Transitional cell carcinoma

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 29, 2016
StartDiseasesTransitional cell carcinoma

A common form of bladder cancer is transitional cell carcinoma (TCC). If a person is told that he or she has bladder cancer, it is most likely transitional cell carcinoma. This cancer starts in the cells that line the bladder on its inside or what is commonly known as the urothelial cells. These cancerous tumors can also occur in other parts of the urinary tract including parts of the kidney, the urethra, and ureters

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Definition & Facts

The urinary bladder can be described as being a hollow muscular organ. Its job is to store urine brought from the kidneys by the two tubes called the ureters. Then urine is stored in the bladder until it is excreted from the body. The urine is carried from the bladder by the urethra to outside the body (urination).

Transitional cell carcinoma is a disease that is the result of the cells lining the urinary bladder losing their ability to regulate their growth. They start to divide uncontrollably, and this abnormal growth creates a mass of cells forming a tumor. The 2016 estimates by the American Cancer Society for bladder cancer in the U.S. are:

  • New cases of bladder cancer will be approximately 58,950 men and 18,010 women for a total of 76,960.
  • Deaths due to bladder cancer will amount to 11,820 men and 4,570 women.

Five percent of all new U.S. cancers have been bladder cancer, and death rates have remained stable in recent years. However, new bladder cancer rates and deaths due to bladder cancer have been dropping slightly in women. Incidence rates for men have decreased, and in men, bladder cancer is the fourth most common cancer.

Symptoms & Complaints

Blood in a person's urine is usually the first sign of transitional cell carcinoma of the bladder. When blood is in the urine, it is said to be hematuria. The urine's color may be an extremely pale yellow, orange or red. Although rare, the urine could be dark red.

In some instances, the urine doesn't change color; however, during a routine medical check-up, blood is found. Other conditions could be the cause of the hematuria or blood in the urine including a noncancerous lesion, infection, bladder stones, kidney stones or kidney disease. The exact cause can be pinpointed by follow-up tests.

Urination changes are also common symptoms. Urinating frequently, feeling pain while urinating, or having a feeling or urgency to urinate even if the bladder is not full are all symptoms of bladder cancer. However, these changes may also be a sign of conditions that are less serious including an infection or a benign tumor. Another sign of transitional cell carcinoma could be the inability to urinate

Pain in the lower back that won’t go away can be a symptom of larger bladder cancers. Additional symptoms include pelvic pain, extreme fatigue, weight loss with no reason, high blood pressure, and anemia.

Causes

Currently, the precise cause of transitional cell carcinoma is not known. However, a variety of possible causes have been identified. For example, smoking is considered a risk factor of bladder cancer since twice as many smokers as nonsmokers have been diagnosed with the disease. In addition, exposure to some chemicals used in the dye, leather, rubber, paint and textile industries are believed to be causes of higher risks of developing transitional cell carcinoma.

Bladder cancer risk is also believed to increase with age since most cases are diagnosed in people between 50 and 70 years of age. Hormone replacement therapy often used by women who are postmenopausal was shown by studies in 2003 to increase the risk of bladder cancer as well as other cancers significantly.

Conditions such as kidney and bladder stones or urinary tract infections can cause long-term irritation of the bladder and may also increase the risk of getting bladder cancer. A person's risk of bladder cancer can also be increased by a past medical history of having tumors.

A person who has been treated with the drug cyclophosphamide for a previous cancer may increase their risk of developing bladder cancer. Radiation treatment aimed at the pelvis can also raise the risk of developing TCC.

Diabetes is sometimes treated with the medication pioglitazone. If this medication is taken for more than a year, it may increase the risk of a patient developing bladder cancer or TCC. Diabetes medications that include pioglitazone are Actoplus Met® and Duetact®.

Transitional cell carcinoma risk can also be increased by breathing in fumes on a regular basis such as with a job around machinery. Race and gender also can increase the risk of TCC. For example, more white males are diagnosed with TCC than African American, Asian Americans or other races. Fewer women are diagnosed with TCC. Another factor that will increase a person's risk of developing TCC is parasitic diseases.

