Transitional cell carcinoma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]

Transitional cell carcinoma (also called urothelial cell carcinoma) is a type of cancer that typically occurs in the urinary system, the kidney, ureter, urinary bladder, and urethra. It is the most common type of bladder cancer and second most common type of kidney cancer. Transitional cell carcinoma arises from the transitional epithelium (also called urothelium), a tssue lining the inner surface of the urinary tract. Among transitional cell carcinomas, upper urinary tract transitional cell carcinomas are rare cancers accounting for 5-7% of all transitional cell cancer cases transitional cell carcinoma commonly affects individuals older than 60 years of age with the average age of presentation being 65. Males are more commonly affected than females. The male to female ratio is approximately 2 to 1. Based on the growth pattern, transitional cell carcinoma may be classified into either papillary urothelial carcinoma or non-papillary urothelial carcinoma. Transitional cell carcinoma may be classified according to World Health Organization in a collaborative effort conjointly with the International Society of Urological Pathologists (ISUP) into two groups infiltrating urothelial carcinomas and non-invasive urothelial carcinomas. Based on the degree of cellular differentiation, transitional cell carcinoma may be classified into two grades: low grade and high grade. Genes involved in the pathogenesis of transitional cell carcinoma of bladder include HRAS, Rb1, PTEN/MMAC1, NAT2, and GSTM1. On gross pathology, flat lesions or papillary lesions are characteristic findings of non-invasive transitional cell carcinomas; a large infiltrative mass or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of invasive transitional cell carcinomas. On microscopic histopathological analysis, loss of cell polarity, nuclear crowding, and cytologic atypia are characteristic findings of flat lesion; fibrovascular stalks, umbrella cells, and eosinophilic cytoplasm are characteristic findings of papillary lesion; invasion beyond the basement membrane is the characteristic finding of invasive transitional cell carcinomas. Transitional cell carcinoma of bladder must be differentiated from squamous cell carcinoma of the bladder, adenocarcinoma of the bladder, renal cell carcinoma, renal calculi, prostate cancer, and cystitis. Transitional cell carcinoma of renal pelvis must be differentiated from renal cell carcinoma, kidney metastasis, renal medullary carcinoma, renal lymphoma, renal abscess, renal tuberculosis, pyelitis cystica, and papillary necrosis. Common risk factors in the development of transitional cell carcinoma are smoking, occupational exposure to chemicals, chronic bladder irritation, chemotherapy, radiation therapy, arsenic, personal history of cancer in the urinary tract, congenital bladder anomalies, and aristolochic acids. Common complications of transitional cell carcinoma include metastasis, anemia, hydronephrosis, urethral stricture, and urinary incontinence. Depending on the stage and grade of the tumor at the time of diagnosis, the prognosis of transitional cell carcinoma may vary. However, the 5-year survival rate of patients with bladder transitional cell carcinoma is approximately 77.5% and of patients with upper urinary tract transitional cell carcinoma is approximately 75%. The staging of transitional cell carcinoma is based on the TNM staging system. The most common symptoms of transitional cell carcinoma of bladder include hematuria, urinary frequency,urinary urgency, and dysuria. The most common symptoms of transitional cell carcinoma of upper urinary tract include hematuria and pain in the flank or abdomen. Less common symptoms of transitional cell carcinoma include loss of appetite, weight loss, fatigue, and fever. Abdominal and pelvic CT scans may be helpful in the diagnosis and staging of transitional cell carcinoma. On CT scan, transitional cell carcinoma of bladder is characterized by either focal regions of thickening of the bladder wall, or as masses protruding into the bladder lumen, or in advanced cases, extending into adjacent tissues. On CT scan, transitional cell carcinoma of upper urinary tract is characterized by homogenously enhancing mass that centered on the renal pelvis and extend towards pelviureteric junction, preserved renal contour, and focal pelvicalyceal filling defect. On ultrasound, transitional cell carcinoma is characterized by solid, hypoechoic mass located within the renal pelvis or within a dilated calyx. CT urograohy may be diagnostic of transitional cell carcinoma. Findings on CT urography suggestive of upper urinary tract transitional cell carcinoma include filling defect within the renal collecting system, distortion, obliteration, or amputation of calices, and stipple sign. The predominant therapy for transitional cell carcinoma is surgical resection. MRI findings of transitional cell carcinoma of renal pelvis include isointense to renal parenchyma on T1 and T2, moderate enhancement on T1 contrast. MRI findings of transitional cell carcinoma of bladder and ureter include isotense to muscle on T1 signal, slightly hyperintense to muscle on T2 signal, and demonstrate enhancement on contrast MRI. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required. Patients with superficial tumors of bladder are treated with intravescical injection of BCG, whereas patients with local spread and distant metastasis are treated with systemic chemotherapy. External beam radiation therapy may be the treatment for people who can’t have surgery. Surgery is the mainstay of treatment for transitional cell carcinoma. The feasibility of surgery depends on the stage of transitional cell carcinoma at diagnosis. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required. Primary prevention strategies of transitional cell carcinoma include cessation of smoking, avoid exposure to industrial chemicals, avoid aristolochic acids, taking lots of fruits and vegetables, and drinking plenty of liquids.

