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What Is Metastatic Urothelial Carcinoma

Treatment Of The Primary Lesions

Metastatic urothelial carcinoma

Primary UTUC occurred in 10 cases involving the renal pelvis in three and the ureter in seven primary LTUC in five cases, involving the bladder in four and the proximal urethra in one. A total of eleven patients underwent primary lesions radical surgery and subsequently developed metastasis, and the remaining four patients had distant metastasis on initial diagnosis. Among primary tumor resection patients, nine patients showed no local progression during the follow-up period, one patient experienced local relapse and received secondary surgery, another patient was found to have recurrence in the urinary tract and underwent surgical treatment. Six patients were classified as WHO grade 2 and the other nine patients as grade 3. The median interval between initial diagnosis of UC and spinal metastasis was 10 months, 7.5 months for UTUC and 36 months for LTUC, 40 months for WHO grade 2 and 5 months for WHO grade 3, .

Table 2 Treatment Information of Primary Urothelial Carcinoma

Figure 1 Metastasis interval from initial diagnosis of urothelial carcinoma to the confirmation of spinal metastasis between upper tract urothelial carcinoma and lower tract urothelial carcinoma patients , different WHO grade patients .

Prognosis & Survival Rate

The prognosis of the Urothelial Carcinoma depends upon the invasive nature of the malignancy and spreading of metastasizing. In the case of initial stage low-grade cancerous lesion provides a good prognosis, whereas poor prognosis is reported with the high grade cancerous lesion. The local invasion of the carcinoma can provide 5 years survival, whereas involvement of the lymph nodes can cause 0 to 30 percent 5 years survival1.

References

  • David F Jarrard. Urothelial Tumors of the Renal Pelvis and Ureters. Sep 18, 2016. Medscape. Online available at http://emedicine.medscape.com/article/452449-overview#a8
  • MARIANA DEACU, MDLINA BOOTEANU, MARIANA ACHIE, GABRIELA BLTESCU, V. SÂRBU, MARIANA BRDA Urothelial carcinoma of the renal pelvis associated with cystic disease of the kidney. Rom J Morphol Embryol. 2011 52:497-501. Online available at https://www.ncbi.nlm.nih.gov/pubmed/21424101
  • Rugvedita Parakh, Monika Roychowdhury, Bladder Urothelial carcinoma-invasive General. 18 July 2016. Online available at http://www.pathologyoutlines.com/topic/bladderurothelialinvasivegen.html
  • Sensitivity Analysis And Publication Bias

    Sensitivity analysis was conducted to examine the stability and reliability of the results of this meta-analysis. In RC vs. NS cohort or MC vs. NS cohort on, the sensitivity analysis for the result of salvage surgeries and OS did not alter significantly, demonstrating that no single study could significantly influence the pooled HR or the 95% CI . Overall, our results were stability and reliability.

    Figure 4vs.vs.

    As displayed in Figure 5, the P value of Beggs test was 0.462 and the P value of Eggers test was 0.200 in the pooled analysis of RC vs. NS cohort based on OS. In the pooled analysis of MC vs. NS cohort based on OS, the P value of Beggs test and Eggs test was 0.806 and 0.509 respectively. P values were all above 0.05, indicating no evidence of significant publication bias in this article.

    Figure 5vs.vs.

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    Trc105 In Adults With Advanced/metastatic Urothelial Carcinoma

    The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
    First Posted : April 4, 2011Results First Posted : March 2, 2015Last Update Posted : January 13, 2017
    • Study Details

    Background:

    – Urothelial cancer often responds initially to standard chemotherapy treatments, but frequently recurs and can often spread to other parts of the body. TRC105, an experimental drug that blocks the development of the new blood vessels needed for tumor growth, may be able to shrink or stabilize urothelial cancer tumors. TRC105 has been given previously to individuals with other types of cancer, and researchers are interested in determining its safety and effectiveness in treating urothelial cancer.

    Objectives:

    – To determine the safety and effectiveness of TRC105 as a treatment for metastatic urothelial cancer that has not responded to standard treatments.

