Transitional Cell (Urothelial) Carcinoma (TCC)

Overview 

The ureters are the long tubes that connect the kidneys to the bladder. The top of each ureter is attached to the area of the kidney known as the renal pelvis. Your renal pelvis and ureters are lined with a certain type of cell known as transitional cells. TCC starts in these cells and can form in the renal pelvis, the ureter or both. 

Transitional cell carcinoma – also known as urothelial carcinoma – is the most common type of cancer that can occur in the renal pelvis and ureter. 

Transitional cell carcinoma causes

The cause of transitional cell carcinoma is not yet fully understood. However, there does seem to be a genetic link in some people with the condition. A personal history of bladder cancer and smoking can affect the risk of getting TCC. 

Transitional cell carcinoma risk factors

Having a risk factor doesn’t mean you will get cancer. It’s important to talk with your doctor if you think you may be at risk for TCC. The following factors may increase your risk for developing transitional cell cancer of the renal pelvis and ureter:

• A personal history of bladder cancer
• Being a smoker
• Being exposed to coal, tar or asphalt
• History of using phenacetin (pain medication not sold in the United States since 1983)
• Using the cancer medications cyclophosphamide or ifosfamide
• Working in the plastics or chemical industry

Transitional cell carcinoma symptoms

There may be no signs or symptoms for this type of cancer, especially in its early stages. When they do occur, signs and symptoms of TCC can include:

• Blood in your urine
• Fatigue
• Needing to urinate more often than usual
• Pain while urinating
• Persistent back pain
• Unintentional weight loss

Transitional cell carcinoma diagnosis

Your oncologist may use one or more of the following tests to diagnose TCC:

• Physical exam - your doctor will perform a complete physical exam – including asking questions about your health history and related risk factors.
• Biopsy - in this test, your doctor removes a biopsy (small tissue sample) from your renal pelvis or ureter. Lab specialists closely examine the tissue sample checking for abnormalities.
• Computerized tomography (CT) scan - your doctor may order a CT scan of your kidneys and bladder. This specialized imaging test uses a series of X-ray images to create detailed images of the inside of your body.
• Intravenous pyelogram (IVP) - this test checks the flow of fluid from the kidneys to the bladder. Your doctor can use IVP results to determine if your body is handling urine correctly.
• Magnetic resonance imaging (MRI) - this imaging test uses magnets and computer-generated radio waves to create detailed images of the inside of your body.
• Ultrasound - your doctor may order an ultrasound, an imaging test that uses sound waves to create detailed images of your abdomen.
• Ureteroscopy - this procedure examines the inside of the ureter and renal pelvis to check for abnormal areas. Your doctor will use a ureteroscope (a thin tube with a light and lens for viewing) inserted through the urethra into the bladder, ureter and renal pelvis.
• Urinalysis - your doctor may order this test, which checks a sample of your urine for abnormal levels of blood, protein or bacteria within it. These can be signs of problems with your bladder, kidneys or ureters.

Transitional cell carcinoma treatments

Depending on your personal health history, the extent of your TCC and other factors, your oncologist may recommend one or more of the following treatment options:

• Biological therapies - these types of therapies involve using the body’s immune system to fight cancer.
• Chemotherapy - this treatment involves the use of medications to destroy cancer cells. Chemotherapy drugs can be delivered via a pill taken orally (by mouth) or an intravenous or IV liquid (injected into a vein).
• Surgery - your oncologist may recommend surgery to remove the cancer cells. Depending on the extent of your TCC, your surgeon may need to remove a kidney, a ureter or some bladder tissue. Your surgeon may surgically remove the cancer cells or use laser or electrical current to destroy cancer cells.

When should I seek care?

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing an oncologist for more specialized treatment.