From the Guidelines
Transitional cell carcinoma and papillary bladder carcinoma are not distinct entities, but rather represent overlapping classifications of bladder cancer, with transitional cell carcinoma referring to the cell type of origin and papillary describing a growth pattern. The most recent and highest quality study, 1, published in 2024, provides updated information on the classification of urinary tract tumors, including the adoption of a modified terminology where the designation of “subtype” is used to replace “variant” histology when referring to distinct morphologic categories within a given tumor type. Key points to consider include:
- Urothelial carcinoma is the most common histologic subtype of bladder cancer, accounting for approximately 90% of cases, and may present with either papillary or non-papillary growth patterns, as noted in 1 and 1.
- Papillary tumors tend to be lower grade, less invasive, and have better prognosis, though they frequently recur, as discussed in 1 and 1.
- Non-papillary tumors are typically higher grade, more likely to invade the bladder muscle wall, and have worse outcomes, highlighting the importance of histological examination for proper classification, as emphasized in 1 and 1.
- Treatment planning is crucial, with low-grade papillary tumors potentially managed with transurethral resection and intravesical therapy, while invasive disease often requires more aggressive approaches, including radical cystectomy and systemic chemotherapy, as outlined in 1, 1, and 1. Considering the most recent evidence, the distinction between transitional cell carcinoma and papillary bladder carcinoma is essential for treatment planning and prognosis, with a focus on the growth pattern and degree of cellular differentiation, as highlighted in 1.
From the Research
Difference between Transitional and Papillary Bladder Cancer
- Transitional cell carcinoma (TCC) of the bladder makes up 90% of bladder cancers 2
- Papillary TCC is a type of superficial TCC, which can be treated with surgery alone (transurethral resection) as initial therapy 2
- Bladder papillomatosis is a rare entity, characterized by diffuse tumor proliferation, and can be treated with endoscopic resection and intravesical BCG therapy 3
- The prognosis of papillary TCC is generally good, but recurrence rates are high, with 70.8% of patients experiencing recurrence in one study 3
Key Characteristics
- Transitional cell carcinomas are divided into superficial and muscle-invasive tumors, with most being superficial tumors 4
- Pathologists play a significant role in diagnosing bladder tumors and reporting features important for determining prognosis, including depth of invasion, tumor grade, and multicentricity 4
- Bladder cancer can range from unaggressive and noninvasive tumors to aggressive and invasive tumors with high disease-specific mortality 5
Treatment Options
- Non-muscle-invasive tumors are treated with endoscopic resection and adjuvant intravesical therapy, depending on the risk classification 5
- Muscle-invasive disease requires more aggressive therapy, such as radical cystectomy and urinary diversion or trimodal therapy with maximal endoscopic resection, radiosensitizing chemotherapy, and radiation 5
- Neoadjuvant chemotherapy, particularly cisplatin-based combination chemotherapy, can improve overall survival in muscle-invasive TCC 6