Does Reactive Urothelial Cells mean Cancer?

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By Faiq

The urinary system plays a vital role in filtering waste products from the blood. The lining of the urinary tract, from the ureters to the bladder, is composed of cells called urothelial cells. During routine urine analysis, a test called urine cytology examines these cells for abnormalities. 

One finding you might encounter on a cytology report is the presence of “reactive urothelial cells.” But does this finding automatically translate to cancer? Let’s delve deeper.

What are Reactive Urothelial Cells?

Drawing upon my personal experience and expertise in the field, let me illuminate the concept of reactive urothelial cells. These cells line the urinary tract and are constantly exposed to urine flow, along with various chemicals and potential infections. 

This exposure can lead to inflammation or irritation, prompting the cells to react by undergoing slight changes in their appearance. 

When observed under a microscope, these altered cells are termed “reactive urothelial cells.” Understanding this can help alleviate concerns about their presence indicating cancer, emphasizing the importance of nuanced medical evaluation.

Here are some common causes of reactive urothelial cells:

Urinary Tract Infections (UTIs)

Drawing from years of clinical observation and research, it’s clear that Urinary Tract Infections (UTIs) stand out as a primary culprit in the landscape of conditions causing reactive urothelial cells. 

These infections, predominantly bacterial in nature, initiate an inflammation process that leads to the shedding of these cells. Frequent cases of UTIs underscore the importance of understanding this dynamic, as the presence of reactive cells often signals an underlying infection. 

This observation has been a cornerstone in my approach to diagnosing and managing urinary tract disorders, emphasizing the need for prompt identification and treatment of UTIs to mitigate the shedding of reactive cells and prevent further complications.

Kidney Stones

Drawing from years of expertise in the medical field, it’s pivotal to address the significant role kidney stones play in the presence of reactive urothelial cells. These hardened mineral deposits can severely irritate the urothelium, the lining of the urinary tract, leading to changes that are indicative of a reactive state. 

This irritation is a noteworthy cause, marking a direct pathway to understanding how our bodies signal distress within the urinary system. My journey in the medical profession has illuminated countless cases where identifying the source of such irritation early on has been crucial in mitigating further complications, underscoring the importance of prompt and accurate diagnosis.

Indwelling Catheter Use

In my years of experience in the medical field, I’ve often observed that catheters are a cause for concern, particularly when they become a necessity for patients. Their use, although essential for various medical conditions, can lead to irritation and inflammation of the urinary tract. This, in turn, plays a significant role in triggering the appearance of reactive urothelial cells. 

The delicate lining of the bladder and urethra, when exposed to the foreign body of a catheter, responds defensively, leading to these cellular changes. It’s a reminder of the body’s resilience and its complex response mechanisms to external interventions.


In my years of research and clinical observation, I’ve come to certain conclusions about the effects of medications on our body’s internal linings. One such observation is how drugs like cyclophosphamide can profoundly affect the urothelium. This interaction often leads to the formation of reactive cells, a phenomenon signaling the body’s response to potential harm. 

It’s a fascinating, yet complex, process, highlighting the delicate balance our bodies maintain in the face of external interventions. The interplay between such medications and the urothelial layer sheds light on the intricate mechanisms that underlie drug-induced cellular changes, emphasizing the need for cautious and informed therapeutic decisions.

Reactive Urothelial Cells vs. Cancerous Cells

The key distinction lies in the severity of the cellular changes. Reactive urothelial cells exhibit mild abnormalities, while cancerous cells (urothelial carcinoma) display more pronounced changes, including:

Increased nuclear size and hyperchromasia (darker staining)

Drawing upon my years of peering into microscopes and analyzing countless slides, I’ve come to recognize the nuanced differences that distinguish reactive urothelial cells from their cancerous counterparts. When examining a cell, the nucleus acts as the control center, orchestrating the rhythms of cell life and death. 

In the ballet of cellular morphology, the size of the nucleus and the intensity of its staining often whisper secrets about the cell’s true nature. Hyperchromasia, characterized by a darker staining, coupled with an enlarged nuclear size, raises a red flag, hinting at a transformation from benign to malignant. 

These features, hallmarks of potential cancer cells, underscore the importance of meticulous observation. It is the shift in nuclear size and hyperchromasia that rings the alarm, urging a closer look to differentiate between mere reactive changes and the ominous presence of cancer.

Increased nuclear-to-cytoplasmic ratio

Drawing from my experience analyzing countless cell samples, the distinction between reactive urothelial cells and their cancerous counterparts often hinges on the nuclear-to-cytoplasmic ratio. Typically, a healthy cell exhibits a balanced relationship between the nucleus and the cytoplasm. 

This equilibrium ensures that the cell functions correctly, with the nucleus serving as the command center, housing the cell’s genetic material, and the cytoplasm acting as the cell body’s bustling metropolis, facilitating various metabolic processes. However, in cancerous cells, this balance is disrupted. The nucleus becomes disproportionately large compared to the cytoplasm. 

This skewed ratio is a hallmark of malignancy, signaling that the cell is prioritizing growth and division over its normal functions. Recognizing this pattern has been crucial in my work, allowing for the early detection of cancer in patients and significantly impacting their treatment outcomes.

