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What Is a Urothelial Neoplasm?

By A. Reed
Updated Mar 03, 2024
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Urothelial neoplasm, or transitional carcinoma (TCC), is a type of cancer that begins in transitional tissue, which is found in the urinary system, including the kidneys, bladder, and ureters, as well as certain parts of the prostate. Transitional epithelium is a kind of tissue having the ability to stretch, accommodating the primary function of the urinary tract — the collection, production, and storage of urine. Manifest by express growth of abnormal epithelial cells, chief symptoms of urothelial neoplasm are abdominal pain and blood in the urine. Though no known cause of TCC exists, certain risk factors may be contributors such as smoking cigarettes and chemotherapy.

TCC manifests in several physiological states which are used to determine the stage of the neoplastic condition and subsequently the plan of management. Least invasive and tending to be the easiest to cure is urothelial neoplasm in situ, as it is generally still superficial, even though it is thought to be potentially very metastatic. This is particularly true if it tends to reoccur. Seen in more advanced stages, metastatic TCC is a condition in which malignant cells spread into the lymph nodes and to distant organs. Staging and tumor grading are most important in determining prognosis, as urothelial neoplasms with more advanced involvement, including invasion of the lymph nodes and muscle tissue, are typically incurable. Low stage tumors, in situ and stage 1, have a 91% survival rate after five postoperative years as of 2011.

Unless the cancer condition is significantly advanced or the health of the patient is poor, typical treatment for urothelial neoplasm is surgery, as well as chemotherapy and immunotherapy. Drugs taken for the purpose of destroying cancerous cells, chemotherapeutic agents are administered locally via catheter into the renal pelvis or systemically. Given to strengthen the patient's immunity either alone or in conjunction with chemotherapy, immunotherapy is more effective against low-stage, low-grade cancer.

Specific kinds of chemotherapeutic agents that cause a condition referred to as hemorrhagic cystitis, especially problematic in children, are associated with TCC. Caused by inflammation and infection, hemorrhagic cystitis is characterized by frequent urination, a feeling of urgency, clots of blood in the urine, or not being able to void at all. Research indicates that a factor which remarkably increases TCC risk is cigarette smoking, which is linked to more advanced states of the disease, as well as higher incidence of morbidity. Other risk factors which make people more susceptible to developing a urothelial neoplasm are abuse of painkillers and recurring, long-term recurrent urinary tract infections and kidney stones.

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