Bladder Transitional Cell Carcinoma

Bladder transitional cell carcinoma is a type of cancer that begins in the cells lining the bladder and other parts of the urinary system. While it accounts for about 90% of bladder cancer cases, when detected early, it can be treated successfully—though it frequently returns even after treatment.

Table of contents

• What is bladder transitional cell carcinoma?
• Other names for this condition
• Parts of the body affected
• Signs and symptoms
• What causes this cancer
• Who is at higher risk
• How doctors diagnose this condition
• Treatment options
• Outlook and follow-up care

What is bladder transitional cell carcinoma?

Bladder transitional cell carcinoma, also known as urothelial carcinoma, is cancer that starts in special cells called transitional cells (or urothelial cells) that line the inside of the bladder and other parts of the urinary system^[1]. These cells are remarkable because they can stretch when the bladder fills with urine and shrink back down when it empties^[5].

This type of cancer is by far the most common form of bladder cancer. It accounts for approximately 90% of all bladder cancer cases in the United States and about 95% worldwide^[1][6]. Almost all bladder cancers are urothelial carcinomas^[10].

The bladder is a hollow, balloon-shaped organ in the lower part of the abdomen that stores urine. It has a muscular wall that allows it to expand to hold urine made by the kidneys and contract to release urine from the body^[10]. Transitional cell carcinoma can also occur in other parts of the urinary system where these same cells are found, including the tubes that connect the kidneys to the bladder (ureters) and the area at the center of each kidney where urine collects (renal pelvis)^[1].

Urothelial carcinoma, transitional cell cancer, TCC

Parts of the body affected

Transitional cells are found throughout the urinary system, which is why this cancer can develop in several locations^[4]. The urinary system includes the kidneys, which filter blood and make urine; the ureters, which are long tubes that carry urine from the kidneys to the bladder; the bladder itself, which stores urine; and the urethra, which is the tube that carries urine out of the body^[5].

• Bladder
• Ureters
• Renal pelvis (inside the kidney)
• Urethra

Because transitional cells line many different parts of the urinary tract system, it is sometimes possible to develop tumors in more than one place. If you have transitional cell carcinoma in your bladder, doctors will also check for tumors in other parts of your urinary tract^[4].

Signs and symptoms

Symptoms of bladder transitional cell carcinoma may not appear right away, especially in the early stages. The most common and usually the first noticeable sign is blood in the urine, which doctors call hematuria^[1][3]. This blood may be visible to you, or it may only be detected through testing.

You should contact a healthcare provider if you notice any of the following symptoms^[1]:

• Blood in your urine (which may make the urine look red, pink, or cola-colored)
• Frequent urination (needing to urinate more often than usual)
• Painful urination (feeling pain or burning when you urinate)
• Persistent low back pain that does not go away
• Extreme fatigue (feeling very tired)
• Unexplained weight loss
• A lump or mass in the kidney area (your side and back, between your ribs and hips)

What causes this cancer

Medical researchers are not entirely sure what causes bladder transitional cell carcinoma, but they understand how it develops. The cancer begins when a healthy transitional cell changes (mutates) and becomes a cancer cell^[1]. These abnormal cells then multiply and can form tumors. Without treatment, the cancer can spread to other parts of the body.

This type of cancer is a clear example of how environmental factors can lead to disease. Scientists know that changes in how transitional cells in the bladder, ureters, and renal pelvis function—especially how they grow and divide—cause the disease^[5]. Many of the known causes involve exposure to harmful substances over time.

Who is at higher risk

Several factors can increase your risk of developing bladder transitional cell carcinoma. By far the most important cause is cigarette smoking, which contributes to approximately one-half of all cases^[6]. In fact, smoking is thought to be the cause of about half of all bladder cancers^[1].

Other risk factors include^[1][4][6]:

• Sex: Men are four times more likely to get bladder cancer than women. Males are also twice as likely to develop kidney cancers
• Age: Most people diagnosed are over age 65
• Chemical exposure: People who work with certain chemicals used in dyes, rubber, leather, paint, textiles, and hairdressing supplies may have an increased risk. Workers in the petroleum industry and those who manufacture paints and pigments (such as aniline dyes) are also at higher risk
• Medical history: Having had bladder cancer before increases your risk of developing transitional cell carcinoma in other parts of the urinary system, like the renal pelvis and ureters
• Certain medications: Some drugs, such as cyclophosphamide, may increase risk
• Chronic irritation: Long-term urinary stone disease, chronic catheter use (as in patients with paraplegia or multiple sclerosis), and chronic infections increase risk
• Misusing pain medications: Long-term misuse of pain medications, including over-the-counter medicines, can increase risk

The risk can be lowered by increased liquid consumption, which presumably reduces the time urine stays in contact with the bladder lining. In contrast, risk increases among people like long-haul truck drivers who have long periods where urine stays in the bladder^[6].

