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  • Transitional Cell Carcinoma

    Kidney & Ureteral Cancer: Transitional Cell Carcinoma


    What is a kidney?
    A kidney is a bean-shaped organ located toward the back of the body, beneath the rib cage. A person is usually born with two kidneys, located on either side of our spine. The primary function of the kidney is to act as a filter to cleanse the blood of waste products and to make hormones to support blood pressure and blood cell production. The kidneys are composed of microscopic tubules that function as filtering units. As they filter the blood, the waste products accumulate in fluid, now called urine, which exits the kidneys via long tubes, the ureters, which pass into the bladder where it is stored and, eventually, expelled from the body.


    What is transitional cell carcinoma?
    Transitional cell carcinoma is an abnormal growth of the cells lining the collecting system of the kidney or ureters. A similar cancer can be found in the bladder. Cancers are formed when the cells normally found in our body grow rapidly and without control. The body's normal defenses, formed by the immune system, are unable to destroy the cancer cells because they grow so quickly. As a result, these cells lump together and form a mass, known as a tumor or a cancer. Once a cancer begins to form, it can continue to grow uncontrollably and possibly spread beyond the area where it began. Microscopic pieces of tumor can also break off and spread to different locations of the body by way of the blood system or the lymphatic system. This spreading of tumor cells is called metastases.


    Who gets transitional cell carcinoma of the kidney or ureter?
    Transitional cell carcinoma is the medical name for the second most common form of kidney cancer. Approximately 4,000 new patients with transitional cell kidney cancer will be diagnosed in the United States this year. Renal cell carcinoma cancer is equally common in men and women and in both Caucasians and African-Americans.


    What causes transitional cell carcinoma of the kidney or ureter?
    Many factors have been identified as potential causes of transitional cell carcinoma. These include: cigarette smoking, which more than quadruples the risk and contributes to as the vast majority of cases, and occupational exposure to organic compounds, petroleum products, heavy metals, and asbestos. These same patients are at risk for bladder cancer and approximately 5-10% of patients with transitional cell kidney cancer will develop bladder cancer.


    How can I tell if I have transitional cell carcinoma of the kidney or ureter?
    Many kidney cancers remain undetected until they become very large simply because there are no signs or symptoms that specifically point to its diagnosis. Currently, there are no blood tests available to detect kidney cancer. However, some warning signs can alert you to the possibility of a kidney cancer. These include blood in the urine (hematuria), a palpable lump in the abdomen, and pain in the side or back that will not go away. People may also feel very tired, lose their appetite, and experience weight loss without dieting. Many patients never experience any of these symptoms and have their kidney cancer diagnosed when they are being examined or tested for some other complaint or at their regular annual visit to a doctor.


    How do I know if I have transitional cell cancer?
    Most of the tests a doctor can order to determine if you do indeed have transitional cell kidney cancer are radiological studies. An ultrasound study is a common initial study: it takes a picture of kidney that can be seen on a television screen. A special type of kidney X-ray, called an intravenous pyelogram (IVP), enables us to visualize the outline of the kidney as well as the bladder and ureters. IVPs used quite often in patients with hematuria (blood in your urine). A CT scan is a sophisticated X-ray that images the organs of the body very closely. This is considered the best test for determining the presence of masses on the kidney. Magnetic resonance imaging (MRI), which uses magnetic waves to image organs in great detail, may also be performed. A bone scan may be ordered to determine whether the kidney cancer has spread to the bones. A renal scan can help determine how well the kidneys are functioning. Blood tests can be performed to look for abnormal levels of creatinine, a sign of impaired kidney functioning, or abnormal levels of liver enzymes, which may suggest that the cancer involves the liver. Cystoscopy, an examination of the bladder using a telescope, is also commonly performed, to rule out the presence of a bladder cancer. Sometimes, when X-ray studies are equivocal, a retrograde pyelogram or ureteroscopy may be performed. These studies are done under anesthetic to take better pictures of the ureter and kidney.


    What happens if I am diagnosed with transitional cell cancer?
    “Staging” refers to the process of determining how much cancer is present in the body and where it exists. All cancers are assigned a “stage” prior to treatment. Such staging is important because it helps to determine the prognosis as well as the type of treatment that would be most beneficial. The stage of the cancer is simply a means of defining the extent of the tumor: whether the cancer is only in the kidney, or whether it has spread outside the organ to other places in the body, for example. In order to stage a cancer, several diagnostic tests may be obtained: a CT scan or MRI of the abdomen, chest, and head; a chest X-ray; a bone scan and blood tests. Cystoscopy will be performed. After staging is completed, you will meet with a urologist to discuss treatment options.


    How is transitional cell carcinoma of the kidney treated?
    The stage of the cancer, as well as the age and general health of the patient, help to determine what treatment will be most effective. If the cancer is diagnosed as Stage I, Stage II, or Stage III, the most likely initial treatment will be surgical. Surgery almost always involves a nephroureterectomy, which involves removing the entire kidney and ureter, the tissues that surround it, and a small “cuff” of the bladder where the ureter inserts.


    If the tumor is limited to a small section of the ureter, you may be a candidate for a ureterectomy. This operation involves removing the segment of ureter containing cancer and then reconnecting the two ends, leaving the kidney in place. The appropriateness of this operation depends upon the aggressiveness, location, and extent of the cancer.


    In very select cases, a patient may undergo endoscopic surgery, in which the tumor is removed while the kidney and ureter are left intact. This is rarely performed and is usually reserved for patients with poor health, poor kidney function, and small, superficial, and non-aggressive tumors.


    Minimally-invasive (laparoscopic) techniques are used to perform nephroureterectomies and ureterectomies unless the tumor invades surrounding organs. Laparoscopic surgery is a minimally invasive technique in which the surgeon views the anatomy and performs the operation using a camera and tools inserted through small holes in the patient's skin.


    If the cancer has spread to tissue surrounding the kidney or ureter, or if it has metastasized to distant organs (such as the lung or liver), drug therapy (chemotherapy) may be used in additional to surgery.