Imaging and staging of transitional cell carcinoma: part 1, lower urinary tract

Transitional cell carcinoma (TCC) of the bladder is one of the most common malignancies affecting the genitourinary tract and is characterized by multifocality and a high incidence of recurrence. Radiologists play an important role in the staging and surveillance of this malignancy. In this article, we discuss the epidemiology, pathologic characteristics, and patterns of tumor spread of bladder carcinomas. We illustrate and focus on the role of imaging in the diagnosis, staging, and surveillance of TCC.

The hallmark of TCC is multiplicity and recurrence. Cystoscopy is the method of choice for evaluation of the primary tumor in patients with bladder carcinoma. Imaging acts as an adjunct to accurately stage disease in these patients. Nearly 2-4% of patients with bladder cancer develop upper tract TCC. Hence, surveillance of the upper tract, in which imaging plays a central role, is an important component in the management of TCC. As in every other cancer, we face some limitations in nodal staging of TCC, particularly when the nodes are not enlarged. Development and validation of newer scanning techniques and MR contrast agents may help address some of these limitations in the future.