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What Is Transitional Cell Carcinoma Of The Kidney

The Following Stages Are Used For Transitional Cell Cancer Of The Renal Pelvis And/or Ureter:

Transitional Cell Carcinoma, Causes, Signs and Symptoms, Diagnosis and Treatment.

Stage 0

In stage 0, abnormalcells are found in tissue lining the inside of the renal pelvis or ureter. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stages 0a and 0is, depending on the type of tumor:

  • Stage 0a is also called noninvasive papillary carcinoma, which may look like long, thin growths that grow out from the tissue lining the inside of the renal pelvis or ureter.
  • Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the renal pelvis or ureter.

Stage I

In stage I, cancer has formed and has spread from the tissue lining the inside of the renal pelvis or ureter to the connective tissue layer.

Stage II

In stage II, cancer has spread to the muscle layer of the renal pelvis or ureter.

Stage III

In stage III, cancer has spread:

  • from the muscle layer of the renal pelvis to fat around the renal pelvis or to tissue in the kidney or
  • from the muscle layer of the ureter to fat around the ureter.

Stage IV

Renal Cell Carcinoma Of The Kidney With Synchronous Ipsilateral Transitional Cell Carcinoma Of The Renal Pelvis

Dogan Atilgan

1Gaziosmanpasa University Faculty of Medicine Department of Urology, 60100 Tokat, Turkey

Abstract

A 73-year-old man was admitted to our clinic with flank pain and gross macroscopic hematuria. Radiologic examination revealed a solid mass in the left kidney and additionally another mass in the ureteropelvic junction of the same kidney with severe hydronephrosis. Left nephroureterectomy with bladder cuff removel was performed, and histopathological evolution showed a Fuhrman grade 3 clear cell type RCC with low-grade TCC of the pelvis.

1. Introduction

Simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma in the ipsilateral kidney is a rare entity. There are only about 50 cases reported in the literature to date .

Herein, we reported a 73-year-old man who admitted to our clinic with simultaneous RCC and TCC of the left kidney.

2. Case Presentation

CT image of the solid renal parenchymal mass in the left kidney.
CT image of the solid mass in the left ureteropelvic junction with severe hydronephrosis.
Macroscopic view of RCC and TCC with severe hydronephrosis.
Microscopic overview of the RCC .
Papillary urothelial carcinoma .

3. Discussion

Several possible aetiological factors have been implicated for primary renal pelvic neoplasms. Although the etiology of coexistence of different type renal neoplasms is still unclear, chronic irritation, hydronephrosis, and urinary calculi have been the most commonly discussed etiologic factors .

Available Treatments At Rcca

Your treatment team at Regional Cancer Care Associates will determine whether you require surgery, nonsurgical treatment options, or a combination of both. If youre a candidate for bladder cancer surgery, nephroureterectomy is one of the most common procedures. During surgery, the affected kidney, ureter, and surrounding bladder tissue are removed to eliminate cancer cells. Segmental resection is also common, as it removes the portion of the ureter that contains cancer. If your cancer has spread outside the renal pelvis and ureter, your doctor will discuss additional surgical options specific to the site of your cancer.

Several nonsurgical treatment options are often used in conjunction with surgery or independently. These include chemotherapy, immunotherapy, targeted therapy, and more. You may also be eligible for clinical trials that test the efficacy of new treatment methods and medications for transitional cell carcinoma.

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Looking For More Of An Introduction

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

  • ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to kidney cancer. This free fact sheet is available as a PDF, so it is easy to print.

What Is The Outlook For This Type Of Cancer

Transitional cell carcinoma. Causes, symptoms, treatment ...

The outlook for someone diagnosed with cancer of the renal pelvis and ureter depends on a number of factors that your doctor will discuss with you. In particular, the chance of recovery is dependent on:

  • Stage of the cancer. People with advanced stages of the disease will have a lower survival rate, even with treatment.
  • Location of the tumor. If the tumor is located beyond the ureter and renal pelvis, the cancer may quickly metastasize to the kidney or other organs, reducing chances for survival.
  • Overall kidney health. If there are underlying kidney disorders, the survival rate is lower, even with treatment.
  • Cancer recurrence. Cancer recurrences have lower cure and survival rates than initial cancers.
  • Metastasis. If the cancer has spread to other organs in the body, the survival rate is lower.

Its important to see your doctor for regular checkups and to let them know about any new symptoms youve developed. This helps your doctor catch potentially serious conditions in the earliest stages.

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Ajcc Stage Groupings And Tnm Definitions

The American Joint Committee on Cancer has designated staging by TNM classification to define carcinoma of the renal pelvis and ureter.