    Eligibility:

    – Individuals at least 18 years of age who have been diagnosed with urothelial cancer that has spread to other parts of the body and has not responded to standard chemotherapy.

    Design:

    Condition or disease
    Urothelial CarcinomaUreteral NeoplasmsUreter CancerNeoplasm, UreteralCancer of the Ureter Drug: TRC105

    BACKGROUND:

    OBJECTIVES:

    ELIGIBILITY:

    DESIGN:

    Experimental: Single Arm – TRC105 in Urothelial CarcinomaTRC105 15 mg/kg/dose every two weeks Drug: TRC105

    How Is Metastatic Bladder Cancer Treated

    Cystectomy. The high

    The way that metastatic bladder cancer is treated depends primarily on where the cancer has spread and the type of cells that make up the primary tumor. Its important to remember that when bladder cancer spreads, the secondary tumors are still considered to be bladder cancer not lung cancer, liver cancer or any other type of malignancy. Potential treatment options may include chemotherapy, radiation therapy and clinical trials.

    At Moffitt Cancer Center, weve treated many patients with metastatic bladder cancer, creating tailored treatment plans for every single one. To help ease the burdens of treatment, we also offer comprehensive supportive care services for patients and their caregivers.

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    Advanced Or Metastatic Transitional Cell Carcinomas

    First-line chemotherapy regimens for advanced or metastatic transitional cell carcinomas consists of gemcitabine and cisplatin) or a combination of methotrexate, vinblastine, adriamycin, and cisplatin.

    Taxanes or vinflunine have been used as second-line therapy .

    Immunotherapy such as pembrolizumab is often used as second-line therapy for metastatic urothelial carcinoma that has progressed despite treatment with GC or MVAC.

    In May 2016, the FDA granted accelerated approval to atezolizumab for locally advanced or metastatic urothelial carcinoma treatment after failure of cisplatin-based chemotherapy. The confirmatory trial failed to achieve its primary endpoint of overall survival.

    In April 2021, the FDA granted accelerated approval to sacituzumab govitecan for people with locally advanced or metastatic urothelial cancer who previously received a platinum-containing chemotherapy and either a programmed death receptor-1 or a programmed death-ligand 1 inhibitor.

    Centers And Patients Characteristics

    The 51 active centers were located in Austria , France , Italy and Spain . The split between public and private practice was 7/0 in Austria, 6/1 in France, 16/5 in Italy and 15/1 in Spain. Among the 218 patients under study, 51 were followed in private centers, and 167 in public centers.

    The mean number of patients recruited per center was 4.3 . Thirty-four centers recruited up to 4 patients, 11 centers between 5 and 9 patients, and 6 centers recruited 10 patients.

    Of the 218 patients, 5 were excluded from the analysis because 2 did not received any platinum-based chemotherapy and 3 had multiple different consecutive chemotherapy regimens. However, these patients were included in the patient characteristics analysis.

    Males represented 84 % of the patients and median age was 68. Thirty-three patients were75 years old. Regarding the number of systemic chemotherapy treatments at study entry, 45 patients had received just one previous chemotherapy regimen 136 had received 2 regimens, and 37 had received 3 or more regimens.

    At registration, the treatment status of the patients was: ongoing chemotherapy n=140 , best supportive care n=42 , pending decision n=28 and other situations n=8 .

    Most patients were initially treated with surgery including radical cystectomy, partial cystectomy or nephro-ureterectomy. Only 8 patients were treated by radiotherapy.

    Table 1 Conditions contributing to cisplatin ineligibility

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    About The Bladder Renal Pelvis And Ureter

    The bladder is a hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra. The renal pelvis is a funnel-like part of the kidney that collects urine and sends it into the ureter. The ureter is a tube that runs from each kidney into the bladder. The urethra is the tube that carries urine out of the body. The prostate gland is also part of the urinary tract.

    The bladder, like other parts of the urinary tract, is lined with a layer of cells called the urothelium. This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin, fibrous band called the lamina propria.

    What Is Bladder Cancer

    Immunotherapy in metastatic urothelial carcinoma

    Bladder cancer starts when cells that make up the urinary bladder start to grow out of control. As more cancer cells develop, they can form a tumor and, with time, spread to other parts of the body.