Based on the growth pattern, transitional cell carcinoma may be classified into either papillary urothelial carcinoma or non-papillary urothelial carcinoma. Transitional cell carcinoma may be classified according to World Health Organization in a collaborative effort conjointly with the International Society of Urological Pathologists (ISUP) into two groups infiltrating urothelial carcinomas and non-invasive urothelial carcinomas. Based on the degree of cellular differentiation, transitional cell carcinoma may be classified into two grades: low grade and high grade.

Genes involved in the pathogenesis of transitional cell carcinoma of bladder include HRAS, Rb1, PTEN/MMAC1, NAT2, and GSTM1. On gross pathology, flat lesions or papillary lesions are characteristic findings of non-invasive transitional cell carcinomas; a large infiltrative mass or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of invasive transitional cell carcinomas. On microscopic histopathological analysis, loss of cell polarity, nuclear crowding, and cytologic atypia are characteristic findings of flat lesion; fibrovascular stalks, umbrella cells, and eosinophilic cytoplasm are characteristic findings of papillary lesion; invasion beyond the basement membrane is the characteristic finding of invasive transitional cell carcinomas.

There are no established causes for transitional cell carcinoma.

Transitional cell carcinoma of bladder must be differentiated from squamous cell carcinoma of the bladder, adenocarcinoma of the bladder, renal cancer, renal stones, prostate cancer, and cystitis. Transitional cell carcinoma of renal pelvis must be differentiated from renal cell carcinoma, kidney metastasis, renal medullary carcinoma, renal lymphoma, renal abscess, renal tuberculosis, pyelitis cystica, and papillary necrosis.

Among transitional cell carcinomas, upper urinary tract transitional cell carcinomas are rare cancers accounting for 5-7% of all transitional cell cancer cases. The incidence of upper urinary tract transitional cell carcinoma was estimated to be 0.6-1.1 cases per 100,000 individuals in the United States. Transitional cell carcinoma commonly affects individuals older than 60 years of age with the average age of presentation being 65. Males are more commonly affected with transitional cell carcinoma than females. The male to female ratio is approximately 2 to 1.

Common risk factors in the development of transitional cell carcinoma are smoking, occupational exposure to chemicals, chronic bladder irritation, chemotherapy, radiation therapy, arsenic, personal history of cancer in the urinary tract, congenital bladder anomalies, and aristolochic acids.

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for transitional cell carcinoma.

Common complications of transitional cell carcinoma include metastasis, anemia, hydronephrosis, urethral stricture, and urinary incontinence. Depending on the stage and grade of the tumor at the time of diagnosis, the prognosis of transitional cell carcinoma may vary. However, the 5-year survival rate of patients with bladder transitional cell carcinoma is approximately 77.5% and of patients with upper urinary tract transitional cell carcinoma is approximately 75%.

The staging of transitional cell carcinoma is based on the TNM staging system.