Table 1. Definitions of TNM Stage 0a

Stage

Patients may also be designated as having localized, regional, or metastaticdisease, as follows:

Localized

Patients with localized disease may be classified into three groups:

  • Group 1: Low-grade tumor confined to the urothelium without lamina propria invasion .
  • Group 2: Grade IIII carcinomas without demonstrable subepithelial invasion orfocal microscopic invasion or papillary carcinomas with carcinoma in situ and/or carcinoma in situ elsewhere in the urothelium.
  • Group 3: High-grade tumors that have infiltrated the renal pelvic wall or renalparenchyma or both but remain confined to the kidney. Infiltration ofmuscle in the upper tract may not be associated with as much potential fordistant dissemination as appears to be the case for bladder cancer.

Regional

  • Group 4: Extension of tumors beyond the renal pelvis or parenchyma and invasionof peripelvic and perirenal fat, lymph nodes, hilar vessels, and adjacenttissues.

Metastatic

  • Spread of the tumor to distant tissues.

Each of these classifications has been subclassified into categories ofunicentricity or multicentricity. The latter category indicates a more pervasive tumordiathesis and generally a less favorable prognosis.

References
  • Batata M, Grabstald H: Upper urinary tract urothelial tumors. Urol Clin North Am 3 : 79-86, 1976.
  • Transitional Cell Cancer Of The Renal Pelvis And Ureter Is A Disease In Which Malignant Cells Form In The Renal Pelvis And Ureter

    The renal pelvis is the top part of the ureter. The ureter is a long tube that connects the kidney to the bladder. There are two kidneys, one on each side of the backbone, above the waist. The kidneys of an adult are about 5 inches long and 3 inches wide and are shaped like a kidney bean. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine collects in the middle of each kidney in the renal pelvis. Urine passes from the renal pelvis through the ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.

    The renal pelvis and ureters are lined with transitional cells. These cells can change shape and stretch without breaking apart. Transitional cell cancer starts in these cells.

    Transitional cell cancer can form in the renal pelvis, the ureter, or both.

    Renal cell cancer is a more common type of kidney cancer. See the PDQ summary about Renal Cell Cancer Treatment for more information.

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    Certain Factors Affect Prognosis And Treatment Options

    The prognosis depends on the stage and grade of the tumor.

    The treatment options depend on the following:

    • The stage and grade of the tumor.
    • Where the tumor is.
    • Whether the patient’s other kidney is healthy.
    • Whether the cancer has recurred.

    Most transitional cell cancer of the renal pelvis and ureter can be cured if found early.

    Transitional Cell Carcinoma Malignant Brenner Tumor

    Managing Renal Pelvis Transitional Cell Carcinoma

    Transitional cell carcinoma may be mistaken for either an endometrioid or a serous carcinoma.323 The microspaces commonly present in transitional cell carcinomas confer an endometrioid quality. However, broad undulating papillae are not a feature of endometrioid carcinomas, whereas squamous differentiation and associated endometriosis are much more common in endometrioid than in transitional cell carcinomas. The slitlike fenestrations that may be present in transitional cell carcinoma mimic an appearance often present in serous carcinomas. However, the latter usually have more complex papillae lacking transitional-like cells and often contain psammoma bodies.

    Transitional carcinomas of the urinary tract rarely metastasize to the ovaries, but when they do, they can closely mimic both borderline and malignant Brenner tumors and ovarian transitional cell carcinomas.325 Borderline and malignant Brenner tumors usually contain residual foci of benign Brenner tumor, not a feature of a metastasis. If the ovarian tumor is a pure transitional cell carcinoma, immunohistochemistry can be very useful. The majority of ovarian transitional carcinomas are positive for Wilms tumor antigen and all are negative for CK-20, whereas the reverse is true for urinary transitional cell carcinomas.326-328

    Cristina Magi-Galluzzi, … Jonathan I. Epstein, in, 2007

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    Advanced Or Metastatic Transitional Cell Carcinomas

    First-line chemotherapy regimens for advanced or metastatic transitional cell carcinomas consists of gemcitabine and cisplatin) or a combination of methotrexate, vinblastine, adriamycin, and cisplatin.

    Taxanes or vinflunine have been used as second-line therapy .

    Immunotherapy such as pembrolizumab is often used as second-line therapy for metastatic urothelial carcinoma that has progressed despite treatment with GC or MVAC.

    In May 2016, the FDA granted accelerated approval to atezolizumab for locally advanced or metastatic urothelial carcinoma treatment after failure of cisplatin-based chemotherapy. The confirmatory trial failed to achieve its primary endpoint of overall survival.

    In April 2021, the FDA granted accelerated approval to sacituzumab govitecan for people with locally advanced or metastatic urothelial cancer who previously received a platinum-containing chemotherapy and either a programmed death receptor-1 or a programmed death-ligand 1 inhibitor.

    Urothelial Carcinoma The Most Common Form Of Bladder Cancer Linked To Smoking

    While bladder cancer may not be as frequently spotlighted as other types of cancer like melanoma, lung cancer, or breast cancer, it’s the fourth most common cancer in American men and the ninth most common in American women. According to data from the Centers for Disease Control and Prevention, over 55,000 men and 17,000 women get bladder cancer in the U.S. every year. Of these, nearly 16,000over one in fourwill die as a result of a malignancy.