If a person's history or his or her family history includes bladder cancer, colon cancer, a urinary system cancer, cancer in the uterus, cancer of the the ovaries or other organs, the risk of developing TCC may be higher.

Diagnosis & Tests

When and if a doctor suspects a patient may have transitional cell carcinoma, several steps are necessary to make the correct diagnosis. Taking a complete medical history to check for the existence of risk factors is the first step.

The second step is a complete and thorough physical examination as well as an assessment of all the symptoms and signs of TCC. The diagnostic process will also include a test of a urine sample by a laboratory to determine whether the symptoms reported are the result of a bacterial infection. Once that possibility is eliminated, a urine cytology test is performed by examining the urine sample under a microscope to determine whether there is a presence of cancerous cells.

Another test for diagnosing TCC is an intravenous pyelogram (IVP). In order to perform this test, a dye is injected into the patient's bloodstream in a vein of an arm. An X-ray is done after the dye is injected. This allows the imaging of the bladder, kidneys, urethra and ureters with multiple X-rays. Any abnormalities in the lining of any of these organs can be detected by these X-rays.

In order to see the inside of the bladder, a physician uses a cystoscopy procedure. This procedure is done by inserting a thin, hollow and lighted tube through the urethra into the bladder. If there are any masses within the bladder which appear suspicious, a tissue biopsy can be done to a piece of the mass. By examining the tissue piece microscopically, the presence of cancer can be determined as well as the type of the cancer. 

Treatment & Therapy

There are three treatment modes commonly used to fight TCC: surgery, radiation therapy, and chemotherapy. Only if the cancer is in early stages will surgery be chosen as the preferred treatment.

The surgery is performed without cutting the abdomen open if the tumor hasn't metastasized or spread to the bladder's inner layers and is localized to a small area. The tumor is removed through a cystoscope, and any remaining cancer is burned. Surgery is performed through an incision in the abdomen if the cancer has invaded the bladder walls. A partial cystectomy can be done removing only a part of the bladder if the cancer isn't very large.

However, if the cancer is found to be in more than one bladder area, a radical cystectomy is done, removing the entire bladder. In men, adjoining organs including the prostate are removed. In women, the ovaries, uterus, and Fallopian tubes are removed.

Radiation therapy uses penetrating high energy waves such as gamma rays, X-rayss, neutron rays or proton rays to either destroy the cancer cells or to prevent their reproduction. Radiation therapy can be used:

  • Alone
  • Before surgery making the cancer easier to remove after it has been shrunk (neoadjuvant therapy)
  • During surgery killing any remaining cancer cells
  • After surgery in order to kill any remaining cancer cells (adjuvant therapy)
  • To shrink inoperable tumors and reduce the pain caused by the tumor
  • In combination with chemotherapy

With chemotherapy, chemicals are used to kill cancer cells. It is especially useful in cases where the cancer has spread to other places in the body or metastasized. It kills the cancer cells anywhere they may be in the body.

Prevention & Prophylaxis

There is no certain way to prevent TCC or bladder cancer since the causes of the disease are not known. However, smokers are up to 7 times more likely than nonsmokers to have bladder cancer so quitting smoking is crucial to preventing this cancer.

Those people who work with cancer-causing chemicals should take any appropriate and possible precautions to prevent getting the disease. Women should consider the risks of hormone replacement and weigh its benefits cautiously. A person who has a high risk of developing TCC or has had conditions causing long-term bladder irritation should have regular cancer screenings done in order to detect the cancer during its early stages. 

It is essential that TCC is detected in the early stages since the prognosis is then excellent. If the first diagnosis is in the early stages, 94 percent or more people will survive at least five years. However, the five-year survival rate drops significantly to 49 percent if the disease spreads to nearby tissues. Only 6 percent of patients will survive five years if the disease has spread to distant organs.