The most common symptoms of transitional cell carcinoma of bladder include hematuria, urinary frequency, urinary urgency, and dysuria. The most common symptoms of transitional cell carcinoma of upper urinary tract include hematuria and pain in the flank or abdomen. Less common symptoms of transitional cell carcinoma include loss of appetite, weight loss, fatigue, and fever.

Common physical examination findings of transitional cell carcinoma of bladder include cachexia, pallor, and a pelvic mass may be palpated.

Laboratory findings consistent with the diagnosis of transitional cell carcinoma include blood in the urine, abnormal cells in the urine, and elevated tumor markers.

Abdominal and pelvic CT scans may be helpful in the diagnosis and staging of transitional cell carcinoma. On CT scan, transitional cell carcinoma of bladder is characterized by either focal regions of thickening of the bladder wall, or as masses protruding into the bladder lumen, or in advanced cases, extending into adjacent tissues. On CT scan, transitional cell carcinoma of upper urinary tract is characterized by homogenously enhancing mass that centered on the renal pelvis and extend towards pelviureteric junction, preserved renal contour, and focal pelvicalyceal filling defect.

MRI findings of transitional cell carcinoma of renal pelvis include isointense to renal parenchyma on T1 and T2, moderate enhancement on T1 contrast. MRI findings of transitional cell carcinoma of bladder and ureter include isotense to muscle on T1 signal, slightly hyperintense to muscle on T2 signal, and demonstrate enhancement on contrast MRI.

On ultrasound, transitional cell carcinoma is characterized by solid, hypoechoic mass located within the renal pelvis or within a dilated calyx.

CT urograohy may be diagnostic of transitional cell carcinoma. Findings on CT scan urography suggestive of upper urinary tract transitional cell carcinoma include filling defect within the renal collecting system, distortion, obliteration, or amputation of calices, and stipple sign.

The predominant therapy for transitional cell carcinoma is surgical resection. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required. Patients with superficial tumors of bladder are treated with intravescical injection of BCG, whereas patients with local spread and distant metastasis are treated with systemic chemotherapy. External beam radiation therapy may be the treatment for people who can’t have surgery.

Surgery is the mainstay of treatment for transitional cell carcinoma. The feasibility of surgery depends on the stage of transitional cell carcinoma at diagnosis. Adjunctive chemotherapy, radiation therapy, and immunotherapy may be required.

Primary prevention strategies of transitional cell carcinoma include cessation of smoking, avoid exposure to industrial chemicals, avoid aristolochic acids, taking lots of fruits and vegetables, and drinking plenty of liquids.

There are no secondary preventive measures available for transitional cell carcinoma.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

• In 1922, Broders et al introduced a grading system based on the portion of undifferentiated urothelial cells.the system observed both bladder urothelium changes over time and prognosis.^[1]
• In 1931, Aschner classified tumors of the bladder as papillary vs solid. by adding up to invasion existence, he found that disease prognosis is poor with solid tumors.^[2]
• In 1944, Jewett and Strong proved a relation between depth of penetration (stage) to the incidence of local extension and metastases.^[3]
• In 1948, McDonald and Thompson proved that there is a co-relation between vascular and lymphatic invasion.they also figured a direct relation between these findings and prognosis.^[4]
• In 1952, Jewett-Marshall-Strong redefined the staging system,to be based on bimanual palpation and biopsy into sub-stages: 0, A and B1 and B2 and C (2).
• Continuing his studies in 1956 Marshall established gradation of tumor and its staging.^[5]

The following are a few famous cases of [disease name]:

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2] Ramyar Ghandriz MD[3]

Based on the growth pattern, transitional cell carcinoma may be classified into either papillary urothelial carcinoma or non-papillary urothelial carcinoma. Transitional cell carcinoma may be classified according to World Health Organization in a collaborative effort conjointly with the International Society of Urological Pathologists (ISUP) into two groups: infiltrating urothelial carcinomas and non-invasive urothelial carcinomas.Based on the degree of cellular differentiation, transitional cell carcinoma may be classified into two grades: low grade and high grade.

