Transitional cell carcinoma
Transitional cell carcinoma are a relatively rare, aggressive cancer of cats, frequently affecting the bladder but may also affect the ureters and kidneys. It is one of the more common neoplasia of the urinary tract.
Cats have much lower incidence of lower urinary neoplasia, primarily due to the low volume of renally-excreted tryptophan metabolites, ortho-aminophenol in particular, which can accumulate in the bladder of dogs and humans and act as a carcinogen.
The most common site of tumor development is the trigone area of the bladder. Less commonly, these neoplasms originate in the urethra and may involve the prostate gland of males or the vaginal vault of females. The pattern of neoplastic cell growth may be papillary, non-papillary, or invasive. Metastasis occurs approximately 50% of the time. The most common sites for metastasis include regional lymph nodes, surrounding soft tissues, bones of the hindquarters, and lung.
Cyclo-oxygenase-2 (COX-2) overexpression appears to be commonly associated with this disease, suggesting a role of chronic inflammatory/irritant triggers for onset of neoplastic changes.
Transitional cell carcinomas are relatively slow growing and the mean age for development of clinical signs is approximately 9 years. Early signs can be confused with FLUTD (feline lower urinary tract disease), but symptoms associated with urinary neoplasia usually progress over time, whereas those associated with FLUTD often wax and wan.
Common reported signs include dysuria, persistent hematuria, anorexia, lower abdominal pain and intermittent vomiting. Weight loss may also be apparent. Changes such as hematuria, pyuria, proteinuria, or bacteruria are common on urinalysis.
Dysuria, hematuria, and pollakuria are very pertinent historical facts. Cytology may used to evaluate urine sediment or fine-needle aspirations of discrete masses or suspicious lesions. Fine-needle aspiration may be assisted by abdominal palpation or ultrasonographic location of the mass. A mass may also be palpable in the caudal abdomen. Urinary obstruction is not a consistnt sign. Other less common signs include weight loss, anorexia and intermittent vomiting.
Ultrasound and contrast cystography are useful imaging tools to define the presence and extent of a neoplasm or suspicious lesion.
Transitional cell carcinomas tends to be relatively aggressive tumours that have often invaded into the muscle layers of the bladder wall by the time of a diagnosis. Additionally, about 20 - 30% of cats present with metastasis at the time of diagnosis.
Definitive diagnosis requires biopsy of neoplastic tissue, usually acquired via laparotomy. Anisokaryosis is a key cytologic feature; some affected nuclei may be extremely large (5-10 times normal).
In dogs, the diagnosis of transitional cell carcinoma may be improved with the use of a commercially available bladder tumor antigen detection test. This test has not been recorded for use in cats.
In cats, surgery is the recommended treatment in advanced cases or urinary TCC, involving partial cystectomy. Unlike humans, construction of an artificial bladder using ileal tissue and creation of a stoma is not normally performed.
Median survival time is 6 - 8 months, but longer-term survival has also been reported in cats treated with meloxicam. In cats, there is a reverse relationship between survival and COX-2 status, with COX-2 negative cats surviving a mean of 375 days versus COX-2 positive cats (MST 123 days).
Peroxicam may have had some effect against neoplastic cells in 3 of 10 dogs with TCC. This drug currently is being used as palliative treatment for transitional cell carcinoma in cats.
Intravesicular chemotherapy using intravescicular cisplatin and gemcitabine or immunotherapy using bacillus Calmette-Guérin (BCG), which are the standard method of car in human patients, may be warranted.
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