Transitional Cell Carcinoma: Kidney Cancer

The least common form of kidney and pelvis cancer is transitional cell carcinoma (TCC), also called renal urothelial carcinoma (UC). This type of cancer accounts for roughly 7 percent of all kidney cancers.

In cases of TCC in which the cancer has not spread beyond the renal pelvis (the center of the kidney) or ureter, cure rates are about 90 percent. However, once the cancer has spread past that area, cure rates plummet to 10 to 15 percent.

Causes and Risk Factors for TCC

Transitional cells join together different structures. Transitional cell carcinoma forms tumors as it develops on the lining of the renal pelvis, the ureter or the bladder. Though the cause of transitional cell carcinoma is not known, identified risk factors include:

• age of 60 to 70 years
• Caucasian ethnicity
• exposure to dyes and chemicals used to manufacture plastics, rubber, textiles and leather
• male gender (TCC is two to three times more common in men than women.)
• misusing or abusing pain medicines over a long period of time (including over-the-counter medicines)
• smoking and tobacco use.

Symptoms of Transitional Cell Carcinoma

Though symptoms may be absent during the early stages of TCC, they become much more pronounced as the tumor grows. The most common symptoms are:

• dull flank pain, which occurs in approximately 15 to 40 percent of all patients

• hematuria (blood in the urine), which occurs in 75 to 95 percent of patients flank mass (a lump you can feel in your side or abdomen).

It is very rare for a patient to have no symptoms.

Diagnosis of Transitional Cell Carcinoma

Since symptoms are usually significant, TCC is often discovered at an earlier stage than other kidney cancers. The following tests are used to diagnose TCC:

• Imaging tests, such as CT scans and ultrasonography (ultrasound), are often used to visualize the internal structures of the kidney, ureter and bladder to examine them for any signs of cancer.
• >In addition to imaging tests, lab tests can also help diagnose kidney cancer. Urine cytology, a lab test that uses a microscope to examine urine contents, can sometimes detect cancer cells in the urine.
• A physical exam helps a doctor feel masses and abnormal growths. Physical exams, along with a patient's medical history, helps doctors determine an individual's risk of developing TCC.
• Ureteroscopy may also be used to visually inspect the bladder, ureter and renal pelvis for abnormal tissue. In this procedure, a uteroscope is inserted into the urethra and is threaded up into the bladder and ureter. This technique may also allow for small tissue samples to be taken for examination under a microscope.

Treatment of Transitional Cell Carcinoma

The main treatment option for TCC is surgery. Surgical treatment is the only treatment that is aimed at curing the disease in early stages, though it can also reduce pain in patients with more advanced TCC.

The most common form of surgical intervention is a laparoscopic nephroureterectomy, which removes the entire affected kidney, the ureter and the portion of the bladder that connects to the ureter.

If the disease has only affected a part of the ureter, a segmental resection of the ureter may be used instead. In a resection, the diseased part of the ureter is removed and the two remaining ends of the ureter are reattached.

New Treatments for TCC

Several types of new TCC treatments are currently undergoing clinical trials. These treatments include:

• Fulguration: Fulguration uses an electric current to remove or burn the tumor.
• Laser surgery: Laser surgery uses a laser to cut out or kill cancerous cells.
• Regional chemotherapy combined with regional biologic therapy: Regional chemotherapy combined with regional biologic therapy uses a combination of drugs to reduce cancerous growths and stimulate the immune system. These drugs are usually placed directly into the region that is affected by the cancer. This two-pronged approach allows for drugs to kill cancer cells or stop them from dividing. It also increases the immune system's ability to attack cancerous cells.
• Segmental resection of the renal pelvis: Segmental resection of the renal pelvis is similar to resection of the ureter in that it only removes the cancerous portion of the kidney, leaving the rest. This is usually done in cases where the patient has only one functional kidney.

Resources

American Cancer Society (October 21, 2005). What is Kidney Cancer (Renal Cell Carcinoma)? Retrieved July 11, 2007 from the American Cancer Society Web site: http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_is_kidney_cancer_22.asp.

Guruli, G., Konety, B.R. (July 27, 2006). Transitional Cell Carcinoma, Renal. Retrieved July 11, 2007 from the eMedicine Web site: http://www.emedicine.com/med/topic2003.htm.

National Cancer Institute (n.d.). General Information About Transitional Cell Cancer of the Renal Pelvis and Ureter. Retrieved July 11, 2007 from the National Cancer Institute Web site: http://www.cancer.gov/cancertopics/pdq/treatment/transitionalcell/Patient/page1.

National Cancer Institute (n.d.).Treatment Option Overview. Retrieved July 11, 2007 from the National Institutes Web site: http://www.cancer.gov/cancertopics/pdq/treatment/transitionalcell/Patient/page4.