Based on the growth pattern, transitional cell carcinoma may be classified into two subtypes:^[1]

Transitional cell carcinomas may be classified according to World Health Organization in a collaborative effort conjointly with the International Society of Urological Pathologists (ISUP) into two groups: infiltrating urothelial carcinomas and non-invasive urothelial carcinomas:^[2]

According to the WHO grading criteria, there are two grades of transitional cell carcinoma based on the degree of cellular differentiation:

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2] Ramyar Ghandriz MD[3]

Genes involved in the pathogenesis of transitional cell carcinoma of bladder include HRAS, Rb1, PTEN/MMAC1, NAT2, and GSTM1. On gross pathology, flat lesions or papillary lesions are characteristic findings of non-invasive transitional cell carcinomas; a large infiltrative mass or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of invasive transitional cell carcinomas. On microscopic histopathological analysis, loss of cell polarity, nuclear crowding, and cytologic atypia are characteristic findings of flat lesion; fibrovascular stalks, umbrella cells, and eosinophilic cytoplasm are characteristic findings of papillary lesion; invasion beyond the basement membrane is the characteristic finding of invasive transitional cell carcinomas.

• The surface epithelium (urothelium) that lines the mucosal surfaces of the entire urinary tract is exposed to potential carcinogens that are either excreted in the urine or activated from precursors in the urine by hydrolyzing enzymes.
• This “field cancerization” effect is one hypothesis to explain the multifocal occurrence that is a characteristic feature of urothelial carcinomas of both the urinary bladder and the upper urinary tract.^[1]
• In the majority of cases, multifocal urothelial carcinomas are monoclonal which supports their presumed origin from a single genetically altered cell,referred to as the monoclonality hypothesis.
• Under normal conditions, the bladder, the lower part of the kidneys, the ureters, and the proximal urethra are lined with a specialized mucous membrane referred to as transitional epithelium (also called urothelium).
• Most cancers that form in the bladder, the lower part of the kidneys, the ureters, and the proximal urethra are transitional cell carcinomas (also called urothelial carcinomas) that derive from transitional epithelium.

• There has been a small increase in risk in relatives of those with bladder cancer, and the risk appears to be greatest in those whose affected relatives were diagnosed before age 60 years^[2][3][4]
• Genetic mutations involved in the pathogenesis of bladder cancer include:^[5]

• HRAS mutation
• Rb1 mutation
• PTEN/MMAC1 mutation
• NAT2 slow acetylator phenotype
• GSTM1 null phenotype

The following table illustrates the findings on gross pathology for the subtypes of transitional cell carcinoma:^[6][7][8]

• Flat lesions^[6][9][10]

• On microscopic histopathological analysis, loss of cell polarity, nuclear crowding, and cytologic atypia are characteristic findings.

• Papillary lesions

• On microscopic histopathological analysis, fibrovascular stalks, umbrella cells, and eosinophilic cytoplasm are characteristic findings.

• Invasive urothelial carcinomas grow from the lining of the renal pelvis or ureter into the deeper layers of the renal pelvis or ureter wall, such as lamina propria and muscularis.^[8]
• Transitional cell carcinomas with mixed epithelial features are invasive tumors that have different types of cells mixed with the cancer cells.
• They occur less often than typical invasive transitional cell carcinomas and are generally considered to be more aggressive.
• The following table illustrates the findings on microscopic analysis for invasive transitional cell carcinomas with mixed epithelial features:

According to the WHO grading criteria, there are two grades of transitional cell carcinoma based on the degree of cellular differentiation:

Following table illustrates the cancers that may be associated with transitional cell carcinoma of urinary tract:^[11]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2] Ramyar Ghandriz MD[3]

Disease name] may be caused by [cause1], [cause2], or [cause3].

OR

Common causes of [disease] include [cause1], [cause2], and [cause3].

OR

The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].

OR

The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.

• Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of disease name, however complications resulting from untreated disease name is common.
• Life-threatening causes of [symptom/manifestation] include [cause1], [cause2], and [cause3].
• [Cause] is a life-threatening cause of [disease].

Common causes of [disease name] may include:

• [Cause1]
• [Cause2]
• [Cause3]

OR

• [Disease name] is caused by an infection with [pathogen name].
• [Pathogen name] is caused by [pathogen name].

