Urothelial Carcinoma (Transitional Carcinoma)

What is urothelial carcinoma?

Urothelial carcinoma is cancer that starts in your urothelium, the tissue that lines parts of your urinary system. Urothelial carcinoma accounts for about 90% of all cases of bladder cancer and 7% of all cases of kidney cancer, including cancer in your renal pelvis and ureter. Bladder and kidney cancers caused by urothelial carcinoma have similar symptoms. They also have similar prognoses — caught early on, these cancers are easily treated, but often come back.

How does urothelial carcinoma affect my body?

Urothelial carcinoma may affect your bladder and kidneys in different ways.

Urothelial carcinoma in your bladder

Your bladder is a triangle-shaped organ that’s centered between your hipbones, above your urethra and below your kidneys. Pee (urine) from your kidneys drains into your bladder, which is lined with tissue called urothelium. Urothelium is made of cells that stretch when your bladder fills with pee and collapses when it’s empty. (Your bladder can hold about 2 cups of pee.)

In bladder cancer, abnormal urothelial cells spread from the inner lining to other layers deep in your bladder. The abnormal cells may also spread through your bladder wall into the fatty tissues that surround your bladder. Left untreated, bladder cancer may grow through your bladder walls to nearby lymph nodes and then other areas of your body, including your bones, lungs or liver.

Bladder cancer can be high-grade or low-grade:

• High-grade urothelial carcinoma may be life-threatening. It often comes back after treatment. It may spread into the muscle layer of your bladder, to other areas in your body and to your lymph nodes.
• Low-grade urothelial carcinoma may come back (recur), but rarely spreads into your bladder’s muscle layer or other parts of your body.

Urothelial carcinoma in your kidneys

Most people have two kidneys. Kidneys are bean-shaped organs that sit just below your ribcage and behind your belly. Your kidneys clear toxins and waste from your blood by producing pee (urine) that collects in your renal pelvis located in the middle of each kidney. From there, your pee drains through a long tube drains that connects your kidney to your bladder. This tube is your ureter. Like your kidneys, your renal pelvis and ureter are lined with urothelial tissue.

In kidney cancer, abnormal urothelial cells form tumors in your kidneys, renal pelvis or ureter. Kidney cancer may spread to other organs or tissues.

Who is affected by urothelial carcinoma?

Bladder cancer is the sixth most common cancer in the U.S. Urothelial bladder cancer represents 90% of all cases of bladder cancers. Men and people assigned male at birth (AMAB) are four times more likely to develop bladder cancer than women and people assigned female at birth (AFAB).

Kidney cancer is the eighth most common cancer. Urothelial kidney cancer represents about 7% of all kidney cancers. Kidney cancer is most common in people between the ages of 65 and 74. Men and people AMAB are twice as likely as women and people AFAB to develop the disease.

What is the primary symptom of urothelial carcinoma?

Urothelial carcinoma may not cause symptoms right away. In general, blood in your pee (urine) is the first noticeable symptom. You should contact a healthcare provider if you notice blood in your pee or other symptoms, including:

• Persistent back pain.
• Tiredness.
• Unexplained weight loss.
• Painful urination (dysuria).
• A lump or mass in your kidney area.
• Low-grade fever.

What causes urothelial carcinoma?

Medical researchers aren’t sure exactly what causes urothelial carcinoma in your bladder and kidneys. But they have identified some common risk factors:

• Cigarette smoke: Smoking cigarettes increases your risk of developing urinary system cancers linked to urothelial carcinoma.
• Exposure to certain chemicals: Studies show that people who work with certain chemicals used in dyes, rubber, leather, paint, some textiles and hairdressing supplies may have an increased risk of urinary system cancers linked to urothelial carcinoma.

How do healthcare providers diagnose urothelial carcinoma?

Healthcare providers may use the following tests to diagnose bladder and kidney cancer, including urothelial carcinoma. Tests include:

• Urinalysis: A test to check the color of your pee (urine) and its contents, such as sugar, protein, blood and bacteria.
• Urine cytology: Healthcare providers examine your pee under a microscope to check for abnormal cells. Cancer in your kidneys, bladder or ureter may shed cancer cells into your urine.
• Intravenous pyelogram (IVP): A series of X-rays of your kidneys, ureter and bladder to check for cancer. Healthcare providers inject a contrast dye into one of your veins. Then, they take X-rays as the dye moves through your kidneys, ureter and bladder to see if there are any blockages.
• Ureteroscopy: Providers use a thin tube-like instrument with a light and lens for viewing to look inside your ureter and renal pelvis and to take tissue samples.
• Computed tomography (CT scan): CT scans use a computer linked to an X-ray machine to make a series of detailed pictures of areas inside your body. This procedure is also called computerized tomography, or computerized axial tomography.
• Ultrasound: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Healthcare providers may do an abdominal ultrasound to help diagnose cancer of your renal pelvis and ureter.
• Magnetic resonance imaging (MRI): A procedure that uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside your body, such as your pelvis. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Cancer staging

Healthcare providers use a cancer staging system to develop treatment plans and establish prognoses or expected outcomes. Cancer staging describes how tumors are growing or spreading.

Cancer staging is a complicated process to complete, much less explain. It’s understandable if you feel intimidated, confused or unnerved by a process that seems to reduce your illness to a formula of letters and numbers. Your providers understand why you may feel this way. If you’re confused or concerned by what you’re hearing, ask your provider to explain how the cancer staging system works in your situation.

