eMedicine Specialties > Oncology > Carcinomas of the Genitourinary Tract

Transitional Cell Carcinoma, Renal

Author: Georgi Guruli, MD, PhD, Consulting Staff, Department of Surgery, Division of Urology, University Hospital; Assistant Professor, Department of Surgery, Division of Urology, UMDNJ - New Jersey Medical School
Coauthor(s): Badrinath R Konety, MD, Associate Professor, Department of Urology, University of California at San Francisco
Contributor Information and Disclosures

Updated: Jul 27, 2006

Introduction

Background

Renal urothelial (transitional cell) carcinoma is a malignant tumor arising from the transitional (urothelial) epithelium lining of the renal pelvis. Urothelial carcinoma (UC) is the most common tumor of the renal pelvis.

Pathophysiology

The predominant histologic pattern of UC is a papillary tumor with stratified, nonkeratinizing epithelium supported on a thin fibrovascular core.

Upper-urinary-tract urothelial tumors may be bilateral in 2-10% of cases. Patients with primary bladder cancer develop upper-tract UC in 2-4% of cases, with a mean interval of 17-170 months. The incidence is higher and the interval is shorter in patients who are treated with bacillus Calmette-Guérin (BCG) for bladder cancer, in patients with bladder carcinoma in situ (CIS) (upper tract UC in these cases may reach 21%) and in those with certain occupational exposures (see Causes). 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.

UC accounts for more than 90% of renal pelvic tumors. Squamous cell carcinomas (SCCs) account for 0.7-7% of upper-tract cancers.

Frequency

United States

The vast majority of urothelial tumors arise in the bladder. Urothelial tumors of the renal pelvis and ureter are rare, comprising approximately 5-6% of all urothelial tumors and 5-9% of approximately 30,000 renal cancers diagnosed annually.

International

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

Mortality/Morbidity

Renal UC is uniformly fatal unless it is treated.

Race

Upper-tract urothelial tumors are twice as common in whites as in blacks.

Sex

Men are affected 2-3 times more frequently than 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.

Clinical

History

Renal urothelial carcinoma (UC) rarely is reported as an incidental finding. Symptoms are significant enough to suggest the diagnosis in a relatively short time after disease development.

  • Hematuria
    • Gross hematuria is the most common presenting symptom (75-95%).
    • Microscopic hematuria occurs in 3-11% of patients.
  • Pain
    • 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.
  • Patients are rarely asymptomatic (1-2%).

Physical

Physical examination usually is not informative or specific, especially in early stage disease.

  • A palpable flank mass may be noted in less 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 SCC usually present with advanced disease. Renal calculi are present in 14-50% of patients with SCC.
  • Primary adenocarcinoma of the renal pelvis constitutes less than 1% of upper-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.

Causes

The exact cause of upper-tract transitional cell carcinoma (TCC) is not known; however, several risk factors have been identified.
  • Workers in the chemical, petrochemical, aniline dye, and plastics industries, and those exposed to coal, coke, tar, and asphalt, are at increased risk for renal pelvis and ureteral tumors.
  • Cigarette smoking appears to be the most significant acquired risk factor for upper-tract UC. It is suggested that 70% of upper-tract urothelial tumors in men and 40% in women can be attributable to smoking.
  • Balkan endemic nephropathy, a chronic tubulointerstitial disorder, seems to be another risk factor for upper-tract urothelial tumors. This disease is confined to the countries that are located along the Danube River and its tributaries.
  • Analgesic abuse is a risk factor; a combination of phenacetin use and papillary necrosis results in a 20-fold increase in risk for renal urothelial tumors.
  • Chronic bacterial infection with urinary calculus and obstruction may predispose to development of urothelial cancer. SCC is the most common entity in these cases. Schistosomiasis also may predispose to SCC.
  • The chemotherapy drugs cyclophosphamide and ifosfamide are implicated in the development of upper-tract and lower-tract urothelial cancers, particularly following drug-induced hemorrhagic cystitis.

More on Transitional Cell Carcinoma, Renal

Overview: Transitional Cell Carcinoma, Renal
Differential Diagnoses & Workup: Transitional Cell Carcinoma, Renal
Treatment & Medication: Transitional Cell Carcinoma, Renal
Follow-up: Transitional Cell Carcinoma, Renal
Multimedia: Transitional Cell Carcinoma, Renal
References
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References

  1. Boorjian S, Ng C, Munver R, et al. Impact of delay to nephroureterectomy for patients undergoing ureteroscopic biopsy and laser tumor ablation of upper tract transitional cell carcinoma. Urology. Aug 2005;66(2):283-7.

  2. Chen GL, Bagley DH. Ureteroscopic surgery for upper tract transitional-cell carcinoma: complications and management. J Endourol. May 2001;15(4):399-404; discussion 409. [Medline].

  3. Chew BH, Pautler SE, Denstedt JD. Percutaneous management of upper-tract transitional cell carcinoma. J Endourol. Jul-Aug 2005;19(6):658-63.

  4. Clark PE, Streem SB. Endourologic management of upper tract transitional cell carcinoma. ScientificWorldJournal. Jun 7 2004;4 Suppl 1:62-75.

  5. Daneshmand S, Quek ML, Huffman JL. Endoscopic management of upper urinary tract transitional cell carcinoma: long-term experience. Cancer. Jul 1 2003;98(1):55-60. [Medline].

  6. Deligne E, Colombel M, Badet L, et al. Conservative management of upper urinary tract tumors. Eur Urol. Jul 2002;42(1):43-8. [Medline].