Less common causes of [disease name] include:

• [Cause1]
• [Cause2]
• [Cause3]

• [Disease name] is caused by a mutation in the [gene name] gene.

List the causes of the disease in alphabetical order:

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]

Transitional cell carcinoma of bladder must be differentiated from squamous cell carcinoma of the bladder, adenocarcinoma of the bladder, renal cell carcinoma, renal calculi, prostate cancer, and cystitis. Transitional cell carcinoma of renal pelvis must be differentiated from renal cell carcinoma, kidney metastasis, renal medullary carcinoma, renal lymphoma, renal abscess, renal tuberculosis, pyelitis cystica, and papillary necrosis.

Transitional cell carcinoma of bladder must be differentiated from:^[1]

• Squamous cell carcinoma of the bladder
• Adenocarcinoma of the bladder
• Renal cell carcinoma
• Renal calculi
• Cystitis
• Glomerulonephritis
• Pyelonephritis
• Benign prostatic hyperplasia
• Prostate cancer
• Prostatitis

Transitional cell carcinoma of renal pelvis must be differentiated from:^[2]

Filling defect within renal pelvis/dilated calyx

• Renal stone:

• Usually significantly higher attenuating
• Non-enhancing

• Blood clot:

• May be similar in attenuation (blood clot is usually a little higher)
• Does not enhance
• Changes configuration on short term follow up

• Pyelitis cystica
• Renal tuberculosis
• Papillary necrosis

Distortion or obliteration of calices by renal mass

• Renal cell carcinoma

• Often more vascular and thus more enhancing
• Tends to distort the renal outline

• Kidney metastasis
• Renal medullary carcinoma
• Renal lymphoma
• Renal abscess
• Focal xanthogranulomatous pyelonephritis
• Renal tuberculosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2] Anum Gull M.B.B.S.[3]

Among transitional cell carcinomas, upper urinary tract transitional cell carcinomas are rare cancers accounting for 5-7% of all transitional cell cancer cases. The incidence of upper urinary tract transitional cell carcinoma was estimated to be 0.6-1.1 cases per 100,000 individuals in the United States.^[1] Transitional cell carcinoma commonly affects individuals older than 60 years of age with the average age of presentation being 65. Males are more commonly affected with transitional cell carcinoma than females. The male to female ratio is approximately 2 to 1.

• Transitional cell carcinomas of upper urinary tract are rare cancers accounting for 5-7% of all transitional cell cancer cases.^[1]
• Transitional cell carcinoma of the renal pelvis, accounts for only 7% of all kidney tumors.^[2]
• Transitional cell cancer of the ureter, accounts for only 1 of every 25 upper tract tumors.

• Bladder cancer is the ninth most common cancer in the world, with 430,000 new cases diagnosed in 2012.^[3]
• In the United States, approximately 80,000 new cases and 18,000 deaths occur each year due to bladder cancer.^[4]
• In developed regions such as North America and Europe, bladder cancer is predominantly urothelial.
• From 1985 to 2005, the number of bladder cancers diagnosed in the United States increased by over 50 percent, while from 1975 to 1996 the five-year survival rate for those diagnosed with bladder cancer increased from 75 to 81 percent.^[5]

• Transitional cancer is typically diagnosed in older individuals, with a median age at diagnosis of 69 years in men and 71 in women.^[6]
• Transitional cell carcinoma of the urinary bladder is rare in young adults, as less than 1% of such tumors present in the first 4 decades of life.^[7]
• In the United States, white males have the highest risk with roughly twice the incidence seen in African American and Hispanic men.^[8]

• Males are more commonly affected with transitional cell carcinoma than females. The male to female ratio is approximately 2 to 1.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]Anthony Gallo, B.S. [3]

Common risk factors in the development of transitional cell carcinoma are smoking, occupational exposure to chemicals, chronic bladder irritation, chemotherapy, radiation therapy, arsenic, personal history of cancer in the urinary tract, congenital bladder anomalies, and aristolochic acids.

Environmental exposures account for most cases of bladder cancer.

