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Transitional Cell Carcinoma (TCC)

Definition:
  • A type of cancer that occurs in the transitional epithelium ā€“ the tissue that lines the inner part of the urinary system including the renal pelvis, ureters, bladder, and parts of the urethra.
Epidemiology:
  • Most common type of bladder cancer, accounting for over 90% of cases.
  • More frequent in men and in those aged over 60.
Risk Factors:
  • Smoking: Major risk factor, increasing risk up to threefold.
  • Exposure to certain chemicals like aniline dyes and aromatic amines.
  • Previous radiotherapy or chemotherapy (especially cyclophosphamide).
  • Chronic bladder irritation, e.g., from recurrent urinary infections or long-term catheter use.
Clinical Presentation:
  • Painless hematuria: Most common symptom.
  • Frequency, urgency, and dysuria ā€“ symptoms similar to UTI.
  • Possible flank pain or mass if upper urinary tract involvement.
Investigations:
  • Cystoscopy: Direct visualisation of the bladder interior.
  • Urine cytology: Examination of urine under the microscope to detect cancer cells.
  • Imaging: CT urogram or ultrasound to assess for spread and upper tract involvement.
Management:
  • Non-invasive (Ta, T1):
    • Transurethral resection of bladder tumour (TURBT).
    • Followed by intravesical chemotherapy or BCG to reduce recurrence risk.
  • Invasive (T2+):
    • Radical cystectomy (removal of the bladder).
    • Neoadjuvant or adjuvant chemotherapy.
Prognosis:
  • Depends on stage and grade at diagnosis, but TCC tends to have a high rate of recurrence.
  • Regular surveillance with cystoscopy is essential.

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