Transitional cell carcinoma |
Histopathology of urothelial carcinoma of the urinary bladder. Transurethral biopsy. H&E stain.
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Classification and external resources |
Specialty |
Oncology |
ICD-O |
M8120/3-8130 |
eMedicine |
med/2003 radio/711 |
NCI |
C4030 Transitional cell carcinoma |
MeSH |
D002295 |
Transitional cell carcinoma (TCC, also urothelial cell carcinoma or UCC) is a type of cancer that typically occurs in the urinary system: the kidney, urinary bladder, and accessory organs. It is the most common type of bladder cancer and cancer of the ureter, urethra, and urachus. It is the second most common type of kidney cancer, but accounts for only five to 10 percent of all primary renal malignant tumors.
TCC arises from the transitional epithelium, a tissue lining the inner surface of these hollow organs.[1] It can extend from the kidney collecting system to the bladder - "Creeping Tumor".[2]
When the term "urothelial" is used, it specifically refers to a carcinoma of the urothelium, meaning a TCC of the urinary system.
Contents
- 1 Signs and symptoms
- 2 Causes
- 3 Pathology
- 4 Terminology
- 5 Classification
- 6 Treatment
- 7 Associations
- 8 Prostate
- 9 Additional images
- 10 See also
- 11 References
Signs and symptoms
Signs and symptoms depend on the location and extent of the cancer: see for example Bladder cancer.
Causes
Urothelial carcinoma is a prototypical example of a malignancy arising from environmental carcinogenic influences. By far the important cause is cigarette smoking, which contributes to approximately half of the disease burden. Chemical exposures such as those sustained by workers in the petroleum industry, the manufacture of paints and pigments (prototypically aniline dyes), and agrochemicals are known to predispose to urothelial cancer. Interestingly, risk is lowered by increased liquid consumption, presumably as a consequence of increased urine production and thus less "dwell time" on the urothelial surface. Conversely, risk is increased among long-haul truck drivers and others in whom long urine dwell-times are encountered. As with most epithelial cancers, physical irritation has been associated with increased risk of malignant transformation of the urothelium. Thus, urothelial carcinomas are more common in the context of chronic urinary stone disease, chronic catheterization (as in patients with paraplegia or multiple sclerosis), and chronic infections. Some particular examples are listed below:
- certain drugs such as cyclophosphamide via the metabolite acrolein, and phenacetin are known to predispose to TCC (the latter especially with respect to the upper urinary tract).[3]
- radiation exposure
- somatic mutation such as deletion of Chromosome 9p,9q,11p,17p,13q,14q and over expression of RAS (oncogene) and epidermal growth factor receptor (EGFR)
Pathology
TCCs are often multifocal, with 30-40% of patients having more than one tumor at diagnosis. The pattern of growth of TCCs can be papillary, sessile (flat) or carcinoma-in-situ (CIS).
The most common site of TCC metastasis outside the pelvis is bone (35%); of these bone metastases, 40 percent are in the spine.[4]
Terminology
Transitional refers to the histological subtype of the cancerous cells as seen under a microscope.
Classification
The 1973 WHO grading system for TCCs (papilloma, G1, G2 or G3) is most commonly used despite being superseded by the 2004 WHO [5] grading (papillary neoplasm of low malignant potential [PNLMP], low grade, and high grade papillary carcinoma).
Treatment
Transitional cell carcinoma (TCC) can be very difficult to treat. Treatment for localized stage TCC is surgical resection of the tumor, but recurrence is common. Some patients are given mitomycin (which is a chemotherapeutic drug) into the bladder either as a one-off dose in the immediate post operative period (within 24 hrs) or a few weeks after the surgery as a six dose regimen.
Localized/ early TCC can also be treated with infusions of BCG into the bladder. These are given weekly for either 6 weeks (induction course) or 3 weeks(maintenance / booster dose). Side effects include a small chance of developing systemic Tuberculosis (T.B.) or the patient becoming sensitized to the BCG causing severe intolerance and a possible reduction in bladder volume due to scarring.
In patients with evidence of early muscular invasion, radical curative surgery in the form of a cysto-prostatectomy usually with lymph node sampling can also be performed. In such patients, a bowel loop is often used to create either a "neo-bladder" or an "ileal conduit" which act as a place for the storage of urine before it is evacuated from the body either via the urethra or a urostomy respectively.
