Urothelial Carcinoma, also known as transitional cell carcinoma, is a type of cancer that typically occurs in the urinary system, including the bladder, ureters, and renal pelvis. It originates in the urothelial cells that line these organs. Risk factors include smoking, exposure to industrial chemicals, chronic bladder irritation, and certain genetic mutations. The cancer develops when genetic mutations in the urothelial cells cause them to multiply uncontrollably and form a tumor.
Clinical Evaluation
Patient History: Detailed history of symptoms, smoking history, occupational exposures, and family history of cancer.
Physical Examination: Abdominal and pelvic examination to check for masses or tenderness.
Diagnostic Tests
Urinalysis: Examination of urine for blood, cancer cells, and other abnormalities.
Urine Cytology: Microscopic examination of urine to detect cancer cells.
Cystoscopy: A procedure using a thin, lighted tube to examine the inside of the bladder and urethra and to take biopsies of suspicious areas.
Imaging Studies: CT urogram, MRI, or ultrasound to visualize the urinary tract and detect tumors or abnormalities.
Biopsy: Histological examination of tissue samples taken during cystoscopy to confirm the presence of cancer and determine its grade and stage.
Hematuria (blood in the urine), which may be visible or detected microscopically.
Frequent urination.
Painful urination (dysuria).
Pelvic or back pain.
Urgency to urinate.
Weight loss and fatigue in advanced cases.
Swelling in the lower extremities in advanced cases.
The treatment of urothelial carcinoma depends on the stage and grade of the cancer, as well as the patient's overall health and preferences.
Surgery:
Transurethral resection of bladder tumor (TURBT) for early-stage tumors. Partial or radical cystectomy (removal of part or all of the bladder) for more advanced cases. Nephroureterectomy for tumors in the ureters or renal pelvis.
Intravesical Therapy:
Direct administration of medications into the bladder to treat superficial bladder cancer. Bacillus Calmette-Guérin (BCG) therapy or chemotherapy.
Chemotherapy:
Systemic chemotherapy to destroy cancer cells, often used before or after surgery to reduce the risk of recurrence.
Radiation Therapy:
External beam radiation to target and destroy cancer cells, often used in combination with chemotherapy.
Immunotherapy:
Checkpoint inhibitors and other drugs that help the immune system recognize and attack cancer cells.
Targeted Therapy:
Drugs that target specific molecules involved in cancer growth and spread.
Lifestyle Modifications and Supportive Care:
Smoking cessation, healthy diet, regular physical activity, and psychological support to improve quality of life during and after treatment.