What is Urothelial Carcinoma? Let's talk about it in detail!

Have you ever noticed blood in your urine? Or do you have back pain or constant fatigue? While these may not seem like much to worry about, they can sometimes be signs of a cancer that develops in the urinary tract. One such type of cancer is Urothelial Carcinoma , sometimes called Transitional Carcinoma . Today, we're going to talk about this in a little more detail , as if we were talking to a friend.

What is Urothelial Carcinoma? Simply put...

Simply put, Urothelial Carcinoma is a cancer that starts in the tissue called the urothelium, which lines some parts of your urinary system. Think of it like the inner lining of some organs in our bodies. The urothelium is one such tissue. It is mainly found in the bladder, kidneys (especially the renal pelvis), and ureters. Did you know that 90% of bladder cancers and 7% of kidney cancers are urothelial cancers? The symptoms of both are very similar. The best thing is that these cancers are easier to treat and cure if detected early . However, they can sometimes recur. That's why it's important to be aware of this.

How does this cancer affect our bodies?

The way urothelial cancer affects your bladder and kidneys can vary slightly.

Urothelial cancer of the bladder

Your bladder is a small sac-like organ. It's located between your hip bones, above your urethra, and below your kidneys. Urine from your kidneys collects in this bladder. The inside of the bladder is lined with the tissue we mentioned earlier called the urothelium . The cells in this tissue can stretch when your bladder fills with urine and contract when it empties. (Your bladder can normally hold about two cups of urine.) When you develop bladder cancer, the cells in this urothelium divide abnormally and spread from the inner layer of your bladder to other layers. Sometimes, these abnormal cells can break through the walls of your bladder and into the fatty tissue around it. If left untreated, this cancer can spread through the bladder wall to nearby lymph nodes and from there to other areas such as the bones, lungs, and liver. There are two main types of bladder cancer:

• High-grade urothelial cancer : This is a bit more dangerous. It is more likely to come back even with treatment. It can spread to the muscle layer of the bladder, other parts of the body, andIt can spread to the lymph nodes .
• Low-grade urothelial cancer: This can also come back, but it is very unlikely to spread to the muscle layer of the bladder or to other parts of the body.

Urothelial cancer of the kidneys

We normally have two kidneys. They are like two bean-shaped organs, located just below the rib cage and behind the abdomen. The kidneys filter waste products and toxins from the blood and make urine. This urine collects in the middle of the kidney called the renal pelvis . From there, the urine travels down a long tube that connects the kidney to the bladder. This tube is called the ureter . Like the kidneys, the renal pelvis and ureter are also lined with urothelial tissue. Kidney cancer occurs when abnormal urothelial cells grow and form tumors in the kidneys, renal pelvis, or ureter. Kidney cancer can also spread to other organs or tissues.

Who is most likely to develop this cancer?

Bladder cancer is the sixth most common cancer in the United States. And 90% of bladder cancers are urothelial cancers. Men are about four times more likely to develop bladder cancer than women . Kidney cancer is the eighth most common cancer. About 7% of kidney cancers are urothelial cancers. It most commonly occurs in people between the ages of 65 and 74. Men are twice as likely to develop the disease.

What is the main symptom of urothelial cancer?

Urothelial cancer may not have any symptoms in its early stages. However, blood in the urine (hematuria) is usually the first symptom. If you notice blood in the urine or have any of these other symptoms, you should definitely see a doctor :

• Persistent back pain .
• Tiredness, fatigue .
• Being thin for no reason.
• Pain when urinating ( dysuria ).
• It feels like a tumor where the kidneys are.
• I have a slight fever.

What causes this cancer?

Medical researchers still don't know exactly what causes urothelial cancer of the bladder and kidneys. However, they have identified several common risk factors:

• Cigarette smoking: Cigarette smokers have a higher risk of developing urothelial cancer in the urinary system.The risk of developing cancer is very high. This is the main risk factor.
• Exposure to certain chemicals: Studies have shown that people who work in places that manufacture certain dyes, rubber, leather goods, paints, some fabrics, and hair styling products are at increased risk of developing this cancer.

