Transitional Cell Cancer of the Renal Pelvis and Ureter When It Has Spread

Transitional cell cancer of the renal pelvis and ureter that has spread to other parts of the body is an advanced form of this rare cancer. While early-stage disease is highly treatable, metastatic cancer poses greater challenges. Understanding this advanced condition helps patients and families navigate treatment options and make informed decisions about care.

Table of contents

• What Is Transitional Cell Cancer of the Renal Pelvis and Ureter
• Understanding Metastatic Disease
• The Urinary System and Where Cancer Forms
• Outlook and Survival
• Treatment Options
• Risk Factors
• Signs and Symptoms

What Is Transitional Cell Cancer of the Renal Pelvis and Ureter

Urothelial carcinoma, Upper tract urothelial carcinoma, Upper urinary tract urothelial cancer

Transitional cell cancer of the renal pelvis and ureter is a type of cancer that forms in special cells called transitional cells (also known as urothelial cells). These cells line the inside of the renal pelvis and the ureters^[1]. Transitional cells have a remarkable ability—they can stretch when the renal pelvis or bladder fills with urine and shrink when it empties^[1].

This cancer can develop in the renal pelvis, the ureters, or both locations^[1]. The renal pelvis is the area at the center of the kidney where urine collects before flowing into the ureters^[1]. The ureters are long tubes that connect each kidney to the bladder^[1].

Transitional cell cancer of the renal pelvis accounts for only 7% of all kidney tumors, and transitional cell cancer of the ureter accounts for only 4% of upper urinary tract tumors^[3]. This makes it quite rare compared to bladder cancer. When these cancers occur in the renal pelvis or ureters, they are called upper tract cancers^[2]. Transitional cell cancer of the upper tract is uncommon, accounting for about 10% of all transitional cell cancers^[2].

More than 90% of cancers in the upper urinary tract come from transitional cells that have become cancerous and grow in an uncontrolled way^[2]. When this happens, instead of a flat lining, masses form in the urinary tract, which can disrupt urine flow, cause pain, and lead to blockages or bleeding^[2].

• Kidneys
• Renal pelvis
• Ureters
• Bladder
• Urethra

Understanding Metastatic Disease

When doctors talk about metastatic or recurrent transitional cell cancer of the renal pelvis and ureter, they mean the cancer has spread beyond where it started. Metastatic means the cancer has spread to distant parts of the body, such as the lungs, liver, or bone^[8]. This is also called stage 4 or distant metastasis^[8].

Recurrent cancer means the cancer has come back after treatment. If it comes back in the same place where it first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body, which is called distant metastasis or distant recurrence^[8].

Patients with tumors that have penetrated through the urothelial wall or with distant metastases usually cannot be cured with available forms of treatment^[3]. This stark reality makes early detection critically important for this type of cancer.

The Urinary System and Where Cancer Forms

There are two kidneys in the human body, one on each side of the backbone, above the waist^[1]. The kidneys of an adult are about 5 inches long and 3 inches wide and are shaped like a kidney bean^[1].

The kidneys play an important role in the urinary system. They filter and clean the blood by taking out waste products and extra water as urine^[1]. The urine collects in the middle of each kidney in the renal pelvis^[1].

Urine passes from the renal pelvis through the ureter into the bladder^[1]. The bladder holds the urine until it passes through the urethra and leaves the body^[1]. There is a dense mat of cells that lines the entire urinary tract, from the renal pelvis to the ureters, the bladder, and then into most of the urethra^[2].

Outlook and Survival

The outlook for people with transitional cell cancer of the renal pelvis and ureter depends greatly on when the cancer is discovered and how far it has spread. These cancers are curable in more than 90% of patients if they are superficial and confined to the renal pelvis or ureter^[3]. When caught early, these cancers are very treatable^[2].

