When you think of bladder cancer, you most likely have urothelial carcinoma in mind. As the most common type of bladder cancer, urothelial carcinoma accounts for about 90 percent of all bladder cancers.

This article reviews urothelial carcinoma, its symptoms, and its treatment. It also discusses ways to manage the side effects of urothelial carcinoma treatment.

What Is Urothelial Carcinoma?

Urothelial carcinoma occurs when urothelial cells that line the inside of the urinary tract begin to grow out of control. Urothelial cells are also known as transitional cells because they transition (change) their shape to stretch when the bladder is full and contract when it’s empty. This is why urothelial carcinoma used to be called transitional cell carcinoma.

Urothelial cells line the entire urinary system, including your kidneys, ureters (the tubes that connect your kidneys to your bladder), bladder, and urethra (the tube that allows you to empty your bladder). Urinary carcinoma can develop anywhere urothelial cells are found. For example, urothelial carcinoma can cause kidney cancer, but this is less common. About 7 percent of kidney cancers are urothelial carcinoma.

Subtypes of Urothelial Carcinoma

Urothelial carcinoma starts growing in the bladder’s innermost layer. When this occurs, it’s called non-muscle-invasive bladder cancer (NMIBC). NMIBC can also be described as flat or papillary. The term “noninvasive flat carcinoma” refers to when cancer cells grow in a flat patch. “Noninvasive papillary carcinoma” describes a tumor that grows toward the center of the bladder, like a finger.

Low-Grade Versus High-Grade Tumors

Noninvasive papillary carcinomas can also be grouped into subtypes based on their appearance under the microscope. This is also called tumor grading.

Low-grade tumors are usually slow-growing and less likely to invade deeper bladder tissues. Noninvasive low-grade papillary urothelial carcinoma is an example of a low-grade urothelial carcinoma. Noninvasive high-grade papillary urothelial carcinoma is a high-grade type that’s more likely to reach deeper tissues.

Invasive Urothelial Carcinoma

As cancer cells grow and divide, they can invade deeper bladder layers, such as muscle. If this occurs, it’s called invasive urothelial carcinoma or muscle-invasive bladder cancer (MIBC).

What Are the Symptoms of Urothelial Carcinoma?

The symptoms of urothelial carcinoma are the same as those of other types of bladder cancer, including:

• Hematuria (blood in the urine)
• Painful urination
• Frequent urination
• Multiple trips to the bathroom during the night
• Pelvic pain

In the early stages of bladder cancer, when urothelial carcinoma hasn’t become invasive, you may not have any noticeable symptoms. Although most people with bladder cancer will have blood in their urine, the amount may be too small to see or may come and go.

If you have urothelial carcinoma in another part of your urinary tract, such as your kidneys or ureters, you may experience additional symptoms like lower back pain or trouble urinating.

Other medical conditions, such as urinary tract infections, an enlarged prostate, and bladder or kidney stones, can also cause these common symptoms of bladder cancer. This overlap can make urothelial carcinoma difficult to diagnose.

If urothelial carcinoma isn’t caught early, it can continue to grow and cause additional symptoms. Symptoms of advanced, or metastatic, urothelial carcinoma may include:

• Difficulty urinating
• Lower back pain
• Swelling in your lower legs and feet
• Tiredness
• Weight loss

A pelvic mass (an abnormal growth that starts in the lower abdomen or pelvis) can also be a sign of urothelial cancer.

How Is Urothelial Carcinoma Diagnosed?

The process of getting a urothelial cancer diagnosis often starts with a primary care provider. They may suspect urothelial carcinoma because of your symptoms or an abnormal urinalysis (urine test) during a routine exam. If your primary care provider thinks you may have bladder cancer, they’ll refer you to a urologist (a doctor who specializes in treating conditions of the urinary tract and male reproductive organs).

To help diagnose urothelial carcinoma, a urologist may order additional tests such as:

• Urine cytology — A test to screen for cancer cells in urine
• Cystoscopy — A procedure that involves inserting a cystoscope (thin camera) through the urethra and into the bladder to look for abnormal areas and take a biopsy (tissue sample)
• Transurethral resection of bladder tumor (TURBT) — A procedure that’s used to remove tumors for further laboratory tests and can also be part of therapy
• Imaging scans — Tests such as MRI and CT urogram, which provide a detailed image of the inside of your body

The bladder tissue samples taken during a cystoscopy or TURBT are tested to determine the stage and subtype of urothelial carcinoma. These details can help your cancer care team understand your outlook and the best treatment options for you.

