Transitional Cell Cancer of t... Health Article

General Information About Transitional Cell Cancer of the Renal Pelvis and Ureter

Transitional cell cancer of the renal pelvis and ureter is a disease in which malignant (cancer) cells form in the renal pelvis and ureter.

The renal pelvis is part of the kidney and the ureter connects the kidney to the bladder. There are 2 kidneys, one on each side of the backbone, above the waist. The kidneys of an adult are about 5 inches long and 3 inches wide and are shaped like a kidney bean. The kidneys clean the blood and produce urine to rid the body of waste. The urine collects in the middle of each kidney in a large cavity called the renal pelvis. Urine drains from each kidney through a long tube called the ureter, into the bladder, where it is stored until it is passed from the body through the urethra.

The renal pelvis and ureters are lined with transitional cells. These cells can change shape and stretch without breaking apart. Transitional cell cancer starts in these cells. Transitional cell cancer can form in the renal pelvis or the ureter or both.

Renal cell cancer is a more common type of kidney cancer. Refer to the PDQ summary on Renal Cell Cancer Treatment for more information.

Misuse of certain pain medicines can affect the risk of developing transitional cell cancer of the renal pelvis and ureter.

Risk factors include the following:

• Misusing certain pain medicines, including over-the-counter pain medicines, for a long time.

• Being exposed to certain dyes and chemicals used in making leather goods, textiles, plastics, and rubber.

• Smoking cigarettes.

Possible signs of transitional cell cancer of the renal pelvis and ureter include blood in the urine and back pain.

These and other symptoms may be caused by transitional cell cancer of the renal pelvis and ureter. Other conditions may cause the same symptoms. There may be no symptoms in the early stages. Symptoms may appear as the tumor grows. A doctor should be consulted if any of the following problems occur:

• Blood in the urine.

• A pain in the back that doesn't go away.

• Extreme tiredness.

• Weight loss with no known reason.

• Painful or frequent urination.

Tests that examine the abdomen and kidneys are used to detect (find) and diagnose transitional cell cancer of the renal pelvis and ureter.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

• Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria.

• Ureteroscopy: A procedure to look inside the ureter and renal pelvis to check for abnormal areas. A ureteroscope (a thin, lighted tube) is inserted through the urethra into the bladder, ureter, and renal pelvis. Tissue samples may be taken for biopsy.

• Urine cytology: Examination of urine under a microscope to check for abnormal cells. Cancer in the kidney, bladder, or ureter may shed cancer cells into the urine.

• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to check for cancer. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, 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. An ultrasound of the abdomen may be done to help diagnose cancer of the renal pelvis and ureter.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the stage and grade of the tumor.

The treatment options depend on the following:

• The stage and grade of the tumor.

• Where the tumor is.

• Whether the patient's other kidney is healthy.

• Whether the cancer has recurred.

Most transitional cell cancer of the renal pelvis and ureter can be cured if found early.

Stages of Transitional Cell Cancer of the Renal Pelvis and Ureter

After transitional cell cancer of the renal pelvis and ureter has been diagnosed, tests are done to find out if cancer cells have spread within the renal pelvis and ureter or to other parts of the body.

The process used to find out if cancer has spread within the renal pelvis and ureter or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread within these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, 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.

• Ureteroscopy: A procedure to look inside the ureter and renal pelvis to check for abnormal areas. A ureteroscope (a thin, lighted tube) is inserted through the urethra into the bladder, ureter, and renal pelvis. Tissue samples may be taken for biopsy.

• Surgery: Tissues removed during surgery to treat the transitional cell cancer will be examined by a pathologist.

The following stages are used for transitional cell cancer of the renal pelvis and/or ureter:

Stage 0 (Carcinoma in Situ)

In stage 0, the cancer is found only on tissue lining the inside of the renal pelvis or ureter. Stage 0 is divided into stage 0a and stage 0is, depending on the type of tumor:

• Stage 0a may look like tiny mushrooms growing from the lining. Stage 0a is also called noninvasive papillary carcinoma.

• Stage 0is is a flat tumor on the tissue lining the inside of the renal pelvis or ureter. Stage 0is is also called carcinoma in situ.

Stage I

In stage I, cancer has spread through the cells lining the renal pelvis and/or ureter, into the layer of connective tissue.

Stage II

In stage II, cancer has spread through the layer of connective tissue to the muscle layer of the renal pelvis and/or ureter.

Stage III

In stage III, cancer has spread:

• to the layer of fat outside the renal pelvis and/or ureter; or

• into the wall of the kidney.

Stage IV

In stage IV, cancer has spread to at least one of the following:

• A nearby organ.

• The layer of fat surrounding the kidney.

• One or more lymph nodes.

• Other parts of the body.

Transitional cell cancer of the renal pelvis and ureter is also described as localized, regional, or metastatic:

Localized

The cancer is found only in the kidney.

Regional

The cancer has spread to tissues around the kidney and to nearby lymph nodes and blood vessels in the pelvis.

Metastatic

The cancer has spread to other parts of the body.