    The bladder is a hollow organ in the lower pelvis. It has flexible, muscular walls that can stretch to hold urine and squeeze to send it out of the body. The bladder’s main job is to store urine. Urine is liquid waste made by the 2 kidneys and then carried to the bladder through 2 tubes called ureters. When you urinate, the muscles in the bladder contract, and urine is forced out of the bladder through a tube called the urethra.

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    Health Literacy To Empower Patients

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    Radical Cystectomy And Regional Nodal Dissection

    Several groups have reported outcomes for patients with metastatic or unresectable disease treated with postchemotherapy radical cystectomy and regional nodal dissection., Dodd and colleagues reported outcomes for 4 patients with unresectable disease who all achieved a complete response to MVAC. Residual disease was found in 75% of patients and 2 patients were alive at 5 years. In addition, they reported outcomes for 15 patients with regional nodal involvement who underwent MVAC followed by surgery. Of these patients, 6 were alive at 5 years. In their series, patients with unresectable disease and those with regional nodal involvement did far better than those with visceral metastasis. Similarly, Miller and colleagues noted that patients with liver, lung or bone involvement had significantly decreased survival compared to patients without visceral metastasis. A phase 3 trial comparing MVAC to fluorouracil, interferon alfa-2b and cisplatin included 20 patients initially presenting with unresectable disease or nodes below the renal hila who were treated with chemotherapy followed by surgical consolidation. The median survival for this group of patients was 55.2 months from resection and 11 were free of disease with a median follow-up of 51.8 months. A similar group of patients undergoing surgical consolidation at the Memorial Sloan-Kettering Cancer Center identified 9 of 20 patients alive at 5 years.

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    What Is The Prognosis Of Metastatic Urothelial Cancer

    Prognosis for patients with metastatic urothelial cancer is poor, if the cancer is found only in the part of the body where it started it is localized .< img src=”https://i0.wp.com/www.researchgate.net/profile/Muhammed_Mubarak/publication/288071102/figure/fig1/AS:/A-Malignant-urothelial-tumor-composed-of-glands-and-classified-as-primary.png” alt=”A, which refers to extent of a cancer in the body, such as the lungs, One-third of the patients are diagnosed with organ confined disease and 1015% are estimated to present with metastasis, Lancet Oncol 2017 18:31222, If this happens, discusses results from study which examined treatment patterns among patients with metastatic urothelial carcinoma previously treated with PD-1/L1 inhibitor therapy, UC) depends on whether a patient is cisplatin-fit or not, UC) depends on whether a patient is cisplatin-fit or not, We report a case of a 64-y< img src=”https://i0.wp.com/www.researchgate.net/profile/Mohamed_Zaghloul/publication/221923535/figure/download/fig2/AS:/Invasive-urothelial-cell-carcinoma-Small-groups-of-cells-with-glandular-differentiation.png” alt=”Invasive urothelial cell carcinoma, Northwestern University Feinberg School of Medicine, Even if the cancer cells are first discovered in the bones, Pulmonary metastases tend to present as multiple lesions

    Types Of Bladder Cancer

    File:Urothelial carcinoma of the ureter, low mag.jpg ...

    The type of bladder cancer depends on how the tumors cells look under the microscope. The 3 main types of bladder cancer are:

    • Urothelial carcinoma. Urothelial carcinoma accounts for about 90% of all bladder cancers. It also accounts for 10% to 15% of kidney cancers diagnosed in adults. It begins in the urothelial cells found in the urinary tract. Urothelial carcinoma is sometimes also called transitional cell carcinoma or TCC.

    • Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time, these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.

    • Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.

    There are other, less common types of bladder cancer, including sarcoma of the bladder and small cell bladder cancer, among others. Sarcomas of the bladder often begin in the fat or muscle layers of the bladder. Small cell bladder cancer is a rare type of bladder cancer that is likely to spread to other parts of the body.

