Definition and Overview

Transitional cell carcinoma of the kidney is a type of cancer that originates from the transitional cells that line the renal pelvis and ureter. The ureter is a long duct where urine passes from the kidney to the bladder before it leaves the body through the urethra. On top of the ureter is the renal pelvis. Also called pelvis of the kidney, it is the funnel-like or basin-like part of the ureter where kidney tubules drain.

Transitional cells are a type of cells that form the tissue lining of an internal organ. What sets them apart from the other cells is their ability to undergo structural changes in their composition and shape. Because of this characteristic, the ureters, urinary bladder, and urethra are able to expand to accommodate fluctuating volumes of fluid.

Transitional cell cancer (TCC) of the kidney develops in the renal pelvis and is considered rare when compared to renal cell carcinoma, which accounts for more than 90% of kidney cancer cases. TCC of the ureter, just like TCC of the kidney, is also very uncommon. However, TCC of the bladder is the most common type of bladder cancer.

Causes of Condition

Just like any other type of cancer, the causes of transitional cell carcinoma of kidney remain unknown. However, there are a number of factors that may increase one’s risk of developing the condition. TCC of the kidney has been linked to cigarette smoking and exposure to certain cancer-causing chemicals in the workplace, such in the case of those who are in the petroleum industry and exposed to agrochemicals.

In some studies, it was also found that the risk increases among individuals who are forced to hold their urine for longer periods and those who suffer from chronic infections and chronic stone disease. Individuals who regularly undergo catheterization (such as multiple sclerosis patients) that causes chronic physical irritation to the urinary system are also at risk. Other risk factors include:

  • Certain drugs, such as phenacetin (a type of pain killer) and cyclophosphamide

  • Down’s syndrome

  • Early menopause

  • Excessive alcohol intake

  • History of other types of urinary cancer

  • Radiation exposure

  • Somatic mutation

  • Treatment for other cancers

It is important to note that having risk factors do not automatically mean a person would develop TCC of the kidney. It goes the same way for people who do not have risk factors as they do not have an assurance that they will not develop the disease.

Key Symptoms

Kidney cancer symptoms largely depend on the stage of cancer. In the early stages, the condition does not produce obvious symptoms. This explains why the majority of cases are diagnosed when cancer has already reached the advanced stages. Unfortunately, this negatively affects the patient’s prognosis. As the tumor grows, patients may experience the following signs of kidney cancer:

  • Blood in urine

  • Persistent back pain

  • Fatigue that does not go away

  • Unexplained weight loss

  • Frequent and painful urination

It is important to note that symptoms of kidney cancer mentioned above can also be caused by other disorders of the urinary system including bladder cancer and urinary tract infection. Various tests have to be conducted to ascertain that they are caused by TCC of the kidney before any treatment is initiated.

Who to See and Types of Treatments Available

Patients experiencing the symptoms mentioned above are advised to consult a general practitioner for initial assessment. If renal cancer is suspected, the patient will be referred to a health care team composed of a urologist (a doctor specialising in the assessment, diagnosis, and treatment of medical conditions affecting the urinary system) and an oncologist or cancer care specialist, among others.

The patient’s initial visit to the doctor is typically followed by various tests to rule out other medical conditions that share the same symptoms. These tests include a physical exam and thorough review of the patient’s medical history. These are followed by:

  • Urinalysis

  • Ureteroscopy – Using a ureteroscope, this diagnostic test involves looking inside the renal pelvis and ureter to check for the presence of abnormal cells. During the same procedure, the doctor may take tissue samples for biopsy to determine if abnormal cells are malignant (cancerous) or benign (non-cancerous).

  • Urine cytology – This laboratory test looks for cancer cells in the urine sample.

  • Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) scan of the entire urinary system to see if there are any blockages in the area.

  • Ultrasound of the abdomen

If TCC of the kidney has been confirmed, the next step is cancer staging in which doctors determine the stage and grade of the tumor, its location, whether or not the patient’s other kidney is healthy, and whether or not cancer cells have already spread to different organs. Such information is crucial in planning the best possible treatment method for the patient.

The standard kidney cancer treatment is surgery. Depending on the stage of cancer, doctors may elect to perform:

  • Nephroureterectomy - This removes parts of the urinary system including the kidney, bladder cuff, and ureter.

  • Segmental resection of the ureter - This removes the part of the ureter that has been affected by cancer with as little healthy tissue margin as possible. This is done to ensure that no cancer cells remain following the procedure. This option is suitable for superficial tumors that are located in the lower third of the ureter.

Other treatment methods include:

  • Biologic therapy – Involves boosting the patient’s immune system using various substances to fight cancer.

  • Chemotherapy – Involves the use of drugs to stop the growth of cancer cells.

The kidney cancer survival rate is up to 90% in patients with superficial tumors and localised cancer and who received appropriate treatment during the early stages of the disease. However, kidney cancer prognosis is generally poor for patients with deeply invasive tumors, which means that cancer has already spread to distant organs. Their likelihood of cure is between 10%-15%.

References:

  • Krogh J, Kvist E, Rye B: Transitional cell carcinoma of the upper urinary tract: prognostic variables and post-operative recurrences. Br J Urol 67 (1): 32-6, 1991.

  • Corrado F, Ferri C, Mannini D, et al.: Transitional cell carcinoma of the upper urinary tract: evaluation of prognostic factors by histopathology and flow cytometric analysis. J Urol 145 (6): 1159-63, 1991.

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