Bladder cancer stages

Bladder cancer can be either early stage (confined to the lining of your bladder) or invasive (penetrating your bladder wall and possibly spreading to nearby organs or lymph nodes). Bladder cancer stages are:

• Stage I: Cancer is confined to the lining of your bladder or the connective tissue just below the lining, but hasn’t invaded the main muscle wall of your bladder.
• Stage II: Cancer has spread to the muscle wall of your bladder.
• Stage III: Cancer has spread to the fatty tissue outside of your bladder muscle.
• Stage IV: Cancer has spread from your bladder to your lymph nodes or to other organs or bones.

Healthcare providers may also categorize bladder cancer as being noninvasive, non-muscle-invasive or muscle-invasive.

• Noninvasive: This bladder cancer may be tumors in a small section of tissue or cancer that’s only on or near the surface of your bladder.
• Non-muscle-invasive: This refers to bladder cancer that’s moved deeper into your bladder but hasn’t spread to muscle.
• Muscle-invasive: This bladder cancer has grown into your bladder wall muscle and may have spread into the fatty layers or tissues on organs outside of your bladder.

Kidney cancer stages

Healthcare providers don’t break out kidney cancer stages by type of cancer cell. Urothelial carcinoma represents about 7% of all kidney cancers. Kidney cancer and cancer in your renal pelvis and ureter have different cancer stages.

• Stage I: Cancer hasn’t spread from your kidney.
• Stage II: Cancer has grown but hasn’t spread from your kidney.
• Stage III: Cancer has spread from your kidney to your major blood vessels — your renal vein and inferior vena cava — or into the tissue surrounding your kidney or to nearby lymph nodes.
• Stage IV: Cancer has spread from your adrenal gland (the small gland that sits on top of your kidney) or to distant lymph nodes or other organs.

Renal pelvis and ureter cancer stages

• Stage 0: There are abnormal cells in tissue lining your renal pelvis or ureter. This cancer stage may be called papillary carcinoma or carcinoma in situ.
• Stage 1: Cancer spreads through the lining of your renal pelvis and/or ureter into a layer of connective tissue.
• Stage II: Cancer has spread through connective tissue to your renal pelvis and/or ureter’s layer of muscle.
• Stage IV: Cancer spread to nearby organs, one or more lymph nodes, the layer of fat around your kidney or more distant organs such as your lung, liver or bones.

How do healthcare providers treat urothelial carcinoma?

Healthcare providers have different treatments for urothelial carcinoma in your bladder, kidneys, renal pelvis and ureter. Urothelial carcinoma causes 90% of all bladder cancer and 7% of all types of kidney cancer, including cancer in your renal pelvis and ureter.

Bladder cancer treatment

Treatment may include:

• Surgery. Surgeons either remove the tumor or use high-energy electricity to burn it away with a process known as fulguration.
• Chemotherapy.
• Immunotherapy.
• Radiation therapy.
• Targeted therapy.

Kidney cancer treatment

Healthcare providers treat kidney cancer with many of the same treatments they use for bladder cancer. Additional treatments may include:

• Surgery. Surgeons may remove the part of your kidney that contains cancer. They may also remove your entire kidney.
• Cryoablation.
• Radiofrequency ablation.

Renal pelvis and/or ureter cancer treatment

• Surgery. Surgeons remove the part of your renal pelvis or ureter that contains cancer.

How can I reduce my risk of developing urothelial carcinoma in my urinary system?

You may reduce your risk of developing these cancers by not smoking cigarettes and avoiding certain chemicals.

What is the life expectancy for urothelial carcinoma?

Urothelial carcinoma is cancer that starts in cells that line your bladder, your kidneys, renal pelvis and ureter. While the same cancerous cell causes these cancers, each cancer type has different prognoses or expected outcomes.

Bladder cancer prognosis

Like many types of cancer, early detection and treatment increase the chance of living longer with bladder cancer. According to 2018 data from the National Cancer Institute (NCI), 96% of people who received treatment for early-stage cancer were alive five years after diagnosis. Overall, 77% of people with bladder cancer were alive five years after diagnosis.

Kidney cancer prognosis

Like most cancers, kidney cancer, including renal pelvis cancer, is most treatable when found in its early stages. NCI data from 2018 show 93% of people treated for early-stage kidney cancer were alive five years after diagnosis. The overall five-year survival rate was 76.5%.

How do I take care of myself?

If cancer is caught in early stages, healthcare providers can often cure urothelial carcinoma that affects your urinary system. Unfortunately, these types of cancer often come back. If you’ve been treated for one of these cancers, you should do your best to be vigilant about follow-up care.

When should I see my healthcare provider?

You should see your healthcare provider any time you have changes in your body that may indicate urothelial cancer in your urinary system has come back.

A note from Cleveland Clinic

Urothelial carcinoma starts in abnormal cells of tissue lining your bladder, kidney, renal and ureter. Urothelial carcinoma causes 90% of bladder cancer and 7% of kidney cancer, including cancer that affects your renal pelvis and ureter. Bladder and kidney cancer have some common symptoms and prognoses. They’re both easier to treat if caught early on. Unfortunately, both types of cancer may come back. Your healthcare providers will be glad to explain what you should do to decrease your risk of recurring bladder or kidney cancer.