Renal Transitional Cell Carcinoma Clinical Presentation
- Author: Bagi RP Jana, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC more...
Renal urothelial carcinoma (UC) is rarely reported as an incidental finding. Symptoms are significant enough to suggest the diagnosis in a relatively short time after disease development. A small percentage (1-2%) of patients are asymptomatic.
Gross hematuria is the most common presenting symptom, occurring in 75-95% of patients. Microscopic hematuria occurs in 3-11% of patients.
Approximately 14-37% of patients report pain. Pain is usually dull and is caused by the gradual obstruction of the collecting system. Renal colic also may occur with the passage of blood clots.
The physical examination usually is not informative or specific, especially in patients with early-stage disease. A palpable flank mass may be noted in fewer than 20% of patients. The classic clinical triad of hematuria, pain, and mass is also rare (15%) and is usually an indicator of advanced disease.
Patients with squamous cell carcinoma (SCC) usually present with advanced disease. Renal calculi are present in 14-50% of patients with SCC.
Primary adenocarcinoma of the renal pelvis accounts for fewer than 1% of upper urinary tract urothelial tumors. It is associated with chronic urolithiasis, hydronephrosis, and pyelonephritis. A metastatic lesion must be ruled out before a diagnosis of primary disease can be made.
Grollman AP, Shibutani S, Moriya M, et al. Aristolochic acid and the etiology of endemic (Balkan) nephropathy. Proc Natl Acad Sci U S A. 2007 Jul 17. 104(29):12129-34. [Medline].
Colin P, Koenig P, Ouzzane A, et al. Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract. BJU Int. 2009 Nov. 104(10):1436-40. [Medline].
American Cancer Society. Cancer Facts & Figures 2009. Accessed December 12, 2009. [Full Text].
Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009 Mar 15. 115(6):1224-33. [Medline].
Park J, Ha SH, Min GE, et al. The protective role of renal parenchyma as a barrier to local tumor spread of upper tract transitional cell carcinoma and its impact on patient survival. J Urol. 2009 Sep. 182(3):894-9. [Medline].
Novara G, De Marco V, Dalpiaz O, et al. Independent predictors of contralateral metachronous upper urinary tract transitional cell carcinoma after nephroureterectomy: multi-institutional dataset from three European centers. Int J Urol. 2009 Feb. 16(2):187-91. [Medline].
Todenhofer T, Hennenlotter J, Esser M, et al. Combined application of cytology and molecular urine markers to improve the detection of urothelial carcinoma. Cancer Cytopathol. 2012 Nov 21. [Medline].
Vikram R, Sandler CM, Ng CS. Imaging and staging of transitional cell carcinoma: part 2, upper urinary tract. AJR Am J Roentgenol. 2009 Jun. 192(6):1488-93. [Medline].
Jeong YB, Kim HJ. Is It Transitional Cell Carcinoma or Renal Cell Carcinoma on Computed Tomography Image?. Urology. 2011 Dec 21. [Medline].
Rastinehad AR, Ost MC, Vanderbrink BA, et al. A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guerin therapy?. Urology. 2009 Jan. 73(1):27-31. [Medline].
Demery ME, Thezenas S, Pouessel D, Culine S. Systemic chemotherapy in patients with advanced transitional cell carcinoma of the urothelium and impaired renal function. Anticancer Drugs. 2012 Feb. 23(2):143-8. [Medline].
Pak RW, Moskowitz EJ, Bagley DH. What is the cost of maintaining a kidney in upper-tract transitional-cell carcinoma? An objective analysis of cost and survival. J Endourol. 2009 Mar. 23(3):341-6. [Medline].
Straub J, Strittmatter F, Karl A, Stief CG, Tritschler S. Ureterorenoscopic biopsy and urinary cytology according to the 2004 WHO classification underestimate tumor grading in upper urinary tract urothelial carcinoma. Urol Oncol. 2012 Jan 31. [Medline].
Hsueh TY, Huang YH, Chiu AW, et al. A comparison of the clinical outcome between open and hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. BJU Int. 2004 Oct. 94(6):798-801.
Kawauchi A, Fujito A, Ukimura O, et al. Hand assisted retroperitoneoscopic nephroureterectomy: comparison with the open procedure. J Urol. 2003 Mar. 169(3):890-4; discussion 894. [Medline].
Ong AM, Bhayani SB, Pavlovich CP. Trocar site recurrence after laparoscopic nephroureterectomy. J Urol. 2003 Oct. 170(4 Pt 1):1301. [Medline].