Read about what transitional cell cancer (TCC) of the kidney or ureter is, how it's treated and how to cope.
What it is
Transitional cell cancer (TCC) is a rare type of kidney cancer. It starts in cells called transitional cells.
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 urethra. The lining of these organs needs cells that can stretch to expand when urine is stored in or flows through them.
TCC of the kidney starts in the part of the kidney called the renal pelvis.TCC can also start in the ureters, bladder and urethra.
The kidneys and ureters
The kidneys are two bean shaped organs, each about the same size as a fist. They are near the middle of your back, one on either side of your spine.
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.
How common it is
Transitional cell cancer of the kidney is rare. Only about 7 out of 100 kidney cancers (7%) diagnosed in the UK are transitional cell cancers.
Transitional cell cancer of the ureter is even less common. Transitional cell cancer of the kidney is 4 times more common than transitional cell cancer of the ureter.
Transitional cell cancers of the bladder are the most common type of bladder cancer.
Risks and causes
We don’t know what causes most transitional cell cancers. But a number of factors may increase your risk. These include:
- smoking cigarettes
- working with chemicals including industrial dyes, rubber, plastics, aluminium and pesticides
- some medicines including some painkillers (phenacetin) and cyclophosphamide
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.
Diagnosing transitional cell cancer of the kidney or ureter
Your doctor will examine you and you may have blood tests to check your general health. Other tests include:
- urine tests
- intravenous pyelogram (IVP)
- retrograde pyelography
- CT scan
- MRI scan
- chest X-ray
You have a ureteroscopy test under a general anaesthetic. Your doctor puts a thin, flexible telescope into your urethra and extends it into your bladder and ureter. This means they can see the inside the ureter and take tissue samples (biopsies) if they need to.
For retrograde pyelography your doctor puts a flexible tube (catheter) into your bladder and injects dye into it. Then they take a set of X-rays. You may have this at the same time as the ureteroscopy.
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 your cancer is growing (grade)
- your general health, age and level of fitness
The earlier your cancer is found the easier it is to control and possibly cure it.
Surgery is the most common treatment for transitional cell cancer of the kidney. This is usually a major operation so 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.
You will probably have surgery if your cancer hasn't spread and you are fit enough. Most people have surgery to remove their kidney, ureter and part of their bladder. This type of surgery is called a radical nephroureterectomy. It gives the best chance of getting rid of the cancer completely. The surgeon might also remove some of the nearby lymph nodes and some surrounding tissue.
Your surgeon might be able to remove part of the ureter if that’s where your cancer is. This is called a segmental ureterectomy. You only have this sugery if the tumour is small and in the area of the ureter close to the bladder.
You might have laser treatment if:
- you have only one kidney
- your kidneys aren’t working fully
- you aren’t well enough for an operation
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 often because there’s a high risk of the cancer coming back afterwards.
How you have surgery
You have a cut (incision) 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 (laparoscopic) surgery
You have surgery without needing to have a major cut (incision). Instead your surgeon makes several small cuts about 1cm long made in your skin. The surgeon uses a thin, flexible tube with a camera and light on the end (laparoscope) to see inside your body. They put other instruments through the same cuts to do the surgery.
Percutaneous endoscopic surgery
If you only have one kidney, the surgeon might be able to remove just the tumour using a thin, flexible tube with a camera and light on the end (endoscope). They make a small cut in the skin at the side of the body. Then they put the endoscope into the kidney to remove the tumour. They use an ultrasound or CT scan to guide them. This operation is not done often because there is a high risk of the cancer coming back.
You might have chemotherapy after surgery if your surgeon finds that your cancer has spread into the surrounding tissue or the lymph nodes. This reduces the risk of the cancer coming back.
Your doctor might also recommend chemotherapy if your cancer is advanced when you are diagnosed or if you cannot have surgery for other health reasons.
You usually have a combination of chemotherapy drugs. The combinations include:
- GC – gemcitabine and cisplatin
- GemCarbo – gemcitabine and carboplatin
- MVAC – methotrexate, vinblastine, doxorubicin and cisplatin
The drug vinflunine (Javlor) is sometimes used if the cancer has spread or comes back
Rarely, doctors give chemotherapy treatment directly into the ureter. This is called regional chemotherapy. The doctor inserts a tube through your urethra and into the ureter. Or they put a tube into your kidney (nephrostomy tube). They put the put the drugs through the tube. The drugs you have are BCG or mitomycin.
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.
These drugs are also often used in bladder cancer.
Radiotherapy is not often used. You may have radiotherapy to the area of the kidney or ureter if you’re not fit enough to have an operation or if your cancer has spread into surrounding tissue.
Sometimes doctors recommend radiotherapy after surgery, to reduce the risk of the cancer coming back.
You have regular check up appointments after treatment for transitional cell cancer of the kidney or ureter. This is called follow up. Your doctor looks for signs of the cancer coming back or spreading so that it can be found and treated early.
Your doctor will tell you exactly how they will keep a check on you. In the first year you usually have appointments every 3 months. In the second and third year you have appointments every 6 months. After that you have them yearly.
As part of your follow up you have regular tests to look inside your bladder (cystoscopies). This is because transitional cell cancers come back in the bladder in about 20 out of 100 people (20%).
Researchers are looking into new treatments for transitional cell cancers. There are clinical trials using new types of chemotherapy and new biological therapies.
Coping with a diagnosis of a rare cancer can be especially difficult, both practically and emotionally. Being well informed about your cancer and its treatment can make it easier to make decisions and cope with what happens.
Talking to other people
Talking to other people who have the same thing can also help.
Our discussion forum Cancer Chat is a place for anyone affected by cancer. You can share experiences, stories and information with other people who know what you are going through.
The Rare Cancer Alliance offer support and information to people affected by rare cancers.