Papillary Urothelial Carcinoma: Overview and More - Verywell Health

Papillary urothelial carcinoma (more commonly referred to as transitional cell cancer) is a type of bladder cancer. It begins in the urothelial cells located on the surface of the bladder's inner lining.

Urothelial cells are found throughout the urinary tract. Papillary urothelial carcinomas have the appearance of fingerlike protrusions that grow from the bladder's inner lining toward its center. They can be invasive or noninvasive.

The bladder is part of the urinary tract. It is a hollow organ located in the lower pelvis. The bladder's job is to store urine until you are ready to urinate. It has muscular walls that expand to hold urine and contract to release it. Urine exits the bladder through the urethra.

This article will discuss the causes, diagnosis, and treatment of papillary urothelial carcinoma. It will also provide information about the prognosis for this condition.

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Types and Stages of Papillary Urothelial Carcinoma

Papillary urothelial carcinoma can be invasive or noninvasive, as follows:

• Noninvasive remains within the transitional epithelium (urothelium). It does not grow into the bladder's deeper layers. The transitional epithelium is made up of cells that change shape to accommodate the amount of urine being held in the bladder. The transitional epithelium lines most of the urinary tract.
• Invasive is more aggressive. It grows and spreads into the bladder wall's inner layers. This type of cancer is harder to treat.

Like all types of bladder cancer, papillary urothelial carcinoma staging is based on the American Joint Committee on Cancer (AJCC) TNM system. Your overall stage will be determined by information compiled from these three groups:

Tumor Stage (T)

The tumor stage is based on how much the primary (main) tumor has spread from the bladder into nearby tissues. Noninvasive papillary urothelial carcinoma is indicated by the letter "a." Invasive carcinomas are given a number from T1 to T4. The higher the number, the deeper the spread into the bladder, as follows:

• Ta: Noninvasive papillary urothelial carcinoma has not spread.
• T1: Cancer has spread into the connective tissue layer underneath the lining of the bladder but not the muscle of the bladder.
• T2: Cancer has spread deeper into the muscle of the bladder wall.
• T3: Cancer has spread through the bladder wall and into the fatty tissue and surrounding organs.
• T4: Cancer has spread farther beyond the bladder into the pelvis or abdominal wall.
  

Nodal Stage (N)

The nodal stage is determined by the amount of cancer spread, if any, into nearby lymph nodes. The location and number of affected lymph nodes determine the amount of spread, as such:

• N0: No spread into any examined lymph nodes has occurred.
• N1: Cancer cells have been found in one lymph node in the pelvis.
• N2: Cancer cells have been found in two or more lymph nodes in the pelvis.
• N3: Cancer cells have been found in the lymph nodes along the common iliac artery.
  

Metastatic Stage (M)

The metastatic stage is based on how much cancer has spread to distant lymph nodes or organs, such as the liver or lungs, as follows: 

• M0: Cancer has not spread to distant lymph nodes or organs
• M1a: Cancer has spread into distant lymph nodes
• M1b: Cancer has spread into one or more distant organs such as the liver, lungs, or bones
  

Papillary Urothelial Carcinoma Symptoms

The most common symptom of early papillary urothelial carcinoma is blood in the urine (hematuria). Hematuria can be caused by many conditions, whose treatment ranges from easily treatable to serious. If you see blood in your urine or have any signs of bladder cancer, see a healthcare provider.

Early symptoms of papillary urothelial carcinoma include:

• Hematuria
• Painful urination
• Burning sensation during urination
• Needing to urinate more often, including during sleep
• Trouble urinating
• Weak urine stream
• Urgency to urinate, even if your bladder isn't full

If you have advanced papillary urothelial carcinoma, you may also experience these symptoms:

• Inability to urinate
• Lower back pain on one side
• Swollen feet
• Bone pain
• Extreme fatigue
• All-over body weakness

Causes

Papillary urothelial carcinoma begins when the urothelial cells that line the inside of the bladder develop genetic changes, called mutations, in their DNA. The mutated cells live longer than they should and multiply rapidly. This causes a tumor to form. It's not completely understood why these cell changes take place.

Risk factors are not causes. However, they may help predict your likelihood of getting a certain condition. Not everyone who has a risk factor for papillary urothelial carcinoma will get this disease. Genetics and a family history of bladder cancer may, in some instances, increase your risk. Other potential risk factors include:

Smoking

The chemicals in cigarettes, vaping, pipes, and cigars can accumulate in urine, causing damage to the endothelial lining of the bladder. Smoking causes around half of all bladder cancers. If you smoke, you are 3 times more likely to get bladder cancer than someone who doesn't smoke.

Exposure to Carcinogens in the Environment

Certain professions require that workers are consistently exposed to toxins in the air or in smoke. As with tobacco smoke, these toxins can accumulate in urine, causing damage to the bladder's endothelial lining. High risk categories include:

• Factory workers in industries such as rubber, textiles, paint, and leather
• Printers
• Painters
• Hairdressers
• Truck drivers
• Firefighters
• Military personnel
  

Age, Sex, and Ethnicity

There are certain factors out of your control that increase the likelihood of getting this disease. They include:

• Age: Most people diagnosed with this condition are over 55 years old.
• Sex: Males are diagnosed more often with this condition than females.

