Transitional cell cancer of the kidney (renal pelvis) or ureter and its treatment
This page tells you about transitional cell cancer (TCC) of the kidney or ureter and its treatment. There is information about
- The kidneys and the urinary system
- Transitional cells
- Transitional cell cancer of the kidney and ureter
- Risks and causes
- Symptoms of TCC of the kidney or ureter
- Tests to diagnose transitional cell cancer
- How your doctors decide your treatment
The kidney is part of the urinary system. This system filters waste products out of the blood and gets rid of them in the urine.
It is made up of
- Two kidneys
- Two ureters
- The bladder
- The prostate (in men)
- The urethra
The renal pelvis is in the middle of the kidney. Urine collects here and then drains through a tube called the ureter and into the bladder. When you empty your bladder, the urine leaves the body through a tube called the urethra.
There are many different types of cells in the body, each with a particular job to do. Transitional cells are able to change shape and stretch. They make up the lining of the renal pelvis, ureters, bladder and the urethra. The lining of these organs needs cells that can stretch so they can expand when urine is stored in them or flows through them.
Transitional cell cancer develops in the part of the kidney called the renal pelvis. It is rare and only about 7 out of 100 kidney cancers (7%) diagnosed in the UK are transitional cell cancers. The most common type of kidney cancer is renal cell cancer. You can find information about renal cell cancer in the kidney cancer section.
Transitional cell cancer of the ureter is even more uncommon than transitional cell cancer of the kidney. TCC of the kidney is 4 times more common than cancer of the ureter.
Transitional cell cancers of the bladder are the most common type of bladder cancer. You can find more information about TCC of the bladder in the bladder cancer section.
We don’t know what causes most transitional cell cancers. But there are a number of factors that may increase your risk. These include
- Smoking cigarettes
- Working with particular chemicals including industrial dyes, rubber, plastics, aluminium and pesticides
- Some types of medicines – for example some painkillers (phenacetin) and cyclophosphamide
You can find out more about chemicals that may increase the risk of bladder cancer in the bladder cancer risks and causes section.
The symptoms of transitional cell cancer of the kidney are similar to those of other types of kidney cancer. They include blood in the urine and pain in your back, between the lower ribs, and the top of your hip bone.
You may also need to pass urine very often or have pain when passing urine.
The tests that you have to diagnose TCC may include
- Urine tests
- Intravenous pyelogram (IVP)
- Retrograde pyelography
- CT scan
- MRI scan
- Chest X-ray
For a ureteroscopy, your doctor puts a flexible or rigid telescope into your urethra and extends the tip of the scope into the bladder and the ureter. This means they can see the inside of the ureter and take biopsies if they need to. You have this test under a general anaesthetic.
You may have retrograde pyelography at the same time as the ureteroscopy. The doctor puts a flexible tube (catheter) into your bladder and injects dye into it. Then they take a number of X-rays.
Your doctor considers many factors when deciding which treatment is most suitable for you including
- How far your cancer has grown or spread (stage)
- How fast growing your cancer is (grade)
- Your general health
- Your age and level of fitness
The earlier your cancer is found the easier it is to control and possibly cure it.
The most common treatment for transitional cell cancer of the kidney is surgery. Surgery for this type of cancer is usually a major operation and you need to be fit enough to make a good recovery.
Depending on the stage and grade of the cancer you may have chemotherapy after surgery, or rarely radiotherapy.
If your cancer is more advanced you may have chemotherapy or a combination of chemotherapy and radiotherapy.
Before you have treatment your doctor will arrange for you to have tests to check the stage of your cancer and your general health.
Whether your cancer is in your kidney or ureter, you will probably have surgery if your cancer hasn’t spread and you are fit enough. Most people have their kidney, ureter, and part of their bladder removed. This type of surgery is called a radical nephroureterectomy and gives the best chance of getting rid of the cancer completely. You may also have some of the nearby lymph nodes removed and some surrounding tissue.
Your surgeon may consider other types of surgery depending on whether your cancer is in the ureter or the kidney.
If your cancer is in the ureter it may be possible to remove part of the ureter. This is called a segmental ureterectomy. This type of surgery is only done if the tumour is small and is in the area of the ureter close to the bladder.
If you have only one kidney, your kidneys aren’t working fully, or you aren’t well enough for an operation, it may be possible to have laser treatment. This treatment is usually only for people who have early cancers which have a low risk of coming back. Doctors don’t use laser treatment very often because there is a high risk of the cancer coming back afterwards.
There are different ways to have surgery. You may have
Open surgery means that you will have a wound either on your back and side or on your front, across the chest and abdomen. This type of surgery allows the surgeon to easily remove the kidney or ureter and some surrounding tissue.
Keyhole or laparoscopic surgery is also called minimal access surgery. It means that you have surgery without needing to have a major wound (incision). The specialist surgeon uses an instrument called a laparoscope, which is a thin, flexible tube with a camera and light on the end. Instead of one large wound you have several small cuts about 1cm long made in your skin.
The surgeon uses the small cuts to put the laparoscope and other instruments through to do the surgery. There is detailed information about the advantages and disadvantages of keyhole surgery in the types of surgery section in the kidney cancer section.
For people who only have one kidney it may be possible for the surgeon to remove just the tumour using an endoscope. The surgeon makes a small cut in the skin at the side of the body. Then they use an ultrasound or CT scan to guide them and put the endoscope into the kidney to remove the tumour from the kidney or the top of the ureter. This type of operation is not done very often because there is a high risk of the cancer coming back.
If your surgeon finds that your cancer has spread into the surrounding tissue or the lymph nodes you may have chemotherapy after surgery. The chemotherapy reduces the risk of the cancer coming back.
Your doctor may also recommend chemotherapy if your cancer is advanced when you are diagnosed or if you cannot have surgery for other health reasons.
Chemotherapy treatment usually involves having a combination of drugs. The combinations include
- GC – gemcitabine and cisplatin
- GemCarbo – gemcitabine and carboplatin
- MVAC – methotrexate, vinblastine, doxorubicin and cisplatin
Rarely, doctors give treatment directly into the ureter. This is called regional chemotherapy. The drugs you have are BCG or the chemotherapy mitomycin. You have this put through a tube that the doctor inserts through your urethra and into the ureter. Or you may have it through a tube put into the kidney (a nephrostomy tube). This treatment is only used for people who have one kidney, or whose kidneys aren’t working very well, or for people who can’t have an operation.
You can find more information about the side effects of these combinations by using the highlighted drug name links above to go to the cancer drugs section.
Radiotherapy is not often used for TCC of the kidney or ureter. You may have radiotherapy to the area of the kidney or ureter if you are not fit enough to have an operation or your cancer has spread into surrounding tissue (locally advanced TCC).
Sometimes doctors recommend radiotherapy after surgery, to reduce the risk of the cancer coming back.
Researchers are looking into new treatments for transitional cell cancers. There are clinical trials using new types of chemotherapy and new biological therapies.
You can find information about these trials for transitional cell cancer of the kidney on the clinical trials database in the trials and research section. Tick the boxes for closed trials and results if you want to see all the trials.
After you have finished your treatment you will be followed up closely. In the first year you usually have appointments every 3 months. In the second and third year you have appointments every 6 months. And after that you have them yearly.
As part of your follow up you will have regular cystoscopies. This is to check for cancer in your bladder. This is because transitional cell cancers come back in the bladder in about 1 in 5 people (20%).
Your doctor will tell you exactly how they will keep a check on you.
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