Transitional Cell Carcinoma

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  • Most arise in bladder

  • may occur anywhere within urinary tract

  • uncommon <50

  • Men 3:1 women

  • 4x more common than renal cell carcinoma

Causes

  • 4x increase in incidence with smoking

  • Industrial carcinogens (dye, plastics - beta-naphthylamine/benzidene) give 20-60x increase

  • drugs - phenacetin, cyclophosphamide

  • chronic inflammation - schistosomiasis

Pathology

  • Well differentiated are frond-like on cystoscopy

  • Less differentiated form plaques

  • Often multifocal (field-effect of carcinogen)

Clinical Features

  • Painless haematuria

  • Colic + long stringy clots indicates upper tract lesion

  • retention of urine

    • large clots

  • hydronephrosis if near ureteric orifice

  • recurrent UTI

Investigation

  • Urine analysis

    • Dipstix for haematuria

    • cytology

  • IVU

  • Cystoscopy

Histology

  • 'P' system gives extent of invasion

  • 'G' system gives extent of differentiation

Management

  • Resection at cystoscopy

  • Topical chemotherapy (mitomycin)

  • Total cystectomy

 

 

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