How do doctors diagnose this cancer?

Doctors use these tests to diagnose bladder and kidney cancers, including urothelial cancer:

• Urinalysis: A test that checks your urine for color, sugar, protein, blood, and bacteria.
• Urine cytology: A sample of your urine is taken and examined under a microscope to check for abnormal cells. If you have cancer in the kidneys, bladder, or urethra, cancer cells may be found in your urine.
• Intravenous pyelogram (IVP): This is a series of X-ray tests. It is done to check for cancer in the kidneys, ureters, and bladder. Doctors inject a special liquid (contrast dye) into your vein. Then, X-rays are taken as the liquid passes through your kidneys, ureters, and bladder to see if there is any blockage.
• Ureteroscopy: A thin tube-like instrument (with a camera and light) is passed through the urethra to look inside the ureter and renal pelvis. It is also used to take tissue samples.
• CT scan (Computed tomography - CT scan): A computer connected to an X-ray machine takes detailed pictures of various parts of the body.
• Ultrasound: High-energy sound waves (ultrasound) are sent into tissues inside the body and the echoes that return are used to create a picture (sonogram). An abdominal ultrasound may be done to detect cancers of the renal pelvis and ureter.
• MRI (Magnetic resonance imaging - MRI): Uses a magnet, radio waves, and a computer to take detailed pictures of areas inside the body, such as the pelvic cavity.

What is cancer staging?

Doctors use a cancer staging system to plan treatment and determine the prognosis. This describes how the cancer is likely to grow and spread.

Staging cancer is a complicated process. If it feels like your condition is being put into a formula with a few letters and numbers, it can be scary and confusing. Understandably so. If you're not sure about this or are feeling intimidated, ask your doctor to explain how this system applies to your condition.

Stages of bladder cancer

Bladder cancer can be either early stage (limited to the lining of the bladder) or advanced (has penetrated the bladder wall and spread to nearby organs or lymph nodes). The stages of bladder cancer are as follows:

• Stage I: The cancer is limited to the lining of the bladder or the connective tissue underneath it. It has not spread to the main muscle wall of the bladder.
• Stage II: The cancer has spread to the muscular wall of the bladder.
• Stage III: The cancer has spread from the bladder muscle to the fatty tissue outside.
• Stage IV: The cancer has spread from the bladder to lymph nodes, other organs, or the bones.

Doctors also classify bladder cancer as noninvasive , non-muscle-invasive , or muscle-invasive .

• Noninvasive: In this case, the cancer may be present in only a small area of ​​tissue, or may be limited to the surface of the bladder.
• Non-muscle-invasive: In this case, the cancer has gone deep into the bladder, but has not spread to the muscles.
• Muscle-invasive: In this case, the cancer has spread to the muscles of the bladder wall and may have spread to the fatty layers outside the bladder or to the tissues of the organs.

Stages of kidney cancer

Kidney cancer is not staged based on the type of cancer cell. Urothelial cancer accounts for about 7% of kidney cancers. Kidney cancer and renal pelvis/ureter cancer are staged differently.

• Stage I: The cancer has not spread beyond the kidney.
• Stage II: The cancer has grown, but has not spread beyond the kidney.
• Stage III: The cancer has spread from the kidney to the main blood vessels - the renal vein and the inferior vena cava - or to the tissues around the kidney, or to nearby lymph nodes.
• Stage IV: The cancer has spread from the adrenal gland (a small gland located above the kidney), to distant lymph nodes, or to other organs.