You might reduce your risk of developing this cancer by not smoking and avoiding exposure to harmful chemicals^[1].

How doctors diagnose this condition

To determine if you have bladder transitional cell carcinoma, healthcare providers use several different tests. The diagnostic process typically includes^[1]:

Urine tests: Your provider will perform a urinalysis on a urine sample to look for blood, proteins, or other abnormalities. They may also do specific tests to check for cancer cells in your urine (called urine cytology)^[1].

Imaging tests: You may need one or more imaging tests so that your provider can see tumors inside your body. These may include a CT scan (computed tomography), MRI (magnetic resonance imaging), PET scan (positron emission tomography), or ultrasound. You may also need an intravenous pyelogram (IVP), which uses a contrast dye injected into your vein that makes blockages in your kidneys, ureter, and bladder stand out on an X-ray^[1].

Scope tests: Your provider may use a special instrument with a light and lens to look inside your bladder, kidneys, or ureters. This procedure is called cystoscopy when examining the bladder or ureteroscopy when examining the ureters. During these procedures, they may take small tissue samples (biopsies) to test for cancer cells^[1].

After bladder transitional cell carcinoma has been diagnosed, additional tests are done to find out if cancer cells have spread within the urinary system or to other parts of the body. This process is called staging and helps doctors plan the best treatment^[5].

Treatment options

Treatment for bladder transitional cell carcinoma depends on several factors, including the type of cancer you have, the size and location of the tumor, whether it has spread, and your general health^[1]. Surgery is the main treatment for this type of cancer^[1].

Surgery can take several forms. You may have surgery to remove the cancer from your bladder lining, remove all or part of your bladder, or address blockages in the tubes that carry urine^[1]. For some people with more advanced cancer, doctors may need to remove the entire bladder (a procedure called cystectomy) and create a new way for urine to leave the body^[9].

Chemotherapy uses medicines to kill cancer cells. It can be given in two ways for bladder cancer: either directly into the bladder or into a vein (intravenously)^[1]. Chemotherapy may be used before surgery or radiotherapy, at the same time as radiotherapy (called chemoradiotherapy), after surgery to prevent the cancer from coming back, or if the cancer has spread to other parts of the body.

Immunotherapy and targeted medicines help your immune system find and kill cancer cells or stop the cancer from growing. Immunotherapy, such as BCG (Bacillus Calmette-Guérin), can be given directly into the bladder to treat the cancer and reduce the chance of it coming back^[1].

Radiotherapy uses rays of radiation to kill cancer cells. You may have radiotherapy instead of surgery or if the cancer has spread to other parts of your body. It is sometimes given together with chemotherapy (chemoradiotherapy)^[1].

Your specialist treatment team will explain the treatments, discuss the benefits and possible side effects, work with you to create the best treatment plan, and help you manage any side effects^[1]. You will have regular check-ups during and after treatment, which may include additional tests and scans.

Outlook and follow-up care

When caught early, bladder transitional cell carcinoma is easily treatable. However, one important characteristic of this cancer is that it often comes back, even after successful treatment^[1]. Bladder cancer has a high recurrence rate—up to 70% of non-muscle invasive bladder cancers (which make up approximately 70% of those diagnosed) may return within two years of treatment^[18].

Because of this high recurrence rate, it is very important for people who have been treated for bladder transitional cell carcinoma to visit their doctor regularly for follow-up exams and tests. During these visits, doctors check to make sure the cancer has not returned and monitor your overall health.

Many cancer survivors experience fear that the cancer will come back. This is one of the most common concerns among survivors. Over time, many people report thinking about the disease less often as the years go by^[21]. Your healthcare team can provide support and resources to help you cope with these feelings.

There are steps you can take to help protect your bladder and reduce the risk of cancer returning. These include quitting smoking (if you smoke), staying well hydrated by drinking six to eight glasses of water a day, eating a diet rich in fruits and vegetables (at least five servings daily), and exercising regularly for at least 30 minutes a day^[18].