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    The Need For More Clinical And Translational Research

    More research is needed to evaluate the predictive value of patients PD-L1 immune cell expression levels, to better determine which patients will benefit from atezolizumab treatment and to develop future treatment strategies. The associations between PD-L1 expression, molecular subtype, mutation load and response to atezolizumab suggest that the presence of additional neoantigens may correlate with immune system response, and that combination immunotherapies may further enhance therapeutic effects. More clinical trials are needed to define further new therapies in this challenging cancer trial accrual is critical.

    The prior absence of a standard-of-care treatment option in patients with platinum-resistant advanced urothelial cancer, in conjunction with the shown efficacy and relatively favorable toxicity profile of immune checkpoint inhibitors, contributed to the recent FDA approval that rendered atezolizumab the new standard of care for patients with platinum-resistant advanced urothelial cancer, Dr. Grivas says. More clinical and translational research is critical to further understand the immunologic mechanisms and potential treatment combinations and sequences, and to develop prognostic and predictive biomarkers that can aid in optimal patient selection.

    What Is Upper Tract Urothelial Cancer

    Upper tract urothelial cancer is a cancer that occurs in either the inner lining of the tube that connects the kidney to the bladder or within the inner lining of the kidney.

    The lining of the bladder, kidney and ureter are the same, so there are some similarities between upper tract urothelial cancer and bladder cancer.

    Upper tract urothelial cancer is not common with about 470 Australians diagnosed each year. It is three times more likely to be diagnoses in men than women and is more common in people over the age of 70 years.

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    Recurrent Urothelial Carcinoma With Pulmonary Metastasis

    How does metastatic urothelial carcinoma differ in radiologic appearance in the lung vs a primary lung lesion? Dr, 2 Recurrence most often occurs locally in the bladder or remaining upper tract with < 1% involving the colon, Doctors can have different opinions about the best standard treatment plan.When you find out you have metastatic renal cell carcinoma, phase 2 trial, 51.

    Diagnosis Of Upper Tract Urothelial Cancer

    Atezolizumab limits disease progression for metastatic urothelial bladder cancer

    If your doctor thinks you may have UTUC they will take your medical history, perform a physical examination and arrange for you to have a number of tests.

    If the results of these tests suggest that you may have UTUC, your doctor will refer you to a specialist called a urologist, who will arrange further tests. These may include:

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    Prognosis And Life Expectancy

    In general, papillary urothelial cancers have a better prognosis than other types of bladder cancer. Your specific outlook depends on the stage and grade of your cancer. High-grade cancers can spread. Low-grade papillary cancers are less likely to spread. Papillary cancers can also return after theyve been treated.

    Looking For More Of An Introduction

    If you would like more of an introduction, explore this related item. Please note that this link will take you to another section on Cancer.Net.

    • ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to bladder cancer. This free fact sheet is available as a PDF, so it is easy to print.

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    Metastasectomy Could Not Improve The Survival Of Metastatic Urothelial Carcinoma: Evidence From A Meta

    Qianwei Xing1#, Chengjian Ji2#, Yi Wang1#, Xing Wang3, Zhenjie Zhu4

    1 Department of Urology, Affiliated Hospital of Nantong University, Nantong 226001, The First Affiliated Hospital of Nanjing Medical University , Zhenjiang Hospital of Chinese Traditional and Western Medicine , Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China

    Contributions: Conception and design: Q Xing Administrative support: Z Zhu Provision of study materials or patients: Y Wang Collection and assembly of data: X Wang Data analysis and interpretation: C Ji Manuscript writing: All authors Final approval of manuscript: All authors.

    #These authors contributed equally to this work.

    Correspondence to:

    Background: With the advancement of surgical techniques and instruments, surgeries had been increasingly applied to patients with metastatic urothelial carcinoma. However, their survival benefits had not been carefully evaluated.

    Methods: Eligible articles were conducted by comprehensively searching three online databases , published before May 1st, 2019. Overall survival and cancer-specific survival/progression-free survival were analyzed to clarify their associations.

    Despite the positive role of the RC in treating metastatic urothelial carcinoma, MC did not suggest a survival benefit in terms of OS. More strictly designed randomized controlled trials were needed to validate our findings.

    Submitted Aug 31, 2019. Accepted for publication Jan 13, 2020.

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