Chemotherapy for TCC consists of the GC regimen (gemcitabine and cisplatin) or MVAC regimen (methotrexate, vinblastine, adriamycin and cisplatin).[6]
Associations
It is associated with phenacetin, aniline dyes, cyclophosphamide, smoking, and those who drink excessive alcohol.
Prostate
TCC can also be associated with the prostate.[7][8]
Additional images
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Histopathology of urothelial carcinoma of the urinary bladder, showing a nested pattern of invasion. Transurethral biopsy. Hematoxylin and eosin.
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Histopathology of urothelial carcinoma of the urinary bladder.
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Histopathology of urothelial carcinoma of the urinary bladder.
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Micrograph of urethral urothelial cell carcinoma. H&E stain.
See also
- Transitional cell carcinoma of the ovary
References
- ^ "transitional cell carcinoma" at Dorland's Medical Dictionary
- ^ Selvaraj V, Govindarajan P, Deepak M, Sivaraj M. "The creeping tumor:" An unusual presentation of upper urinary tract malignancy. Indian J Urol 2014;30:454-5.
- ^ Colin P, Koenig P, Ouzzane A, Berthon N, Villers A, Biserte J, Roupret M (November 2009). "Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract". BJU International 104 (10): 1436–40. doi:10.1111/j.1464-410X.2009.08838.x. PMID 19689473.
- ^ Punyavoravut V, Nelson SD (August 1999). "Diffuse bony metastasis from transitional cell carcinoma of urinary bladder: a case report and review of literature". Journal of the Medical Association of Thailand 82 (8): 839–43. PMID 10511795.
- ^ Sauter G, Algaba F, Amin MB, Busch C, Cheville J, Gasser T, Grignon D, Hofstaedter F, Lopez-Beltran A, Epstein JI. Noninvasive urothelial neoplasias: WHO classification of noninvasive papillary urothelial tumors. In World Health Organization classification of tumors. Pathology and genetics of tumors of the urinary system and male genital organs. Eble JN, Epstein JI, Sesterhenn I (eds): Lyon, IARCC Press, p. 110, 2004
- ^ von der Maase, H; Hansen, SW; Roberts, JT; Dogliotti, L; Oliver, T; Moore, MJ; Bodrogi, I; Albers, P; Knuth, A; Lippert, CM; Kerbrat, P; Sanchez Rovira, P; Wersall, P; Cleall, SP; Roychowdhury, DF; Tomlin, I; Visseren-Grul, CM; Conte, PF (September 2000). "Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study.". Journal of clinical oncology 18 (17): 3068–77. PMID 11001674.
- ^ Walsh DL, Chang SS (2009). "Dilemmas in the treatment of urothelial cancers of the prostate". Urologic Oncology 27 (4): 352–7. doi:10.1016/j.urolonc.2007.12.010. PMID 18439852.
- ^ Njinou Ngninkeu B, Lorge F, Moulin P, Jamart J, Van Cangh PJ (January 2003). "Transitional cell carcinoma involving the prostate: a clinicopathological retrospective study of 76 cases". The Journal of Urology 169 (1): 149–52. doi:10.1097/01.ju.0000042810.43380.36. PMID 12478124.
