Renal Transitional Cell Carcinoma 

  • Author: Bagi RP Jana, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Jan 17, 2012
 

Background

Renal urothelial carcinoma (transitional cell carcinoma [TCC]) is a malignant tumor arising from the transitional (urothelial) epithelial cells lining the urinary tract from the renal calyces to the ureteral orifice. Urothelial carcinoma (UC) is the most common tumor of the renal pelvis. Over 70,000 cases of bladder cancer are diagnosed annually in the United States. Upper urinary tract TCC is estimated to occur in 5% of all urothelial cancers and in less than 10% of renal tumors. Evidence indicates that the frequency of upper urinary tract malignancies is increasing.[1]

Images of urothelial carcinoma are shown below:

CT scan with contrast, vascular phase. Mass can beCT scan with contrast, vascular phase. Mass can be seen in the left renal pelvis (black arrows). Patient underwent nephroureterectomy. Tumor was high-grade urothelial carcinoma invading subepithelial tissue (stage T1) and measuring 7.5 X 3.2 X 3 cm. Retrograde pyelography. Filling defect can be seenRetrograde pyelography. Filling defect can be seen in the left renal pelvis and lower calix (black arrows). Patient underwent left nephroureterectomy. Tumor was low-grade urothelial carcinoma measuring 2.5 X 2 X 1 cm.
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Pathophysiology

Transitional cell carcinoma accounts for more than 90% of renal pelvic tumors. Other cancer types seen include squamous cell carcinoma (SCC) and adenocarcinoma. The predominant histologic pattern of UC is a papillary tumor with stratified, nonkeratinizing epithelium supported on a thin fibrovascular core. TCC of the upper urinary tract is histologically identical to urinary bladder cancer. These 2 malignancies share the same risk factors and can occur as a part of "field cancerization," which results from exposure of urothelium to carcinogens excreted by or activated in the urine. Hence, upper-urinary-tract urothelial tumors may be multifocal, and in 2-10% of cases, they are bilateral as well.

Patients with upper-tract urothelial tumors are at risk of developing bladder tumors, with an estimated occurrence of 20-48%. Bladder cancer usually appears within 5 years. Patients with primary bladder cancer develop upper-tract UC in 2-4% of cases. The frequency of upper-tract UC may reach 21% in patients with bladder carcinoma in situ (CIS) and in those with certain occupational exposures (see Causes).

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Epidemiology

Frequency

United States

According to American Cancer Society, an estimated 70,980 bladder cancers and 57,760 kidney cancers will be diagnosed in the United States in 2009. Primary renal pelvis and ureteric malignancies, on the other hand, are much less common; it is estimated that 2,270 renal pelvic and ureteric cancers will be diagnosed and 790 patients will die of this disease in 2009.[2] Deaths from urothelial malignancies have been decreasing since 1995.

International

Worldwide statistics vary and are inaccurate, since renal pelvis tumors are not reported separately. The highest incidence is found in Balkan countries (eg, Bosnia, Bulgaria, Croatia, Romania, Serbia), where UCs account for 40% of all renal cancers and are bilateral in 10% of cases.

Mortality/Morbidity

Renal urothelial carcinoma is uniformly fatal unless it is treated. In a multicenter study of 1363 patients with upper-tract urothelial carcinoma who were treated with radical nephroureterectomy, the 5-year cancer-specific survival probability was approximately 73%.[3]

Race

The incidence is slightly higher in African Americans than in other races; reported rates are similar among white Americans, Hispanics, and Native Americans. Renal pelvic tumors are less in common in Asian Americans.

Sex

Men are affected approximately 2 times as frequently as women.

Age

Renal pelvis tumors rarely occur before the age of 40 years. The peak incidence is in the 60- to 70-year age group.

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Proceed to Clinical Presentation
 
 
Contributor Information and Disclosures
Author

Bagi RP Jana, MD  Assistant Professor, University of Texas Medical Branch, Galveston, TX

Bagi RP Jana, MD is a member of the following medical societies: American Cancer Society, American Medical Association, American Society of Clinical Oncology, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Coauthor(s)

Kush Sachdeva, MD  Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Perry, MD, MS, MACP  Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

Additional Contributors

Georgi Guruli, MD, PhD, and Badrinath R Konety, MD, are gratefully acknowledged for their contributions to this topic.

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CT scan with contrast, vascular phase. Mass can be seen in the left renal pelvis (black arrows). Patient underwent nephroureterectomy. Tumor was high-grade urothelial carcinoma invading subepithelial tissue (stage T1) and measuring 7.5 X 3.2 X 3 cm.
CT scan of the same patient as in Image 1, delayed phase. Enhancing mass can be visualized in the left renal pelvis (white arrows).
Retrograde pyelography. Filling defect can be seen in the left renal pelvis and lower calix (black arrows). Patient underwent left nephroureterectomy. Tumor was low-grade urothelial carcinoma measuring 2.5 X 2 X 1 cm.
This radiograph shows a right retrograde pyelogram demonstrating a large filling defect in the mid-ureter due to transitional cell carcinoma (large arrow). Note the characteristic appearance of radiographic contrast material just distal to the obstruction (small arrow), which gives rise to the so-called goblet sign. Contrast is also visible beyond the partially obstructed segment of the ureter in the renal pelvis and collecting system.
Urothelial tumor of the renal pelvis (white arrows), pathology specimen.
 
 
 
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