  7. Gettman MT, Segura JW. Endourological management of upper tract transitional cell carcinoma. BJU Int. Dec 2003;92(9):881-5. [Medline].

  8. Goh M, Montie JE, Wolf SJ, Jr. Urothelial carcinoma of the upper urinary tract. In: Gillenwather JY, Grayhack JT, Howards Ss, Mitchell ME, eds. Adult and Pediatric Urology. Philadelphia: Lippincott Williams & Wilkins. 2002;Vol. 1, 4th ed:Chapter 17.

  9. Ho KL, Chow GK. Ureteroscopic resection of upper-tract transitional-cell carcinoma. J Endourol. Sep 2005;19(7):841-8.

  10. Holmang S, Johansson SL. Urothelial carcinoma of the upper urinary tract: comparison between the WHO/ISUP 1998 consensus classification and WHO 1999 classification system. Urology. Aug 2005;66(2):274-8.

  11. 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. Oct 2004;94(6):798-801.

  12. Ignjatovic I, Dinic L, Prjiv B, Stojkovic I. CT staging of the upper urinary tract urothelial tumors. Medicine and Biology. 2003;10:135-8.

  13. Johnson GB, Grasso M. Ureteroscopic management of upper urinary tract transitional cell carcinoma. Curr Opin Urol. Mar 2005;15(2):89-93.

  14. Kawauchi A, Fujito A, Ukimura O, et al. Hand assisted retroperitoneoscopic nephroureterectomy: comparison with the open procedure. J Urol. Mar 2003;169(3):890-4; discussion 894. [Medline].

  15. Kirkali Z, Tuzel E. Transitional cell carcinoma of the ureter and renal pelvis. Crit Rev Oncol Hematol. Aug 2003;47(2):155-69. [Medline].

  16. Matin SF. Radical laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: current status. BJU Int. Mar 2005;95 Suppl 2:68-74.

  17. McCaffrey JA, Herr HW. Adjuvant and neoadjuvant chemotherapy for urothelial carcinoma. Surg Oncol Clin N Am. Oct 1997;6(4):667-81. [Medline].

  18. Melamed MR, Reuter VE. Pathology and staging of urothelial tumors of the kidney and ureter. Urol Clin North Am. May 1993;20(2):333-47. [Medline].

  19. Messing EM. Urothelial tumors of the renal pelvis and ureter. In: Walsh PC, Retik AB, Vaughan ED, Wein AG, eds. Campbell's Urology. Philadelphia: Saunders. 2002;Vol 4:2765-84.

  20. Michaelson MD, Kaufman DS, Oh WK. Transitional cell carcinoma of the upper uroepithelial tract. Clin Adv Hematol Oncol. Feb 2003;1(2):102-4; discussion 105.

  21. Ong AM, Bhayani SB, Pavlovich CP. Trocar site recurrence after laparoscopic nephroureterectomy. J Urol. Oct 2003;170(4 Pt 1):1301. [Medline].

  22. Pohar KS, Sheinfeld J. When is partial ureterectomy acceptable for transitional-cell carcinoma of the ureter?. J Endourol. May 2001;15(4):405-8; discussion 409. [Medline].

  23. Sagalowsky AI, Jarrett TW. Management of urothelial tumors of the renal pelvis and ureter. In: Walsh PC, Retik AB, Vaughan ED, Wein AG, eds. Campbell's Urology. Philadelphia: Saunders. 2002;Vol 4:2845-75.

  24. Scher HI, Yagoda A, Herr HW, et al. Neoadjuvant M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) for extravesical urinary tract tumors. J Urol. Mar 1988;139(3):475-7. [Medline].

  25. Srinivas S, Guardino AE. A nonplatinum combination in metastatic transitional cell carcinoma. Am J Clin Oncol. Apr 2005;28(2):114-8.

  26. Stewart GD, Bariol SV, Grigor KM, et al. A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tract. BJU Int. Apr 2005;95(6):791-3.

  27. Wang SS, Ho HC, Su CK, et al. Seeding of malignant renal tumor through a nephrostomy tract. J Chin Med Assoc. Jun 2004;67(6):308-10. [Medline].

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Further Reading

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Keywords

renal transitional cell carcinoma, TCC, renal urothelial carcinoma, urothelial carcinoma, UC, renal pelvis, papillary tumor, renal pelvic tumor, bladder tumor, bladder cancer

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Contributor Information and Disclosures

Author

Georgi Guruli, MD, PhD, Consulting Staff, Department of Surgery, Division of Urology, University Hospital; Assistant Professor, Department of Surgery, Division of Urology, UMDNJ - New Jersey Medical School
Georgi Guruli, MD, PhD is a member of the following medical societies: American Association for Cancer Research and American Urological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Badrinath R Konety, MD, Associate Professor, Department of Urology, University of California at San Francisco
Badrinath R Konety, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, and International College of Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Michael C Perry, MD, Professor, Department of Internal Medicine, Nellie B Smith Chair of Oncology, Director, Division of Hematology and Oncology, University of Missouri at Columbia/Ellis Fischel Cancer Center
Michael C Perry, MD 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, Missouri State Medical Association, Southern Association for Oncology, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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 Clinical Oncology, American Society of Hematology, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, 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

John S Macdonald, MD, Professor of Medicine, New York Medical College; Chief, Division of Medical Oncology, St Vincent's Hospital and Medical Center; Medical Director, Saint Vincent's Comprehensive Cancer Center
Disclosure: Nothing to disclose.

 
 
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