Transitional cell carcinoma

Transitional cell carcinoma
Classification and external resources

Histopathology of urothelial carcinoma of the urinary bladder. Transurethral biopsy. H&E stain.
ICD-O: M8120/3-8130
eMedicine med/2003 radio/711
MeSH D002295

Transitional cell carcinoma (TCC, also urothelial cell carcinoma or UCC) is a type of cancer that typically occurs in the urinary system: the kidney, urinary bladder, and accessory organs. It is the most common type of bladder cancer and cancer of the ureter, urethra, and urachus. It is the second most common type of kidney cancer, but accounts for only 5% to 10% of all primary renal malignant tumors.

TCC arises from the transitional epithelium, a tissue lining the inner surface of these hollow organs.[1]

When the term "urothelial" is used, it specifically refers to a carcinoma of the urothelium, meaning a TCC of the urinary system.

Contents

Signs and symptoms

Signs and symptoms depend on the location and extent of the cancer: see for example Bladder cancer.

Causes

  1. certain drugs such as cyclophosphamide and phenacetin are known to predispose to bladder TCC.[2]
  2. long-term usage of analgesics
  3. radiation exposure
  4. somatic mutation such as deletion of Chromosome 9p,9q,11p,17p,13q,14q and over expression of RAS (oncogene) and epidermal growth factor receptor (EGFR)
  5. cigarette smoke
  6. naphthylamines and aniline dyes

Pathology

TCCs are often multifocal, with 30-40% of patients having more than one tumor at diagnosis. The pattern of growth of TCCs can be papillary, sessile (flat) or carcinoma-in-situ (CIS).

The most common site of TCC metastasis outside the pelvis is bone (35%); of these bone metastases, 40% are in the spine.[3]

Terminology

Transitional refers to the histological subtype of the cancerous cells as seen under a microscope.

Classification

The 1973 WHO grading system for TCCs (papilloma, G1, G2 or G3) is most commonly used despite being superseded by the 2004 WHO [4] grading (papillary neoplasm of low malignant potential (PNLMP), low grade and high grade papillary carcinoma).

Treatment

Transitional cell carcinoma (TCC) can be very difficult to treat. Treatment for limited stage TCC is surgical resection of the tumor, but reoccurrence is common. Chemotherapy for TCC consists of the MVAC regimen (methotrexate, vinblastine, adriamycin and cisplatin). TCC can also be treated with infusions of BCG into the bladder.

Associations

It is associated with phenacetin, aniline dyes, cyclophosphamide, smoking, and those who drink excessive alcohol. It is also associated with hereditary nonpolyposis colorectal cancer.

Prostate

TCC can also be associated with the prostate.[5][6]

Additional images

References

  1. ^ "transitional cell carcinoma" at Dorland's Medical Dictionary
  2. ^ Colin P, Koenig P, Ouzzane A, Berthon N, Villers A, Biserte J, Roupret M (November 2009). "Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract". BJU International 104 (10): 1436–40. doi:10.1111/j.1464-410X.2009.08838.x. PMID 19689473. 
  3. ^ Punyavoravut V, Nelson SD (August 1999). "Diffuse bony metastasis from transitional cell carcinoma of urinary bladder: a case report and review of literature". Journal of the Medical Association of Thailand 82 (8): 839–43. PMID 10511795. 
  4. ^ Sauter G, Algaba F, Amin MB, Busch C, Cheville J, Gasser T, Grignon D, Hofstaedter F, Lopez-Beltran A, Epstein JI. Noninvasive urothelial neoplasias: WHO classification of noninvasive papillary urothelial tumors. In World Health Organization classification of tumors. Pathology and genetics of tumors of the urinary system and male genital organs. Eble JN, Epstein JI, Sesterhenn I (eds): Lyon, IARCC Press, p. 110, 2004
  5. ^ Walsh DL, Chang SS (2009). "Dilemmas in the treatment of urothelial cancers of the prostate". Urologic Oncology 27 (4): 352–7. doi:10.1016/j.urolonc.2007.12.010. PMID 18439852. 
  6. ^ Njinou Ngninkeu B, Lorge F, Moulin P, Jamart J, Van Cangh PJ (January 2003). "Transitional cell carcinoma involving the prostate: a clinicopathological retrospective study of 76 cases". The Journal of Urology 169 (1): 149–52. doi:10.1097/01.ju.0000042810.43380.36. PMID 12478124.