Urothelial Carcinoma (Transitional Carcinoma): Symptoms, Causes, Treatment

What are the symptoms of urothelial carcinoma?

The symptoms of urothelial carcinoma (also known as transitional cell carcinoma), which most commonly affects the bladder but can also occur in the renal pelvis, ureters, and urethra, include:

• Blood in the urine (hematuria): This is the most common symptom. The blood may be visible (gross hematuria) or only detectable under a microscope (microscopic hematuria).
• Frequent urination: An increased need to urinate, often accompanied by a sense of urgency.
• Pain or burning during urination (dysuria): Discomfort or a burning sensation while urinating.
• Pelvic pain or lower abdominal pain: Pain or pressure in the pelvic area.
• Back pain: This may occur if the cancer is in the upper urinary tract (renal pelvis or ureter).
• Urinary incontinence: Difficulty controlling urination may develop in more advanced cases.
• Unintended weight loss and fatigue: These may occur if the cancer has spread or is in an advanced stage.

Some people with urothelial carcinoma may not show symptoms until the disease is advanced, which is why regular check-ups and prompt attention to urinary symptoms are important.

What are the causes of urothelial carcinoma?

The causes of urothelial carcinoma (transitional cell carcinoma) are linked to genetic factors, environmental exposures, and lifestyle choices. The primary causes include:

• Smoking: Tobacco smoke is the leading cause of urothelial carcinoma, especially bladder cancer. Carcinogens in tobacco are filtered by the kidneys and stored in the bladder, damaging the urothelial cells over time.
• Chemical exposure: Prolonged exposure to certain industrial chemicals, such as those used in the dye, rubber, leather, and textile industries, can increase the risk. Aromatic amines, aniline dyes, and benzidine are known carcinogens.
• Chronic bladder inflammation: Conditions that cause long-term bladder irritation or infections, such as chronic urinary tract infections (UTIs), bladder stones, or the use of long-term urinary catheters, may contribute to the development of urothelial carcinoma.
• Previous cancer treatments: Certain chemotherapy drugs (like cyclophosphamide) and radiation therapy targeted at the pelvis can increase the risk of developing bladder cancer later.
• Age and gender: Urothelial carcinoma is more common in older adults, particularly those over 55. It is also more prevalent in men than in women.
• Genetic factors: A family history of bladder cancer or specific inherited genetic mutations can raise the risk.
• Schistosomiasis infection: In certain parts of the world, especially Africa and the Middle East, this parasitic infection can cause bladder inflammation that leads to urothelial carcinoma.
• Dietary factors: Diets high in processed meats and low in fruits and vegetables might slightly increase the risk.

Understanding these risk factors can help with prevention and early detection, especially for individuals with a higher risk profile.

What is the treatment for urothelial carcinoma?

The treatment for urothelial carcinoma (transitional cell carcinoma) depends on the stage, grade, and location of the cancer, as well as the patient’s overall health. Treatment options include:

• Surgical Procedures:
• Transurethral resection of bladder tumor (TURBT): This is typically the first treatment for early-stage or superficial bladder cancer. During TURBT, a cystoscope is inserted through the urethra to remove the tumor. This procedure is often followed by intravesical therapy to reduce the risk of recurrence.
• Cystectomy: For more advanced cases, a partial cystectomy (removal of part of the bladder) or a radical cystectomy (removal of the entire bladder) may be required. In a radical cystectomy, nearby lymph nodes, part of the urethra, and surrounding organs (prostate in men, uterus in women) may also be removed.
• Nephroureterectomy: For urothelial carcinoma affecting the upper urinary tract (kidneys and ureters), surgical removal of the affected kidney and ureter may be necessary.
• Intravesical Therapy:
• Intravesical chemotherapy: For early-stage bladder cancer, chemotherapy drugs (like mitomycin) are delivered directly into the bladder to target cancer cells and reduce recurrence.
• Intravesical immunotherapy: Bacillus Calmette-Guérin (BCG) is the most common form of intravesical immunotherapy. It triggers the immune system to attack cancer cells in the bladder.
• Chemotherapy:
• For muscle-invasive bladder cancer, systemic chemotherapy may be used before surgery (neoadjuvant chemotherapy) to shrink the tumor or after surgery (adjuvant chemotherapy) to kill remaining cancer cells. It can also be used in cases of metastatic urothelial carcinoma.
• Radiation Therapy:
• Radiation therapy is an option for patients who cannot undergo surgery or prefer not to. It can also be combined with chemotherapy for a more aggressive treatment approach, particularly in muscle-invasive bladder cancer.
• Immunotherapy:
• For advanced or metastatic urothelial carcinoma, checkpoint inhibitors (like pembrolizumab or atezolizumab) may be used. These drugs help the immune system recognize and destroy cancer cells.
• Targeted Therapy:
• Targeted drugs like erdafitinib can be used for advanced bladder cancer in patients with specific genetic mutations (like FGFR gene mutations).
• Clinical Trials:
• Participation in clinical trials can offer access to new and emerging therapies for urothelial carcinoma.

The treatment plan is typically customized based on the individual’s specific condition, considering factors such as tumor size, location, and whether the cancer has spread.

What is the survival rate for urothelial carcinoma?

The survival rate for urothelial carcinoma, which is the most common type of bladder cancer, varies depending on the stage at diagnosis:

• Stage I (Localized): When urothelial carcinoma is confined to the inner layer of the bladder, the 5-year relative survival rate is around 88%.
• Stage II (Regional): If the cancer has invaded the muscle layer of the bladder but has not spread beyond it, the 5-year relative survival rate is about 63%.
• Stage III (Regional): When the cancer has spread to nearby tissues, such as the prostate, uterus, or vagina, the 5-year relative survival rate drops to approximately 46%.
• Stage IV (Distant): If urothelial carcinoma has spread to distant parts of the body, the 5-year relative survival rate is around 15%.

These survival rates are general estimates and can be influenced by factors such as the patient’s overall health, the specific characteristics of the tumor, and how well the cancer responds to treatment. Early detection and treatment generally lead to better outcomes.