What Is Transition Cell Cancer?

Overview

Transitional cell cancer is the malignancy of transitional cells in a person’s body. Transitional cells are also known as urothelial cells, and these cells line the walls of renal pelvis, ureters, bladder, and urethra. The transitional cells can change shape without breaking apart to allow the urinary tract to stretch and accommodate, increasing or decreasing volumes of excretion. 

Transitional cell cancer can originate anywhere in the urinary system where transitional cells are located. Most cases originate in the bladder.¹ Transitional cell cancer is capable of spreading to other parts of the urinary system as well as outside of it, such as to the pelvic lymph nodes, liver, lungs, and brain.²

Signs and symptoms of transitional cell cancer

While some patients have distressing symptoms, others may not experience any symptoms at all. If you have transitional cell cancer, you might experience some of the following symptoms:

• Hematuria, or blood in urine
• Persistent back pain
• Feeling pain when urinating or frequent urination
• Fatigue
• Sudden weight loss

Management and treatment for transitional cell cancer

Transitional cell cancer patients are commonly treated with surgeries. Examples include:

• Transurethral resection - The removal of the tumour in the bladder by inserting the resectoscope through the urethra. This surgery is more suitable for cancer which has not invaded the muscle wall
• Cystectomy - The partial or complete removal of the urinary bladder. The complete removal of the bladder is known as radical cystectomy and is usually required for cancer that has invaded the muscle wall. A cystectomy's main aim is to prevent further spread of the cancer
• Nephroureterectomy - The removal of the kidney, ureter, bladder cuff, and any other regions that the cancer may have spread to. This is done in order to completely remove the cancer

Chemotherapy may be required following surgery to prevent recurrence in high-risk patients. One of the chemotherapy drugs that may be used is mitomycin, which mainly targets fast-dividing cancer cells.³ Chemotherapy may also be used in patients with cancer that has spread throughout the body.

The treatment that a patient receives would ultimately depend on the stage and grade of cancer. Patients would also need to have regular check-ups to monitor their condition and detect recurrence. 

FAQs

How is transitional cell cancer diagnosed?

People who are suspected to have transitional cell cancer would usually receive a physical examination and a health history check to help detect abnormal lumps and identify possible risk factors. 

Doctors might also advise getting a cystoscopy, which is a screening procedure that involves a tube with a lens inserted through the urethra to the bladder. This can find out the location and size of the tumour.⁴ 

Doctors may also run tests on urine samples. For example, urine cytology is a test done to detect any precancer or cancer cells in urine samples.⁴ Urinalysis, a test that helps analyse the content and concentration of urine samples to detect abnormalities, may also be done.

Imaging techniques such as a CT scan or an MRI may also be required to screen for tumours. 

How common is transitional cell cancer?

The most common form of transitional cell cancer is bladder transitional cell cancer, which contributes to approximately 90% of bladder cancer cases. In 2012, bladder cancer was found to be the ninth most common cancer worldwide, with about 430,000 new cases diagnosed.⁵ 

The number of new transitional cell cancer cases is particularly high in Western Europe and North America, while Eastern Europe and Asian countries have some of the lowest numbers of new cases.⁵

Who is at risk of transitional cell cancer?

The exact causes of transitional cell cancer are still unclear. However, there are known environmental and genetic risk factors that can increase the risks for transitional cell cancer.

Transitional cell cancer has been found to be 3 times more common among males than females, especially in those aged 60 and above.

Transitional cell cancer is especially prevalent among people who are exposed to environmental risk factors, the most common being cigarette smoke. A study supported by Cancer Research UK reported that the average age of smokers being diagnosed with transitional cell cancer is about 4 years younger than non-smokers. Smokers also appear to have larger and higher grade tumours.

Occupational exposure to chemicals is also one of the risk factors for transitional cell cancer. Carcinogenic chemicals can also be present in chemicals such as dyes and in manufacturing processes. Exposure to carbon black dust in diesel fumes is another contributor to the increased risk of transitional cell cancer.

Long-term drinking of water containing arsenic or chlorine is also a cause of concern for increased transitional cell cancer risk.

Although the relationship between genetics and the risks for transitional cell cancer still needs further investigation, some studies on families with multiple cases of transitional cell cancer revealed that certain gene variants and genetic mutations increase the risk for transitional cell cancer.¹

How can I prevent transitional cell cancer

There are currently no proven ways to prevent transitional cell cancer completely, as the cause is still unclear. However, there are lifestyle changes you can make to lower the risk of transitional cell cancer or its recurrence.

Quitting smoking has been suggested to lower the recurrence rate in patients with transitional cell cancer in the bladder that has not invaded the muscle wall.⁶ 

If you are working in an environment that exposes you to chemicals that can increase your risks for transitional cell cancer, it is important that you follow the safety guidelines to reduce your exposure. 

In terms of diet, it is best to cut down on the consumption of processed meat which may be associated with an increased risk for bladder cancers. Try to incorporate more fruits and vegetables into your diet instead, as they are rich in antioxidants which may help to reduce the risk for certain cancers.⁷

When should I see a doctor

If you have observed the above-mentioned signs and symptoms, it is best to seek medical advice from your GP as soon as possible. Transitional cell cancer in the bladder commonly presents with blood in urine. Even if the amount of blood in urine is not significant or this symptom only happens occasionally, you should still see the GP to look into the underlying cause, which could be cancer.

Summary

Transitional cell cancer is a cancer that originates from the transitional cells that line the urinary tract. Transitional cell cancer patients may experience symptoms such as blood in urine, painful urination, and back pain. While the cause of transitional cell cancer is unclear, there are some well-established risk factors, including cigarette smoking, occupational exposure to chemicals, and chronic drinking of water containing arsenic or chlorine. Keeping a healthy lifestyle and quitting smoking are the main ways to lower the risks for transitional cell cancer. If you observe signs and symptoms, make sure to consult your GP as soon as possible to identify the underlying causes.