    The most common type of bladder cancer is called transitional cell carcinoma . Also known as urothelial carcinoma , TCC arises from the inner lining of the urinary tract called, aptly, the transitional urothelium.

    TCC can develop in tissue from anywhere along the tract, including:

    • The renal sinus
    • The ureter
    • The innermost lining of the bladder
    • The urethra
    • The urachus

    TCC is considered the second most common cause of kidney cancer when involving the renal sinus.

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    Metastatic Or Recurrent Transitional Cell Cancer Of The Renal Pelvis And Ureter

    The prognosis for any patient with metastatic or recurrent transitional cellcancer is poor. The proper management of recurrence depends on the sites ofrecurrence, extent of prior therapy, and individual patient considerations. Chemotherapy regimens that have been shown effective for metastatic bladdercancer have generally been applied to transitional cell cancers arising fromother sites. Patients with distant metastases have a poor prognosis and canbe appropriately offered treatment on a clinical trial.

    In patients with metastatic or recurrent transitional cell carcinoma of thebladder, combination chemotherapy has produced high response rates andoccasional complete responses. Results from a randomized trial thatcompared methotrexate, vinblastine, doxorubicin, and cisplatin withsingle-agent cisplatin in advanced bladder cancer showed a significant advantagewith M-VAC in both response rate and median survival. The overall responserate with M-VAC in this cooperative group trial was 39%.

    Other chemotherapy agents that have shown activity in metastatic transitionalcell cancer include the following:

    • Paclitaxel.

    Ifosfamide, gallium nitrate, and pemetrexed have shown limited activity inpatients previously treated with cisplatin.

    Localized Transitional Cell Cancer Of The Renal Pelvis And Ureter

    Transitional Cell Carcinoma Upper Pole Calyces Right ...

    Standard treatment options:

  • Nephroureterectomy with cuff of bladder.
  • Segmental resection of ureter, only if the tumor is superficial and locatedin the distal third of the ureter.
  • Treatment options under clinical evaluation:

    The development of new instrumentation for endourological treatment of uppertract transitional cell cancer has provided new options for regional managementof these cancers. Introduction of electrofulguration and resection instrumentsor laser probes either transureterally or percutaneously may permit destructionof a primary cancer. Introduction of cytotoxic agents has also been employed. Although a biopsy can be taken for staging purposes, the accuracy of thisremains to be determined. The efficacy of treatment by these maneuvers has notbeen established.

  • Electroresection and fulguration or laser fulguration, if the tumor issuperficial.
  • Any parenchymal sparing procedure , if the renal unit issolitary or renal function is depressed.
  • The extent ofdisease in the renal pelvis.
  • The access that these agents may have to the areaof disease.
  • The sensitivity of the cancer being treated.
  • The adequacy andaccuracy of initial tumor staging and continued monitoring.
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    The Kidneys And Ureters

    The kidneys are two bean shaped organs, each about the same size as a fist. They are near the middle of your back, one on either side of your spine.

    The renal pelvis is in the middle of the kidney. Urine collects here and then drains through a tube called the ureter and into the bladder. When you empty your bladder, the urine leaves the body through a tube called the urethra.

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    Purpose Of This Summary

    This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of transitional cell cancer of the renal pelvis and ureter. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.

    Warning Disclaimer Use For Publication

    Transitional Cell Cancer (Cancer of the Renal Pelvis and Ureter): : causes, symptoms, treatment

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    DISCLAIMER: All material available on eHealthMe.com is for informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified healthcare provider. All information is observation-only. Our phase IV clinical studies alone cannot establish cause-effect relationship. Different individuals may respond to medication in different ways. Every effort has been made to ensure that all information is accurate, up-to-date, and complete, but no guarantee is made to that effect. The use of the eHealthMe site and its content is at your own risk.

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    Transitional Cell Carcinoma In The Kidney

    luvmykatJoined: Mar 2003

    Aug 05, 2003 – 6:03 pm

    My husband had a radical left nephrectomy June 30. The doctors were certain they were treating renal cell carcinoma because of the location of his tumor. Only after the pathology results come back did they realize it was transitional cell. For that he said they should have removed the entire ureter and really examined his bladder. To date, they haven’t. They are now going to wait for a few months to check his bladder out until after he has his chemo. Has anyone had or known of a situation like this? He will be doing the MVAC protocol for chemo. I understand this is supposed to be a tough one and will make him really sick, is this true? I dont want to wait if it means we could have a problem.Thanks

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    PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as NCIs PDQ cancer information summary about breast cancer prevention states the risks succinctly: .

    The preferred citation for this PDQ summary is:

    PDQ® Adult Treatment Editorial Board. PDQ Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment. Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .

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