Urothelial carcinoma has also been linked to a family cancer syndrome called Lynch syndrome. Your cancer care team may recommend genetic testing to find out if you have Lynch syndrome. It’s important to know if you have this condition because it also increases your risk of several other cancers, including colon cancer.

Learn more about how bladder cancer is diagnosed.

What Are the Treatment Options for Urothelial Carcinoma?

Treatment recommendations for bladder cancer are generally based on urothelial carcinoma because it’s the most common type of bladder cancer.

The best treatment option for you depends on the type, grade, and stage of your bladder cancer. Your overall health and personal preferences are also important factors when considering bladder cancer treatment.

Surgery

Surgery is often the primary treatment for bladder cancer. In early-stage urothelial carcinoma, a TURBT may be all that’s needed to remove the tumor. For a high-grade tumor that doesn’t respond to treatments such as immunotherapy, a partial cystectomy (removing part of the bladder) or radical cystectomy (removing the entire bladder) might be done. Doctors usually try less invasive therapies first before recommending a radical cystectomy.

If your whole bladder is removed, you’ll also need reconstructive surgery to create a new way for your body to store and pass urine. This procedure is called urostomy or urinary diversion. Your health care team will teach you how to care for it and adjust to these changes.

Radiation Therapy

Radiation therapy uses high-powered radiation to kill cancer cells. Doctors may recommend radiation therapy to treat urothelial carcinoma when the bladder isn’t removed. This treatment can also be used along with others, such as chemotherapy.

Radiation therapy can cause side effects such as:

• Skin changes
• Bladder irritation
• Diarrhea
• Nausea and vomiting
• Tiredness
• Sexual problems

Your cancer care team can help you manage side effects. Their suggestions may include the following tips:

• Take lukewarm showers instead of baths.
• Wear comfortable, loose-fitting clothing.
• Skip hair removal and limit sun exposure during and for some time after treatment.
• Drink plenty of water to stay hydrated, and avoid caffeinated, alcoholic, or carbonated beverages or acidic juices that could irritate the bladder.

Medications

Medication may be given before, after, or instead of surgery to reduce the risk of urothelial carcinoma coming back. Drugs used to treat bladder cancer include chemotherapy, immunotherapy, and targeted therapy.

Some chemotherapy and immunotherapy drugs can be placed directly into the bladder, a method known as intravesical therapy. This approach is often used after a TURBT or to treat NMIBC. For NMIBC, this treatment may be given regularly for six weeks to three years, depending on your care plan.

People with MIBC and advanced bladder cancer may need systemic therapy — treatments that work throughout the entire body to kill cancer cells. These systemic medications are injected into a vein or muscle or taken as a pill.

Potential side effects depend on the type of medication. Common side effects may include:

• Nausea and vomiting
• Constipation or diarrhea
• Hair loss
• Decreased appetite
• Mouth sores
• Infections
• Tiredness

Although medication side effects can be uncomfortable, you can take steps such as these to help manage them:

• Stay as physically active as you can, but take breaks and rest when you’re tired.
• Ask your cancer care team about anti-nausea medications.
• Eat small, frequent meals to prevent or ease nausea.
• Get plenty of liquids to stay hydrated.
• Wash your hands often and stay away from people who are sick to avoid infections.
• Use a gentle shampoo if you experience hair loss.

It’s important to be open and honest with your cancer care team about any new or unusual side effects so they can help you manage them.

What Is the Outlook for Urothelial Carcinoma?

If found early, urothelial carcinoma has a good outlook. However, this type of cancer has a high risk of recurring (coming back) after treatment. About 20 percent of early-stage cases might reappear in another part of the body. The risk of recurrence is about 50 percent for stage 2 and 70 percent for stage 3. Most people with stage 4 urothelial carcinoma can’t be cured, but treatment can help manage symptoms and improve quality of life.

Your cancer care team can give you more information about your outlook based on your cancer stage, how you respond to treatment, and your overall health.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Have you or a loved one been diagnosed with urothelial carcinoma? What symptoms have you experienced? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.