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 need 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 is it?
Transitional cell cancer (TCC) of the kidney is rare. TCC of the ureter is even less common.
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.
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.
Your doctor will examine you and you may have blood tests to check your general health. Other tests include:
- urine tests
- intravenous pyelogram (IVP)
- CT scan
- MRI scan
- chest X-ray
- a test using a camera to look inside your bladder (cystoscopy), or ureter and kidney (ureteroscopy)
Your doctor considers many factors when deciding which treatment is most suitable for you including:
- how big the cancer is
- whether the cancer has spread to other parts of your body
- your general health
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 surgery if the tumour is small and in the area of the ureter close to the bladder.
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.
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.
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 for TCC if the kidney or ureter. 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.
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 can sometimes come back in the bladder.
Researchers are looking into new treatments for transitional cell cancers. There are clinical trials using new types of chemotherapy and new targeted cancer drugs.
Coping with a diagnosis of a rare cancer can be especially difficult. 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 who have the same thing can also help.
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