Transitional Cell Carcinoma (TCC)

Definition:

• A type of cancer that occurs in the transitional epithelium – 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 – 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.