Renal transitional cell carcinoma (urothelial carcinoma)

This page was reviewed under our medical and editorial policy by

Bertram Yuh, MD, MISM, MSHCPM, Urologic Surgeon, City of Hope | Duarte

This page was updated on June 2, 2023.

When cancerous cells develop in the renal pelvis or ureter, it’s known as renal transitional cell carcinoma, also referred to as urothelial carcinoma or urothelial cancer.

What causes renal transitional cell carcinoma?

The kidneys are two bean-shaped organs on either side of the waist—closer to the back of the body than the front—and responsible for filtering waste from the blood and producing urine, which collects in the renal pelvis, an area toward the middle of each kidney.

From the renal pelvis, urine is carried out of the kidneys via a long tube (called a ureter) to the bladder, then exits the body through the urethra. The lining of the renal pelvis is made up of transitional cells that are able to bend and stretch without breaking.

When cancer grows in these pliable cells, it’s called transitional cell carcinoma (TCC). When this type of cancer develops in the renal pelvis and/or the ureter, it’s called renal transitional cell carcinoma. According to the American Cancer Society, about 5 percent to 10 percent of all kidney cancers are TCCs.

Urothelial carcinoma risk factors

Although risk factors may increase the chance of developing cancer, they don’t guarantee someone will get it.

Renal transitional cell carcinoma (TCC) risk factors include:

  • Past or current history of bladder cancer 
  • Smoking
  • Excessive use of pain medications, including phenacetin
  • Exposure to chemicals and dyes used to make items such as leather, plastic, rubber and textile goods.

Renal transitional cell carcinoma symptoms

Although renal transitional cell carcinoma may not cause early symptoms, as the cancerous tumor grows, patients may experience the following:

  • Bloody urine
  • Persistent back pain
  • Extreme fatigue
  • Unexplainable weight loss
  • Recurrent or painful urination

How is renal transitional cell carcinoma diagnosed?

To diagnose renal transitional cell cancer, the care team may perform a variety of exams and tests, as listed below.

Physical exam: The doctor gathers the patient’s personal health history and conducts a physical exam in order to assess overall health.

Lab tests: A urine specimen is collected and evaluated in a urinalysis.

Ureteroscopy: During this procedure, a thin instrument with a lighted lens, called a ureteroscope, is used to examine the renal pelvis for suspicious areas. If abnormalities are found, a small kidney biopsy (a collection of cells from the area) may be taken to check for cancer.

Intravenous pyelogram: The care team may recommend an intravenous pyelogram, which involves injecting contrast dye into the patient's vein and then performing a series of X-rays to detect abnormalities.

Other tests may include:

Additional tests may be conducted to determine whether the cancer has spread beyond the renal pelvis.

Urothelial carcinoma stages

Cancer only located in the kidney is described as localized. If it’s spread to surrounding tissues, lymph nodes and blood vessels, it’s described as regional. Metastatic renal transitional cell carcinoma has spread to other areas of the body.

If the patient has been treated successfully but the cancer returns, it’s described as recurrent.

Renal TCC is given a stage 0 through 4, based on the cancer’s size and location, as listed below.

Stage 0 urothelial cancer: Abnormal cells are found inside the renal pelvis and/or ureter, and may be stage 0a or 0is. Stage 0a describes narrow, lengthy growths that extend from inside these areas, while stage 0is describes a growth that is flat in appearance.

Stage 1 urothelial cancer: Cancer has grown from inside the renal pelvis and/or ureter to the local connective tissue.

Stage 2 urothelial cancer: Cancer has extended to the local muscle layer.

Stage 3 urothelial cancer: Cancer has spread to the kidney itself or to the fat that surrounds the renal pelvis or ureter.

Stage 4 urothelial cancer: The cancer has metastasized to one or more areas, including nearby organs, distant areas of the body, lymph nodes and the fat layer surrounding the kidney.

Learn more about stage 4 metastatic kidney cancer

Urothelial carcinoma treatment

The most common form of treatment for renal transitional cell carcinoma is surgery, including procedures such as:

  • Nephroureterectomy, which involves removal of the affected kidney, ureter and bladder cuff
  • Segmental resection of the ureter, involving removal of the cancerous portion of the ureter, along with a healthy margin of surrounding tissue, followed by reattachment of the remaining ends

Other types of kidney cancer treatment are still being studied and used in clinical trials. These include:

  • Fulguration, removal of cancerous tissue with electricity, using a tool that has a wired loop on one end
  • Segmental resection of the renal pelvis, removal of the affected area of renal pelvis and not the entire kidney
  • Laser surgery, meant to destroy cancer cells
  • Regional chemotherapy and biologic therapy, involving chemotherapy drugs to stop cancer cells from multiplying and biologic therapy to attack cancer through the body’s immune system (“regional” refers to the placing of the drugs directly into the renal pelvis or the ureter)

Patients may also consider asking their care team whether a clinical trial may be the right approach for them.

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