Stages of cancer of the renal pelvis and ureter

• Stage 0: There are abnormal cells in the lining of the renal pelvis or ureter. This is also called papillary carcinoma or carcinoma in situ .
• Stage I (Stage 1): The cancer has spread through the inner layer of the renal pelvis and/or ureter and into the connective tissue layer.
• Stage II:The cancer has spread through the connective tissue to the muscle layer of the renal pelvis and/or ureter.
• Stage IV: (Stage III is not mentioned here, but it is usually between II and IV, indicating spread to nearby structures) The cancer has spread to nearby organs, one or more lymph nodes, the fatty layer around the kidney, or distant organs such as the lungs, liver, or bones.

How do doctors treat urothelial cancer?

Treatment methods vary depending on where the urothelial cancer is located in the bladder, kidneys, renal pelvis, and ureter.

Bladder cancer treatment

Treatment options may include:

• Surgery: Surgeons either remove the cancerous tumor or burn it away using a high-energy electric current. This is called electrocautery (fulguration) .
• Chemotherapy: Drugs are given to destroy cancer cells.
• Immunotherapy: Stimulates your body's own immune system to fight cancer.
• Radiation therapy: Uses high-energy rays to destroy cancer cells.
• Targeted therapy: Drugs that target specific molecules that help cancer cells grow.

Kidney cancer treatment

Some of the same treatments are used for kidney cancer as for bladder cancer. In addition, these treatments may be used:

• Surgery: Only the part of the kidney with the cancer can be removed, or the entire kidney can be removed.
• Cryoablation: Uses extreme cold to destroy cancer cells.
• Radiofrequency ablation: Radio waves are used to heat and destroy cancer cells.

Treatment of cancer of the renal pelvis and/or ureter

• Surgery: The part of the kidney pelvis or ureter where the cancer is located is removed.

What is the survival rate if you develop urothelial cancer?

Although urothelial cancer is a cancer that starts from the same type of cells, the course of the disease can vary depending on where it develops (bladder, kidney, renal pelvis, ureter).

Outlook for bladder cancer

Like most cancers, bladder cancer is more likely to survive if it is detected and treated early. According to 2018 data from the National Cancer Institute (NCI), 96% of people who were treated for early-stage cancer were still alive five years after diagnosis. Overall, 77% of people with bladder cancer were still alive five years after diagnosis.

Outlook for kidney cancer

Like most cancers, kidney cancer (including renal pelvis cancer) is easier to treat if detected early.According to NCI data (2018), 93% of people treated for early-stage kidney cancer are still alive five years after diagnosis. The overall five-year survival rate is 76.5%.

How can I reduce my risk of developing urothelial cancer in my urinary system?

There are two main things you can do to reduce your risk of developing this cancer:

• Not smoking cigarettes.
• Avoiding exposure to certain harmful chemicals.

How can I take care of myself?

If the cancer is caught early, doctors can often cure urothelial cancer, which develops in the urinary tract. But unfortunately, these types of cancers are very likely to come back. If you have been treated for this type of cancer, it is important to continue to have follow-up care as directed by your doctor. This is very important.

When should I see a doctor?

If you notice any changes in your body, especially signs that suggest a recurrence of urothelial cancer in the urinary system, see a doctor immediately. This means that if you experience any new symptoms, such as blood in your urine, back pain, or new fatigue, you should definitely see a doctor.

The most important things to remember (Take-Home Message)

Okay, so, these are the most important things you need to remember from what we've talked about today:

• Urothelial carcinoma is a cancer that develops in the inner layer of your urinary system (bladder, kidneys, and ureters).
• The main symptom is blood in the urine . Other symptoms include back pain, fatigue, and weight loss.
• Smoking and exposure to certain chemicals are the main risk factors.
• If detected early, it is more likely to be treated and cured.
• Because this cancer can recur, it is essential to continue medical checkups after treatment.
• If you have any doubts or symptoms, don't be afraid to talk to a doctor. They will help you.

I hope this information is useful to you. Stay healthy! Urothelial cancer, Urothelial Carcinoma, Urinary cancer, Bladder cancer, Kidney cancer, Blood in urine, Cancer symptoms