan is helpful for a three-dimensional view of the urinary tract to determine if any masses or tumors exist in the bladder or if the cancer has spread to other organs. Pyelography involves injecting a special dye into the vein or urethra and examining a series of timed-interval X-rays of the urinary system to determine if abnormalities exist. The is typically performed during cytoscopy, and abnormal cells can be detected with a microscope.

Treatment and therapy: Treatment for transitional cell carcinoma depends on the stage and location of the cancer. Typically, surgery to remove the entire kidney, the ureter, and the bladder cuff (connecting the ureter to the bladder) will be performed. When the cancer is superficial and in the lower third of the ureter, another procedure called a segmental of the ureter is performed. In this surgery, part of the ureter is removed, and the ends of the ureter are reattached.

Radiation therapy uses high-energy rays to kill cells to shrink the tumor before surgery or if surgery is not an option. Chemotherapy uses one drug or a combination of drugs to kill cancer cells. Superficial bladder cancer can be treated with local chemotherapy by inserting a through the urethra and leaving it in the bladder for several hours, once per week, for several weeks. If the cancer has deeply invaded the bladder or spread to lymph nodes or other organs, chemotherapy may be used to treat the entire body.

Novel therapeutic agents, including enfortumab vedotin, an antibody-drug conjugate that targets Nectin-4, a protein produced by transitional cell carcinomas that did not respond to immunotherapy and chemotherapy, have shown promise. Using erdafitinib and sacituzumab govitecan, also therapeutic agents, has provided additional resources in treating transitional cell carcinomas. Nephroureterectomy is a procedure that has proved effective in treating transitional cell carcinomas of the renal system, pelvis, and ureter. 

Prognosis, prevention, and outcomes: The outcome of transitional cell carcinoma varies depending on the exact location of the cancerous cells and whether the cancer has metastasized. Cancer localized to the kidney or ureter can be cured with surgery. Cancer that has metastasized to other organs is usually not curable, though there are exceptions. Preventive measures include not smoking, wearing protective equipment if exposed to toxic chemicals, and following the physician’s advice concerning the use of all pain medications, including over-the-counter pain medications. Treatment given after the primary treatment to increase the chances of a cure is called adjuvant therapy and may include chemotherapy, radiation therapy, hormone therapy, or biological therapy.

Bibliography

“Advances in Bladder Cancer Research.” National Cancer Institute, 16 May 2024, www.cancer.gov/types/bladder/research. Accessed 23 June 2024.

Anastasiadis, Anastasios, and Theo M. de Reijke. "Best Practice in the Treatment of Nonmuscle Invasive Bladder Cancer." Therapeutic Advances in Urology, vol. 4.1, 2012, pp. 13–32.

“Bladder Cancer Treatment” National Cancer Institute, 16 Feb. 2023, www.cancer.gov/types/bladder/treatment. Accessed 23 June 2024.

Chang, Sam S., and Samir S. Taneja, eds. Urologic Clinics of North America: Diagnosis, Evaluation, and Treatment of Non-Muscle Invasive Bladder Cancer, vol. 40.2, 2013, pp. 155–322.

Ellsworth, Pamela, and Brett Carswell. One Hundred Questions and Answers about Bladder Cancer. 2nd ed., Sudbury: Jones, 2010.

Griffiths, T. R. L. "Current Perspectives in Bladder Cancer Management." International Journal of Clinical Practice, vol. 67.5, 2013, pp. 435–48.

Raghavan, Derek. The Cleveland Clinic Guide to Bladder Cancer. New York: Kaplan, 2010.

Schrier, Robert W., ed. Diseases of the Kidney and Urinary Tract. 8th ed., Philadelphia: Wolters, 2007.

Tannir, Nizar M., ed. Renal Cell Carcinoma. New York: Oxford UP, 2014.

“Transitional Cell Cancer (Kidney/Ureter) Treatment.” National Cancer Institute, 22 Mar. 2024, www.cancer.gov/types/kidney/patient/transitional-cell-treatment-pdq. Accessed 23 June 2024.