urothelial carcinoma

WordNet

1. any malignant tumor derived from epithelial tissue; one of the four major types of cancer

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1. がん,がん腫

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/04/17 09:41:11」(JST)

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Urothelial carcinoma
Histopathology of urothelial carcinoma of the urinary bladder. Transurethral biopsy. H&E stain.
Classification and external resources
Specialty	Oncology
ICD-O	M8120/3-8130
eMedicine	med/2003 radio/711
MeSH	D002295

Urothelial carcinoma (UCC, also transitional cell carcinoma or TCC) is a type of cancer that typically occurs in the urinary system. 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.

When the term "urothelial" is used, it specifically refers to a carcinoma of the urothelium, meaning a TCC of the urinary system.

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Signs and symptoms

Signs and symptoms of TCC are entirely dependent on the location and extent of the cancer.

Causes

Urothelial carcinoma is a prototypical example of a malignancy arising from environmental carcinogenic influences. By far the most important cause is cigarette smoking, which contributes to approximately one-half of the disease burden. Chemical exposure, such as those sustained by workers in the petroleum industry, the manufacture of paints and pigments (e.g., aniline dyes), and agrochemicals are known to predispose one 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:

1. Certain drugs, such as cyclophosphamide, via the metabolites acrolein and phenacetin, are known to predispose to TCC (the latter especially with respect to the upper urinary tract).
2. Radiation exposure
3. Somatic mutation, such as deletion of chromosome 9q, 9p, 11p, 17p,13q, 14q and overexpression 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, 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.

Diagnosis

Bladder diverticula containing stones. Also note that the bladder wall is thickened due to possible transitional cell carcinoma.

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 grading (papillary neoplasm of low malignant potential [PNLMP], low grade, and high grade papillary carcinoma).

• Histopathology of urothelial carcinoma of the urinary bladder, showing a nested pattern of invasion. Transurethral biopsy. Hematoxylin and eosin.

• Histopathology of urothelial carcinoma of the urinary bladder.

• Histopathology of urothelial carcinoma of the urinary bladder.

• Micrograph of urethral urothelial cell carcinoma. H&E stain.

Treatment

Localized/early TCC of bladder

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 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 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.

Advanced or metastatic TCC

As of 2000 Chemotherapy for advanced or metastatic TCC consists of the GC regimen (gemcitabine and cisplatin) or MVAC regimen (methotrexate, vinblastine, adriamycin and cisplatin).

Prostate

TCC can also be associated with the prostate.

See also

• Transitional cell carcinoma of the ovary

References

UpToDate Contents

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• 1. 尿路上皮膀胱癌の初期アプローチおよびマネージメントの概要 overview of the initial approach and management of urothelial bladder cancer
• 2. 膀胱および泌尿器の転移性尿路上皮癌の治療 treatment of metastatic urothelial cancer of the bladder and urinary tract
• 3. Epidemiology and risk factors of urothelial (transitional cell) carcinoma of the bladder
• 4. 腎盂および尿管の悪性腫瘍 malignancies of the renal pelvis and ureter
• 5. 筋層浸潤性尿路上皮膀胱癌に対する補助化学療法 adjuvant chemotherapy for muscle invasive urothelial carcinoma of the bladder

English Journal

• Programmed cell death-1 pathway inhibitors in genitourinary malignancies: specific side-effects and their management.

• Tripathi A1, Kaymakcalan MD, LeBoeuf NR, Harshman LC.
• Current opinion in urology.Curr Opin Urol.2016 Nov;26(6):548-55. doi: 10.1097/MOU.0000000000000332.
• PURPOSE OF REVIEW: Immune checkpoint inhibitors such as those that target the programmed cell death (PD)-1 pathway harness the host immune system to elicit an antitumor response. Their remarkable clinical benefit has led to regulatory approvals in several malignancies including the genitourinary can
• PMID 27517638

• Role of surgical consolidation in metastatic urothelial carcinoma.

• Abe T1, Matsumoto R, Shinohara N.
• Current opinion in urology.Curr Opin Urol.2016 Nov;26(6):573-80. doi: 10.1097/MOU.0000000000000329.
• PURPOSE OF REVIEW: Since the development of systemic combination chemotherapy, postchemotherapy extirpation has been performed in selected patients mainly with locally advanced and/or initially unresectable bladder cancer, and, in very selected patients, surgical consolidation for visceral metastase
• PMID 27471992

• Urothelial Carcinoma Recurrence at an Ileal Orthotopic Neobladder and Unilateral Lower Ureter After Surgery.

• Kawamoto B1, Honda M1, Iwamoto H1, Morizane S1, Hikita K1, Takenaka A1.
• Urology case reports.Urol Case Rep.2016 Sep 17;9:27-9. doi: 10.1016/j.eucr.2016.08.003. eCollection 2016.
• The recurrence of urothelial carcinoma in an orthotopic neobladder is rare. We report the case of a 61-year-old man with a muscle-invasive bladder tumor that was treated using radical cystectomy and the creation of a Studer's orthotopic neobladder. However, nine years after the cystectomy, we detect
• PMID 27656417

Japanese Journal

• 第61回日本泌尿器科学会西日本総会 学術奨励賞 上部尿路腫瘍に対する内視鏡的治療 : 適応および治療成績

• 河内 啓一郎,上原 慎也,和田 耕一郎 [他]
• 西日本泌尿器科 = The Nishinihon journal of urology 74(11), 599-604, 2012-11
• NAID 40019487231

• 脳転移後,集学的治療により長期生存を得ている膀胱尿路上皮癌の1例

• 保田 賢吾,中村 昌史,高本 大路 [他]
• 泌尿器科紀要 = Acta urologica Japonica 58(10), 553-556, 2012-10
• … Pathological diagnosis was metastatic urothelial carcinoma. …
• NAID 40019490014

Related Links

• Urothelial Cancer （尿路上皮がん） 【10報】 - CTC情報サイト

Detection of circulating tumor cells in metastatic and clinically localized urothelial carcinoma. Thomas W. Flaig, Shandra Wilson, Adrie van Bokhoven, Marileila Varella-Garcia, Pamela Wolfe, Paul Maroni, Erin E. Genova, Diana ...

• Urothelial carcinoma: Stem cells on the edge

1.3 Carcinoma stem cells Unlike hematopoiesis, epithelial cell lineage programs are poorly understood. Accordingly, investigations into carcinoma stem cells have chosen empirically based strategies to isolate CSCs.

Related Pictures

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★リンクテーブル★

リンク元	「移行上皮癌」「尿路上皮癌」
関連記事	「urothelial」

「移行上皮癌」

　　[★]

英

transitional cell carcinoma, TCC

同

尿路上皮癌 urothelial carcinoma

関

癌腫、移行上皮乳頭腫、移行上皮

「尿路上皮癌」

　　[★]

英

urothelial carcinoma

関

移行上皮癌

「urothelial」

　　[★]

• 尿路上皮性の、尿路上皮の

関

uroepithelial、urothelium