White people are more often diagnosed with this cancer than other groups in the United States.

Prior Bladder Conditions

Certain health conditions that affect the bladder may increase your risk for papillary urothelial carcinoma and other types of bladder cancer. They include:

Medications and Treatments

Certain treatments for cancer may increase your risk of papillary urothelial carcinoma. These include taking Cytoxan (cyclophosphamide), a chemotherapy drug, for an extended period of time. Radiation treatments to the pelvis may also increase risk.

High doses of Actos (pioglitazone), a diabetes medication, have also been linked to bladder cancer.

Diagnosis

To get a diagnosis of papillary urothelial carcinoma, your healthcare provider will ask about your symptoms, family history, and lifestyle. They may do a digital rectal exam or pelvic (vaginal) exam to see if a bladder tumor can be felt manually.

Additional tests include:

• Urinalysis: To look for blood in the urine
• Urine cytology: To check for cancerous or precancerous cells
• Urine culture: To look for evidence of a bacterial infection, which may rule out cancer
• Urine tumor marker test: To look for substances made by bladder cancer cells

If papillary urinary carcinoma or another type of bladder cancer is suspected, you will need additional tests. They include:

• Cystoscopy: This is an office procedure in which a small camera is placed into the urethra and bladder. It looks for tumors or abnormal changes in the bladder.
• Bladder biopsy: A small piece of the suspicious tumor is removed and sent to the lab for evaluation.
• Transurethral resection of bladder tumor (TURBT): The urologist uses instruments that are sent into your urethra to the bladder to remove the tumor. During this procedure, any papillary tumors that are found will be removed.
• Imaging tests: Tests such as magnetic resonance imaging (MRI), computed tomography (CT) scan, or ultrasound may be done to check for tumor size and for spread into other areas of the body.
  

Treatment

The stage of your cancer and extent of spread will impact the treatment or treatments used. They include:

• Intravesical therapy: This treatment is often used to kill residual cancer cells that remain in the bladder after a TURBT procedure. Chemotherapy or immunotherapy drugs may be used. Treatment can be done right after a resection or in the healthcare provider's office a few weeks after the procedure.
• Radiation therapy: Radiation may be done with or without chemotherapy. Radiation done in conjunction with chemotherapy is called chemoradiation.
• Chemotherapy: Chemotherapy kills quickly dividing cells, such as cancer cells. Chemotherapy medications may be given as an intravesical treatment. If the cancer has spread, chemotherapy drugs will be given intravenously. This is known as systemic chemotherapy.
• Surgery: If the cancer is invasive, a partial or radical cystectomy will be done. These procedures remove some or all of the bladder. Nearby lymph nodes and pelvic organs may also be removed.
  
• Immunotherapy: Immunotherapy drugs help your immune system fight cancer. A weakened form of the bacterium Mycobacterium bovis (bacillus Calmette-Guérin) may be used as an immunotherapy drug. This treatment is referred to as intravesical BCG.
  
• Targeted therapy: Targeted therapy drugs zero in on cancer cells and attack them. These drugs may be used on their own, or in conjunction with other treatments, including surgery, radiation, and chemotherapy
  

Prognosis

Your prognosis will be determined by the stage and how much the cancer has spread. Survival rates for papillary urothelial carcinoma are grouped into in situ, localized, regional, or distant spread categories. In situ alone refers to cancerous or precancerous cells that have remained confined to their original location. This is sometimes called stage 0.

It's important to remember that survival rates are estimates. They're also based on the experiences of people who were diagnosed at least five years earlier. Five-year survival rates don't take new treatments or current clinical trials into account.   

The five-year survival rate for papillary urothelial carcinoma and other types of bladder cancer are:

• In situ alone: 96%
• Localized: 70%
• Regional: 38%
• Distant: 6%
  

Coping

If you have just gotten a diagnosis of papillary urothelial carcinoma, you may be concerned about the treatments you'll undergo and your prognosis. It can be hard to cope with this new process. These coping strategies may help:

• Ask questions: If you don't understand why you need a certain test or treatment, ask. Write down what your oncologist (cancer specialist) and other cancer team members tell you. And don't be afraid to ask for clarification of unclear points or ask follow-up questions.
• Create a support team: You may benefit from having a shoulder to lean on. Reach out to friends and family for support. Joining a cancer support group, such as the Bladder Cancer Advocacy Network, can also be beneficial.
• Live a healthy lifestyle: Self-care is important for overall health, recovery, and serenity. Eat healthy food, exercise, and get plenty of rest. Reduce anxiety through proactive strategies, such as meditation, journaling, and being in nature.
  

Summary

Papillary urothelial carcinoma is a common form of bladder cancer. It may be invasive or noninvasive. Smoking is a risk factor for this disease. Seeing blood in your urine is a common early symptom.

Treatments for papillary urothelial carcinoma include chemotherapy, radiation, and surgery. Your prognosis will be determined, in part, by the amount of spread that has occurred.

A Word From Verywell

If you're experiencing early warning signs for papillary urothelial carcinoma, see a healthcare provider as soon as possible. Many symptoms of this and other forms of bladder cancer are associated with other conditions that are easy to treat.

If you have cancer, early detection and fast treatment can save your life. It's OK to be scared. Even so, don't delay in seeking out a diagnosis.