Transitional Cell Carcinoma Recurrent

When transitional cell carcinoma returns after treatment, it presents unique challenges that require ongoing monitoring and specialized care.

Table of contents

• What Is Recurrent Transitional Cell Carcinoma?
• Parts of the Body Affected
• Signs and Symptoms
• Risk of Cancer Coming Back
• Treatment Approaches
• Follow-Up Care and Monitoring
• Managing Life After Diagnosis

What Is Recurrent Transitional Cell Carcinoma?

Recurrent transitional cell carcinoma means the cancer has come back after treatment. Transitional cells are special cells that line parts of your urinary system. These cells can stretch when your bladder or kidney fills with urine and shrink when it empties^[1]. When cancer develops in these cells and returns after treatment, it is called recurrent disease.

Transitional cell carcinoma is also called urothelial carcinoma. This type of cancer accounts for about 90% of all bladder cancer cases in the United States. Only about 7% of kidney cancers are transitional cell carcinoma^[2].

urothelial carcinoma, transitional cell cancer

Parts of the Body Affected

Transitional cell carcinoma can occur in several parts of the urinary system. The cancer most commonly affects the bladder, but it can also develop in the renal pelvis, which is the area at the center of the kidney where urine collects, and in the ureters, which are long tubes that connect the kidneys to the bladder^[1].

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

The kidneys filter and clean the blood by removing waste products and extra water as urine. The urine collects in the renal pelvis of each kidney, then flows through the ureters to the bladder. The bladder stores the urine until it leaves the body through the urethra^[1].

Signs and Symptoms

Symptoms of recurrent transitional cell carcinoma may not appear right away. Blood in your urine, called hematuria, is usually the first noticeable sign^[2]. You should contact a healthcare provider if you notice bloody urine or other symptoms.

Other signs that cancer may have returned include:

• Painful or frequent urination
• Back pain that does not go away
• A lump or mass in your kidney area, between your ribs and hips
• Extreme tiredness or fatigue
• Unexplained weight loss^[2]

Risk of Cancer Coming Back

Even when caught early and treated successfully, transitional cell carcinomas often come back. Evidence suggests that cancers that do not invade the muscle layer of the bladder, which make up approximately 70% of those diagnosed with transitional cell carcinoma, have a high recurrence rate. Up to 70% may return within two years of treatment^[13].

After treatment for transitional cell cancer of the upper urinary tract, the chance of developing bladder cancer ranges from 30% to 50%. When the cancer involves both the renal pelvis and ureter, the likelihood of later bladder cancer increases to 75%^[3]. The incidence of cancer developing in the opposite kidney or ureter ranges from 2% to 4%^[3].

A personal history of bladder cancer increases your risk of developing transitional cell carcinoma of the renal pelvis and ureters^[2].

Treatment Approaches

Once recurrent transitional cell carcinoma has been diagnosed, treatment is necessary. Surgery is the main form of treatment for cancer that has not spread to distant parts of the body^[6].

For patients with low-grade tumors that have not invaded deeply, doctors may recommend kidney-sparing surgery. This can include endoscopic ablation, where doctors use special instruments with lights and lasers to remove tumors through small tubes inserted into the body^[6].

For more advanced disease, complete removal of the kidney, renal pelvis, ureter, and a portion of the bladder may be recommended to provide the greatest likelihood of cure^[3].

Other treatment options may include:

• Topical therapy, where medicine is placed directly into the affected area
• Chemotherapy, which uses drugs to kill cancer cells throughout the body
• Radiation therapy in some cases^[6]

Medical therapy is usually indicated for patients with advanced disease or when surgery is not possible because of poor general health^[6].

Follow-Up Care and Monitoring

Regular follow-up care is extremely important for people who have been treated for transitional cell carcinoma because of the high risk of the cancer coming back. Because transitional cells line many different parts of the urinary tract system, tumors can develop in more than one place. If you have transitional cell carcinoma in your bladder, you should also be checked for tumors in other parts of your urinary tract^[5].

Follow-up testing may include:

• Urine tests to look for cancer cells
• Imaging tests such as CT scans, MRI, or ultrasound to see inside your body
• Scope tests, where a doctor uses a thin tube with a light and camera to look inside your bladder, kidneys, or ureters^[2]

In rare cases, transitional cell carcinoma can recur within the intestinal urinary diversion after surgery to remove the bladder. The most common presentation is blood in the urine, and the time between surgery and this unusual recurrence can be several years^[11].

Managing Life After Diagnosis

Fear that the cancer will come back is one of the most common concerns experienced by people who have had transitional cell carcinoma. Many cancer survivors report thinking about the disease less often as the years go by^[13].

There are steps you can take to help protect your bladder and reduce the risk of recurrence:

• Quit smoking, as smoking is thought to be the cause of about half of all bladder cancers^[13]
• Stay hydrated by drinking six to eight glasses of water a day
• Eat a diet high in fruits and vegetables, with at least five servings every day
• Exercise regularly, as 30 minutes a day of moderate exercise reduces anxiety and symptoms such as fatigue, nausea, and pain^[13]

To cope with fear and anxiety about recurrence:

• Acknowledge your fears by writing them down
• Learn as much as you can about the disease and your treatment options
• Express your feelings to friends, family members, a counselor, or others going through the same experience
• Find ways to relax when you feel anxious or afraid^[13]

Many people find it helpful to join a cancer support group where they can connect with others who understand what they are experiencing. Having caregivers and family members to support you through treatment and recovery is very important.