Papillary Urothelial Carcinoma - The Urinary Bladder Cancer

Introduction

Papillary urothelial carcinoma is a kind of urinary bladder cancer that develops within a particular type of cell found in the inner lining of the bladder, ureters, and kidneys. These tumors are finger-like projections beginning in the bladder lining and extending inside the urinary bladder. These tumors are not always cancerous; some can be benign or non-cancerous. These cancerous growths stay within the urinary bladder without growing or spreading further. But certain aggressive forms of this cancer can spread to some adjacent organs. Papillary tumors are also found in other body parts, such as the breast or the thyroid.

What Causes Papillary Urothelial Carcinoma?

• Family History - Certain types of bladder cancers have a positive family history. Papillary urothelial cancer is commonly seen in families affected with Lynch syndrome, which is an inherited condition making people susceptible to certain cancers.

• Chronic Infections of the Urinary Bladder - Recurrent urinary tract infections or stones may lead to urothelial cancer.

• Smoking - Smoking is one of the most important causes of cancer, including papillary urothelial cancer.

• Exposure to Certain Chemicals - Certain chemical exposures can increase one's risk of developing urothelial cancers.

• Certain Medications - Excessive use of Phenacetin in certain painkillers might increase one's risk of developing cancer. Intake of Aristolochic acid, which is present in certain supplements, can also increase cancer risk.

• Exposure to arsenic.

• Genetic mutations.

• Treatment with chemotherapeutic drugs such as Cyclophosphamide.

• Radiation therapy in the pelvic area.

What Are the Symptoms of Papillary Urothelial Carcinoma?

The symptoms of papillary urothelial carcinoma are as follows:

• Blood in the urine.

• Frequent urge to urinate.

• Irritation of the urinary bladder.

• Not able to urinate even with the urination urge.

• Pain.

• Swelling or edema.

• Fever.

• Night sweats.

• Loss of appetite.

• Loss of weight.

What Are the Risk Factors Associated With Papillary Urothelial Carcinoma?

Less Water Intake - Less water intake leads to toxin and waste build-up in the body.

• Age - The risk of cancer is greater in the elderly.

• Gender - Cancer affects males more than females.

• Race - White people are much more susceptible to developing urothelial cancer.

• Genetic Factors - Individuals with a positive family history of bladder cancer are at an increased risk of developing papillary urothelial cancer.

• Individuals born with bladder defects are at an increased risk of developing papillary urothelial cancer.

• Conditions such as schistosomiasis, which is a parasitic infection, can also increase one's risk of developing urothelial cancer.

What Are the Types of Papillary Urothelial Carcinoma?

A papillary carcinoma can be of two types - invasive or noninvasive. The invasive cancers are found in the innermost part of the urinary bladder. Noninvasive cancers are found in the inner layer of the urinary bladder and have not spread deep into the bladder or other organs. Papillary tumors can be categorized into four types:

• Papilloma - It is a benign or non-cancerous tumor of the urinary bladder.

• Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLM) - This type of papillary tumor is a pre-cancerous tumor that is not expected to metastasize or spread.

• Low-grade Papillary Urothelial Carcinoma - This papillary tumor grows slowly and has a high chance of relapse.

• High-grade Papillary Urothelial Carcinoma - This type of papillary tumor has quick growth and is capable of spreading fast.

What Are the Stages of Papillary Urothelial Carcinoma?

Papillary Urothelial Carcinoma is divided into stages based on their spread to the nearby organs in the following:

• Stage Zero - This stage is also known as noninvasive papillary urothelial carcinoma. In this stage, the cancer is found in the inner lining of the urinary bladder and has not grown within the muscular tissue of the bladder.

• Stage One - In this stage, cancer has progressed into the lining of the urinary bladder but not into the muscular layer.

• Stage Two - Cancer has metastasized into the muscular layer of the urinary bladder but not to the adjacent lymph nodes.

• Stage Three - Cancer has metastasized or spread to the tissues of the adjacent organs of the urinary bladder, such as the prostate glands, the uterus, or the vagina.

• Stage Four - Cancer has spread to other parts of the body, including the lymph nodes.

What Are the Grades of Papillary Urothelial Carcinoma?

• Low-grade Tumors - The cells of a low-grade tumor are quite similar to the other healthy cells. However, their growth is very slow and does not usually spread to other parts.

• High-grade Tumors - High-grade tumors have abnormal cells that tend to spread to the adjacent tissues and organs.

How Is Papillary Urothelial Carcinoma Diagnosed?

A thorough examination of the symptoms, a detailed family history, and lifestyle is required for proper diagnosis. The following methods can make the diagnosis:

• Digital Rectal Examination - To manually feel the bladder.

• Urinalysis - A urine test to detect the presence of blood in the urine.

• Urine Culture - In case of a bacterial infection.

• Urine Cytology - To detect the presence of pre-cancerous or cancerous cells.

• Tumor Marker Tests - To detect the presence of substances secreted by the cancerous cells.

• Cystoscopy - This procedure detects the presence of tumorous growths in the bladder with the help of a small camera.

• Imaging Tests - Imaging tests such as MRI (magnetic resonance imaging), CT (computed tomography), or ultrasound can be used to detect the spread of the tumor to the adjacent areas of the body.

How Is Papillary Urothelial Carcinoma Treated?

• Surgery - Papillary urothelial carcinoma can be surgically treated. Transurethral removal of the tumor is done to treat noninvasive papillary urothelial carcinoma. In this surgery, a small camera with a tool is inserted to resect the tumor. The tissue is collected and sent for biopsy to check whether it is cancerous.

• Chemotherapy - Chemotherapy is usually prescribed if some amount of the cancerous cells are still present after the surgery. It involves using strong medications to kill cancerous cells. However, it has its share of side effects, like nausea, vomiting, exhaustion, and a weak immune system.

• Immunotherapy - Immunotherapy can be used in combination with chemotherapy or surgery to treat papillary urothelial cancers.

• Radiation Therapy - Radiation therapy uses strong rays to kill the tumor by shrinking its size. It is used in combination with other treatment modalities.

How Is the Prognosis of Papillary Urothelial Carcinoma?

Papillary urothelial carcinoma is a slow-growing tumor of the urinary bladder. It responds well if treated on time. However, the prognosis depends on the stages and grade of cancer. Cancers with lower grades or preliminary stages have a better outlook than those with advanced stages or high-grade cancers. The prognosis is also different for different people based on their age and the cancer type.

Conclusion

Papillary urothelial carcinoma is a type of urinary bladder cancer. It is usually of two types - invasive or noninvasive. There are several risk factors contributing to the development of carcinoma. The treatment is done via surgery, radiation therapy, chemotherapy, and immunotherapy. The prognosis is determined by the promptness of the treatment and the metastasis to other organs.