Common risk factors in the development of transitional cell carcinoma are:^{[1][2][3][4][5][6]}

• Smoking
  • Smoking tobacco is the strongest risk factor for developing cancer of the renal pelvis or ureter.
  • Risk increases with the length of time a person smokes and with the number of cigarettes smoked.
• Exposure to secondhand smoke
• Phenacetin
• Aromatic amines, such as 2-naphthylamine, benzidine
• Human papilloma virus
• Balkan nephropathy
• Well-characterized carcinogenic chemicals
  • 4-aminobiphenyl
  • 4-nitrobiphenyl
  • 2-amino-1-naphthol
• Occupational exposure to chemicals

• Metal workers
• Painters
• Rubber industry workers
• Textile and electrical workers
• Miners
• Cement workers
• Transport operators
• Excavating-machine operators
• Jobs that involve the manufacture of carpets, paints, plastics, and industrial chemicals.

• Chronic bladder irritation
• Drinking chlorinated water
• High concentrations of arsenic in drinking water
• Decreased fluid intake
• Consumption of Chinese herbs that contain aristolochic acid
• Inflammation
• Chronic urinary tract infection
• Bladder stones
• Schistosoma haematobium

• Trauma
• Chemotherapy

• Cyclophosphamide
• Ifosfamide

• Radiation therapy
• Arsenic
• Congenital bladder anomalies

• Urachus
• Exstrophy

• Urothelial cancers of the renal pelvis and ureter
• Augmentation cystoplasty
• Thiazolidinediones given for diabetes
• Other factors

• Air pollution
• Artificial sweeteners
• Coffee and tea
• Hair dyes

• Genetic effects

• Hereditary
• Mutation in the TP53 gene
• Alterations of the RB gene
• Differences in the endogenous mechanisms responsible for metabolizing chemical carcinogens

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for transitional cell carcinoma.^[1]

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for transitional cell carcinoma.^[1]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2] Anum Gull M.B.B.S.[3]

Common complications of transitional cell carcinoma include metastasis, anemia, hydronephrosis, urethral stricture, and urinary incontinence. Depending on the stage and grade of the tumor at the time of diagnosis, the prognosis of transitional cell carcinoma may vary. However, the 5-year survival rate of patients with bladder transitional cell carcinoma is approximately 77.5% and of patients with upper urinary tract transitional cell carcinoma is approximately 75%.

Common complications of transitional cell carcinoma include:

• Metastasis
• Anemia
• Hydronephrosis
• Urethral stricture
• Urinary incontinence

• Based on data from 2005-2011, the 5-year survival rate of patients with bladder cancer is approximately 77.4%.^[1][2]

• Between 2004 and 2010, the 5-year relative survival of patients with bladder cancer was 79.1%.^[3]

• When stratified by age, the 5-year relative survival of patients with bladder cancer was 83.8% and 74.1% for patients <65 and ≥ 65 years of age respectively.^[3]

• The survival of patients with bladder cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of bladder cancer:^[3]

• Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 2004 and 2010 of bladder cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.^[3]

• Depending on the stage and grade of the tumor at the time of diagnosis, the prognosis may vary. However, the 5-year survival rate of patients with upper urinary tract transitional cell carcinoma is approximately 75%.^[1]
• The major prognostic factor at the time of diagnosis of upper tract transitional cell cancer is the depth of infiltration into or through the uroepithelial wall.
• Most superficial tumors are likely to be well-differentiated, while infiltrative tumors are likely to be poorly differentiated.^[4]
• They are curable in more than 90% of patients if they are superficial and confined to the renal pelvis or ureter.
• Patients with deeply invasive tumors that are still confined to the renal pelvis or ureter have a 10% to 15% likelihood of cure.
• Patients with tumors with penetration through the urothelial wall or with distant metastases usually cannot be cured with currently available forms of treatment.
• When involvement of the upper urinary tract is diffuse (involving both the renal pelvis and ureter), the likelihood of subsequent development of bladder cancer increases to 75%.
• DNA ploidy has not added significant prognostic information beyond that provided by stage and grade.

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