Glandular and epithelial neoplasms (ICD-O 8010-8589)
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Epithelium |
Papilloma/carcinoma
(8010-8139) |
- Small cell carcinoma
- Combined small cell carcinoma
- Verrucous carcinoma
- Squamous cell carcinoma
- Basal cell carcinoma
- Transitional cell carcinoma
- Inverted papilloma
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Glands |
Adenomas/
adenocarcinomas
(8140-8429) |
Gastrointestinal |
- tract: Linitis plastica
- Familial adenomatous polyposis
- pancreas
- Insulinoma
- Glucagonoma
- Gastrinoma
- VIPoma
- Somatostatinoma
- Cholangiocarcinoma
- Klatskin tumor
- Hepatocellular adenoma/Hepatocellular carcinoma
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Urogenital |
- Renal cell carcinoma
- Endometrioid tumor
- Renal oncocytoma
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Endocrine |
- Prolactinoma
- Multiple endocrine neoplasia
- Adrenocortical adenoma/Adrenocortical carcinoma
- Hurthle cell
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Other/multiple |
- Neuroendocrine tumor
- Adenoid cystic carcinoma
- Oncocytoma
- Clear cell adenocarcinoma
- Apudoma
- Cylindroma
- Papillary hidradenoma
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Adnexal and
skin appendage (8390-8429) |
- sweat gland
- Syringocystadenoma papilliferum
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Cystic, mucinous,
and serous (8440-8499) |
Cystic general |
- Cystadenoma/Cystadenocarcinoma
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Mucinous |
- Signet ring cell carcinoma
- Mucinous cystadenoma / Mucinous cystadenocarcinoma
- Mucoepidermoid carcinoma
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Serous |
- Ovarian serous cystadenoma / Pancreatic serous cystadenoma / Serous cystadenocarcinoma / Papillary serous cystadenocarcinoma
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Ductal, lobular,
and medullary (8500-8549) |
Ductal carcinoma |
- Mammary ductal carcinoma
- Pancreatic ductal carcinoma
- Comedocarcinoma
- Paget's disease of the breast / Extramammary Paget's disease
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Lobular carcinoma |
- Lobular carcinoma in situ
- Invasive lobular carcinoma
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Medullary carcinoma |
- Medullary carcinoma of the breast
- Medullary thyroid cancer
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Acinar cell (8550-8559) |
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Other |
Complex epithelial (8560-8589) |
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- See also
- Template:Epithelium and epithelial tissue
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Tumors: urogenital neoplasia: urinary organs (C64–C68/D30, 188–189/223)
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Abdominal |
Kidney |
Glandular and epithelial neoplasm: |
- Renal cell carcinoma
- Renal oncocytoma
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Complex and mixed tumor: |
- Wilms' tumor
- Mesoblastic nephroma
- Clear-cell sarcoma of the kidney
- Angiomyolipoma
- Cystic nephroma
- Metanephric adenoma
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by location: |
- Renal medullary carcinoma
- Juxtaglomerular cell tumor
- Renal medullary fibroma
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Ureter |
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Pelvic |
Bladder |
- Transitional cell carcinoma
- Inverted papilloma
- Squamous-cell carcinoma
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Urethra |
- Transitional cell carcinoma
- Squamous-cell carcinoma
- Adenocarcinoma
- Melanoma
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Retroperitoneum |
- Malignant fibrous histiocytoma
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Index of the urinary system
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Description |
- Anatomy
- Physiology
- Development
- Cells
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Disease |
- Electrolyte and acid-base
- Congenital
- Neoplasms and cancer
- Other
- Symptoms and signs
- Urine tests
- Blood tests
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Treatment |
- Procedures
- Drugs
- Intravenous fluids
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- Tumors: male urogenital neoplasia (C60–C63/D29, 185–187/222)
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Internal |
Testicles |
Sex cord-
gonadal stromal |
- Sertoli-Leydig cell tumour
- Sertoli cell tumour
- Leydig cell tumour
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Germ cell |
G |
- Seminoma
- Spermatocytic seminoma
- Intratubular germ cell neoplasia
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NG |
- Embryonal carcinoma
- Endodermal sinus tumor
- Gonadoblastoma
- Teratoma
- Choriocarcinoma
- Embryoma
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Prostate |
- Adenocarcinoma
- High-grade prostatic intraepithelial neoplasia
- Small-cell carcinoma
- Transitional cell carcinoma
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External |
Penis |
- Carcinoma
- Extramammary Paget's disease
- Bowen's disease
- Bowenoid papulosis
- Erythroplasia of Queyrat
- Hirsuties coronae glandis
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Index of reproductive medicine
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Description |
- Anatomy
- Physiology
- Development
- sex determination and differentiation
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Disease |
- Infections
- Congenital
- Neoplasms and cancer
- male
- female
- gonadal
- germ cell
- Other
- Symptoms and signs
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Treatment |
- Procedures
- Drugs
- benign prostatic hypertrophy
- erectile dysfunction and premature ejaculation
- sexual dysfunction
- infection
- hormones
- androgens
- estrogens
- progestogens
- GnRH
- prolactin
- Assisted reproduction
- Birth control
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