However, the outlook changes dramatically for advanced disease. Patients with deeply invasive tumors that are confined to the renal pelvis or ureter have a 10% to 15% likelihood of cure^[3]. When the cancer spreads, long-term survival rates taper off, depending on how far the cancer has traveled within the body^[2].

The major factor affecting outlook at the time of diagnosis is the depth of infiltration into or through the uroepithelial wall^[3]. Most superficial tumors are likely to be well differentiated, while infiltrative tumors are likely to be poorly differentiated^[3].

There is also a significant risk of cancer developing in other parts of the urinary tract. The incidence of subsequent bladder cancer after previous upper tract transitional cell cancer ranges from 30% to 50%^[3]. When involvement of the upper tract is diffuse (involving both the renal pelvis and ureter), the likelihood of subsequent bladder cancer increases to 75%^[3].

Treatment Options

Treatment for metastatic or recurrent transitional cell cancer of the renal pelvis and ureter differs from treatment for early-stage disease. Because these upper tract cancers come from the same types of cells that line the bladder, doctors treat them the way they treat bladder cancers, not the way they treat other kidney cancers^[2].

There are now a large number of treatments available, ranging from surgery to immune therapies to chemotherapies, including combinations of these approaches^[2].

Surgery

While surgery is the main treatment for cancer confined to the renal pelvis or ureter, its role in metastatic disease is different. Total excision of the ureter with a bladder cuff, renal pelvis, and kidney is recommended to provide the greatest likelihood of cure for localized disease^[3]. However, for metastatic cancer, surgery may be used in combination with other treatments^[11].

Chemotherapy

Chemotherapy uses anticancer drugs to destroy cancer cells. It can be used before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy) to treat cancer of the renal pelvis or ureter that has spread to the lymph nodes or other parts of the body^[11].

Neoadjuvant chemotherapy offers the advantage of using cisplatin-based regimens while patients still have maximal kidney function, before it is reduced by surgery^[12]. Adjuvant chemotherapy is generally recommended in select patients with adequate kidney function^[12].

Medical therapy is usually indicated for patients with advanced disease or in whom surgical treatment is contraindicated because of poor general condition^[12].

Other Treatment Options

Treatment may also include radiation therapy, targeted therapy, and immunotherapy^[2]. The role of radiation therapy in the management of upper urinary tract transitional cell cancer is not well defined, though some studies suggest adjuvant radiation therapy to improve local control after radical surgical treatment for high-grade disease^[12].

Risk Factors

Several factors can increase the risk of developing transitional cell cancer of the renal pelvis and ureter. A personal history of bladder cancer and smoking can increase the risk^[1].

People who are at increased risk may have one or more of the following factors^[2]:

• A history of bladder cancer
• Lynch syndrome (an inherited syndrome that increases the risk of several cancers, including urothelial cancer)
• Being a smoker
• Having been exposed to chemicals or dyes used in the manufacturing process to create plastics, rubber, printed materials, leather goods, and hairdressing supplies

This cancer typically affects adults ages 65 and older^[2]. Males are four times more likely to get bladder cancer and twice as likely to develop kidney cancers compared to females^[5]. Most people diagnosed are over age 65^[5].

Kidney damage caused by the painkiller phenacetin is a risk factor for transitional cell cancer, but phenacetin has been off the market since the late 1980s and was not frequently used in the United States^[2]. No other painkillers have been associated with transitional cell cancer^[2].

Signs and Symptoms

Symptoms of transitional cell cancer of the renal pelvis and ureter include blood in the urine and back pain^[1]. Blood in the urine (hematuria) is usually the first noticeable sign^[5].

Other symptoms include^[2]:

• Back pain
• Cramps in the side or back
• Fatigue
• Unexplained weight loss
• Pain or burning with urination
• Frequent urination

Additional symptoms may include a lump or mass in the kidney area (the side and back, between the ribs and hips), painful or frequent urination, and persistent low back pain^[5]. Symptoms may not show up right away^[5].

You should contact a healthcare provider if you notice bloody urine or any of these other symptoms^[5].