نظرة عامة
Urothelial carcinoma is a cancer that starts in urothelial cells. These cells line much of the urinary tract, including the bladder, renal pelvis, ureters and part of the urethra.
The renal pelvis is the part of the kidney where urine collects. The ureters are tubes that carry urine from the kidneys to the bladder. Urothelial carcinoma used to be called transitional cell carcinoma.
Most urothelial carcinomas start in the bladder. In the United States and Europe, urothelial carcinoma accounts for about 90% of bladder cancers. Bladder cancer is most often diagnosed in older adults, with a median age at diagnosis of 73.
Urothelial carcinoma also can start elsewhere in the urinary tract, but this is much less common.
Urothelial carcinoma may stay in the inner lining of the urinary tract. Or it may grow into deeper tissues or spread to other parts of the body.
Your healthcare team can help you understand what the cancer's location and other features mean for you.
Types
Urothelial carcinoma of the bladder
Urothelial carcinoma of the bladder starts in the urothelial cells that line the inside of the bladder. It is the most common type of bladder cancer in the United States.
Urothelial tumors of the bladder can grow in different patterns. Papillary urothelial carcinoma grows outward from the bladder lining. Carcinoma in situ (CIS) is a flat, high-grade cancer in the bladder lining. These cancers also may be described as non-muscle invasive or muscle invasive based on how deeply they have grown into the bladder wall.
Upper tract urothelial carcinoma
Upper tract urothelial carcinoma (UTUC) starts in urothelial cells in the upper urinary tract. It can form in the renal pelvis or in a ureter. UTUC accounts for about 5% to 10% of urothelial carcinomas.
UTUC is related to urothelial carcinoma of the bladder, but there are important differences in how it is diagnosed and treated. People with UTUC also can develop urothelial carcinoma in the bladder. For this reason, follow-up may include checking the upper urinary tract, which includes the renal pelvis and ureters, as well as the lower urinary tract, which includes the bladder and urethra.
Urothelial carcinoma of the urethra
Urothelial carcinoma also can start in the tube that carries urine out of the body, called the urethra. Cancer that starts in the urethra, also known as primary urethral cancer, is rare. Not all urethral cancers are urothelial carcinoma. Other types include squamous cell carcinoma and adenocarcinoma.
Other types of bladder cancer
Not all bladder cancers are urothelial carcinoma. Less common types include squamous cell carcinoma and adenocarcinoma. Some bladder cancers contain more than one type of cancer cell.
الأعراض
Urothelial carcinoma of the bladder may cause:
- Blood in the urine, called hematuria. This is the most common symptom. The blood may turn urine red or brown. Sometimes, blood does not change the color of the urine. In this situation, blood is found only with a urine test.
- Urinating more often than usual.
- Feeling an urgent need to urinate.
- Pain or burning with urination.
Blood in the urine often is an early warning sign of bladder cancer. Other urinary symptoms, such as frequent or urgent urination and pain with urination, also can occur early.
Pain in other areas can occur when bladder cancer is more advanced or has spread. Depending on the location of the cancer, pain may be felt in the pelvis, belly, side or back.
Symptoms of upper tract urothelial carcinoma
Blood in the urine also is a common symptom of upper tract urothelial carcinoma. Some people have pain in the side of the body between the ribs and hip.
Urothelial carcinoma and urinary tract infections
Some bladder cancer symptoms are like those of a urinary tract infection (UTI). Both illnesses can cause the need to urinate more often, the feeling of an urgent need to urinate, painful urination and, sometimes, blood in the urine. These symptoms can have many causes, so symptoms alone cannot tell whether you have cancer or an infection.
Research has found that bladder cancer took longer to diagnose in women who were first diagnosed with a UTI than in men. It is important to see your healthcare professional if you have lasting or unexplained urinary symptoms.
When to seek care
See a healthcare professional if you have unexplained blood in your urine or urinary symptoms that do not have a known cause. Also seek care if urinary symptoms persist or return after treatment for another suspected cause, such as a UTI.
الأسباب
It's not clear what causes most urothelial bladder carcinomas. Genetic changes in urothelial cells may play a role in how the cancer develops. Some of these changes can cause cells to grow out of control and form a tumor.
Some people inherit genetic changes that raise the risk of urothelial carcinoma. Lynch syndrome is an inherited condition associated with a higher risk of urothelial cancer, particularly upper tract urothelial carcinoma.
عوامل الخطورة
Factors that may raise the risk of urothelial carcinoma of the bladder include:
- Smoking. Smoking can raise the risk of bladder cancer by exposing the urinary tract to cancer-causing chemicals that leave the body in urine.
- Age. Bladder cancer can happen at any age, but it is more common in older adults.
- Sex at birth. Men are more likely to get bladder cancer than are women.
- Some chemicals. Regular contact with certain chemicals at work or in the environment may raise the risk. These include arsenic and chemicals used in some dye, rubber, leather, textile and paint industries.
- Certain cancer treatments. Treatment with cyclophosphamide and radiation treatments aimed at the pelvis can raise the risk of bladder cancer.
- Personal or family history. Having had bladder cancer raises the risk of getting it again. A family history also may raise the risk.
- Lynch syndrome. This inherited condition raises the risk of urothelial carcinoma and is especially important in upper tract urothelial carcinoma.
Upper tract urothelial carcinoma (UTUC) shares several risk factors with bladder urothelial carcinoma, including smoking and some chemical exposures. Kidney stones and Lynch syndrome also are linked to UTUC.
Long-lasting bladder inflammation or infection is associated mainly with squamous cell bladder cancer rather than the more common urothelial type of bladder cancer.
الوقاية
There's no sure way to prevent urothelial bladder carcinoma. These steps may lower the risk of bladder cancer:
- Don't smoke. If you don't smoke, don't start. If you smoke, talk with a healthcare professional about a plan to help you stop.
- Use chemicals carefully. If you work with chemicals, follow workplace safety instructions.