Transitional Cell Carcinoma Metastatic

Transitional cell carcinoma metastatic is an advanced stage of cancer that has spread from its original location in the urinary tract to other parts of the body, requiring specialized treatment approaches focused on prolonging survival and maintaining quality of life.

Table of contents

• What is Transitional Cell Carcinoma Metastatic?
• Symptoms
• Where the Cancer Spreads
• Prognosis and Outlook
• Treatment Approaches

What is Transitional Cell Carcinoma Metastatic?

Transitional cell carcinoma, also called urothelial carcinoma, is cancer that starts in special cells called transitional cells. These cells line the inside of your urinary system, including your bladder, the tubes that carry urine from your kidneys to your bladder (ureters), and a part of your kidney called the renal pelvis.^[1]

Transitional cells get their name because they can change shape. When your bladder fills with urine, these cells stretch. When your bladder is empty, they shrink back down. This ability to stretch and shrink is what allows your urinary system to store and release urine.^[3]

When transitional cell carcinoma becomes metastatic, it means the cancer has spread from where it started to other parts of your body. This is also called advanced stage IV disease. At this stage, the cancer is no longer just in the bladder, kidney, or ureter—it has traveled to distant organs or tissues.^[2]

About 10 to 15 percent of people are diagnosed when the cancer has already spread to other parts of the body. This is sometimes called “de novo” metastatic disease, meaning it was already advanced when first found.^[23]

• Bladder
• Renal pelvis (kidney)
• Ureters
• Lymph nodes
• Lungs
• Liver
• Bones

Symptoms

The most common first sign of transitional cell carcinoma is blood in your urine, which doctors call hematuria. You should contact a healthcare provider if you notice blood in your urine or experience other warning signs.^[3]

Common symptoms include:

• Blood in your urine (may be visible or only detected through testing)
• Pain in your side, between your ribs and hips
• Pain in your lower back that doesn’t go away
• Painful or frequent urination
• Unexplained weight loss
• Feeling very tired (fatigue)
• A lump or mass in your kidney area^[3]

In one reported case, a patient with metastatic transitional cell carcinoma experienced right shoulder and neck pain. The cancer had spread to soft tissue in the shoulder area, which was detected as a palpable mass.^[2]

Where the Cancer Spreads

Transitional cell carcinoma typically spreads in a predictable pattern. The cancer most commonly moves first to nearby lymph nodes in the pelvis. From there, it can spread to organs and other parts of the body.^[2]

The most common sites where metastatic transitional cell carcinoma spreads include:

• Pelvic lymph nodes
• Lungs
• Liver
• Bones

Less commonly, the cancer can spread to the brain, especially after patients have received chemotherapy treatment. In rare cases, it may spread to soft tissue areas such as the shoulder girdle.^[2]

In one documented case, a patient developed metastatic disease in unusual locations including the right scapula (shoulder blade), both femurs (thigh bones), and parts of the pelvis. The patient also had soft tissue masses in the shoulder area.^[2]

Prognosis and Outlook

When transitional cell carcinoma has spread beyond the urinary tract, the prognosis is generally more limited than when the cancer is caught early. Patients with tumors that have penetrated through the wall of the urinary tract or have distant metastases (spread to other organs) usually cannot be cured with currently available treatments.^[6]

However, treatment goals for metastatic disease focus on important outcomes. The aim is to prolong survival, shrink or slow the growth of tumors, ease symptoms, and improve quality of life. In other words, treatment helps you live as well as you can for as long as you can. In rare cases, treatment may even result in a cure.^[23]

For patients whose cancer has not yet spread, the outlook is much better. These cancers are curable in more than 90 percent of patients if they are superficial and confined to the renal pelvis or ureter. Patients with deeply invasive tumors that remain confined to these areas have a 10 to 15 percent likelihood of cure.^[6]

One important factor affecting outlook is how deeply the cancer has grown into the wall of the urinary tract. This is the major factor doctors consider when predicting how the disease will progress. Superficial tumors tend to be less aggressive, while tumors that have grown deeper into the tissue are usually more aggressive.^[6]

Treatment Approaches

Treatment for metastatic transitional cell carcinoma is different from treatment for cancer that has not spread. Once the diagnosis is made, treatment is mandatory. The main approaches include chemotherapy, immunotherapy, and newer targeted treatments.^[8]

Chemotherapy

Chemotherapy using platinum-based drugs, particularly cisplatin, is currently the standard first-line treatment. Cisplatin-based chemotherapy provides a median survival of about 14 months. However, up to 50 percent of people with metastatic disease cannot receive cisplatin because of kidney problems or other health issues.^[13]

Common chemotherapy combinations used include drugs such as methotrexate, vinblastine, doxorubicin, and cisplatin. In cases where cisplatin cannot be used, carboplatin may be an alternative option.^[2]

Some patients may receive chemotherapy before surgery (called neoadjuvant chemotherapy). This approach offers the advantage of treating the cancer while patients still have maximum kidney function, before surgery reduces it. After surgery, some patients with adequate kidney function may receive additional chemotherapy (called adjuvant chemotherapy) to reduce the risk of the cancer coming back.^[8]

Immunotherapy

Immunotherapy works by helping your body’s immune system recognize and attack cancer cells. These treatments have shown promise, especially in patients who cannot receive cisplatin-based chemotherapy.^[1]

One type of immunotherapy, called maintenance therapy with avelumab, has been shown to improve survival. When given to patients whose cancer responded to platinum-based chemotherapy, it helped them live longer compared to those who did not receive this treatment.^[13]

Antibody-Drug Conjugates and Targeted Therapy

Newer treatment options called antibody-drug conjugates have shown promise in selected patients, particularly those whose disease has progressed despite platinum-based chemotherapy. These treatments combine an antibody that targets cancer cells with a chemotherapy drug.^[13]

For patients whose tumors have specific genetic changes in a gene called FGFR (fibroblast growth factor receptor), targeted therapy with FGFR inhibitors may be an option. These drugs specifically attack cancer cells with these genetic changes. One such drug, erdafitinib, has been shown to extend survival in patients with FGFR alterations who had previously received immunotherapy.^[13]

Managing Side Effects

Chemotherapy can cause significant side effects. In the case report of one patient who received combination chemotherapy, side effects included nausea, vomiting, diarrhea, loss of appetite, anemia, mouth sores, and infections. Because of these severe side effects, the patient had to stop treatment early.^[2]

Your medical team will work with you to manage side effects and maintain your quality of life during treatment. This may include medications to control nausea, treatment for infections, and nutritional support.

Palliative Care

For patients with metastatic disease, palliative care plays an important role. This type of care focuses on relieving symptoms, managing pain, and improving quality of life. Palliative care can be provided alongside other treatments and is not just for end-of-life situations.^[23]