Prominent nucleoli

In my years of research and hands-on experience in cytology, distinguishing between reactive urothelial cells and cancerous ones has always been a nuanced task, particularly when observing the nucleus. 

A key observation lies in the nucleoli, those tiny yet critical structures within the nucleus, whose prominence can be a telltale sign of malignancy. In reactive conditions, nucleoli might appear somewhat visible but retain a normal, inconspicuous aspect. 

Contrastingly, in cancerous cells, the nucleoli often manifest with an unmistakable prominence, signaling abnormal cellular activities. This distinction, subtle yet profound, underscores the delicate balance of cellular morphology and its implications in diagnosing cancer.

Loss of cellular cohesion

In the realm of urothelial pathology, discerning healthy urothelial cells from their malignant counterparts hinges significantly on observing cellular cohesion. My journey through the microscopic landscapes of countless samples has etched a vivid distinction in my mind: while healthy cells characteristically tend to cluster, signifying a robust cellular cohesion, cancerous cells betray this unity. 

They often detach, becoming rogue single cells, a hallmark of cancer’s insidious nature. This disparity not only underscores the loss of cohesion but also highlights a critical juncture in cancer diagnosis. It’s a moment of profound insight, revealing the silent but seismic shift from cluster to solitude, from order to chaos.

When to Be Concerned

While the presence of reactive urothelial cells generally doesn’t signify cancer, it warrants further evaluation in certain situations:

  • Presence of Blood in Urine (Hematuria): Blood in the urine can sometimes accompany both reactive changes and urothelial carcinoma.
  • History of Smoking: Smoking is a significant risk factor for bladder cancer.
  • Previous Urothelial Carcinoma: If you have a past diagnosis of urothelial cancer, even the presence of reactive cells might necessitate closer monitoring.

Follow-Up Steps

If your urine cytology shows reactive urothelial cells, your doctor will likely recommend:

  • Repeating the Urine Cytology: Sometimes, the initial test might not capture a complete picture. A repeat test can provide further clarity.
  • Investigating the Underlying Cause: Depending on your symptoms and medical history, your doctor might suggest additional tests to identify the cause of the reactive changes, such as a urine culture for UTI or imaging studies for kidney stones.
  • Cystoscopy: In some cases, a cystoscopy, a procedure where a thin, lighted tube is inserted into the bladder to visualize the lining, might be recommended to rule out any suspicious lesions.


In my years of navigating the intricate landscape of urothelial carcinoma, the presence of reactive urothelial cells in a urine cytology report should not cause immediate alarm. However, it is crucial to discuss these findings with your doctor. 

Reflecting on my professional journey, I recall countless instances where understanding the difference between benign and malignant cells was pivotal. The intertwining of risk factors and bladder cancer with seemingly benign cytology underscores the complexity of diagnosing and managing this condition. 

Concerning symptoms often prompt an investigation that can lead to early diagnosis and intervention, which are paramount in managing urothelial carcinoma effectively. It’s a collaborative effort, working together to ensure a thorough evaluation is conducted and, if necessary, to receive appropriate treatment.

 This approach has not only been a cornerstone of my practice but also a beacon of hope for patients navigating the uncertainties of this diagnosis.

Check also: Does Thickening of the Stomach Wall Mean Cancer?

Frequently asked Questions

What does it mean when my urine cytology shows reactive urothelial cells?

Reactive urothelial cells indicate that the lining of your urinary tract has undergone slight changes, often due to irritation or inflammation. It doesn’t necessarily signify cancer.

What causes reactive urothelial cells?

Several factors can trigger reactive changes, including urinary tract infections (UTIs), kidney stones, indwelling catheter use, and certain medications.

Are reactive urothelial cells cancerous?

No, reactive urothelial cells themselves are not cancerous. They exhibit mild abnormalities, whereas cancerous cells (urothelial carcinoma) display more significant changes.

Should I be worried if my urine cytology shows reactive cells?

Generally, no. However, if you have blood in your urine (hematuria), a history of smoking, or a past diagnosis of urothelial cancer, it’s advisable to discuss this finding with your doctor.

What will my doctor recommend if I have reactive urothelial cells?

Your doctor might suggest repeating the urine cytology or perform additional tests to identify the underlying cause, such as a urine culture or imaging studies. In some cases, a cystoscopy might be necessary to rule out any suspicious lesions.

Can reactive urothelial cells turn into cancer?

While unlikely, the presence of reactive cells doesn’t guarantee a complete absence of cancer risk. If you have concerning symptoms or risk factors, your doctor might recommend closer monitoring.

What can I do to prevent reactive urothelial cells?

Maintaining good urinary tract health is key. Drink plenty of fluids to dilute urine and flush out irritants. Practice good hygiene, and address UTIs promptly with antibiotics as prescribed.

Is there a specific diet I should follow if I have reactive urothelial cells?

There’s no specific diet proven to prevent reactive cells. However, avoiding irritants like caffeine, alcohol, and spicy foods might be helpful if you experience urinary tract discomfort.

Can certain medications cause reactive urothelial cells?

Yes, some medications, like cyclophosphamide, can affect the urothelium and lead to reactive changes. Discuss any concerns about medications with your doctor.

How often should I get a urine cytology if I have had reactive urothelial cells in the past?

Your doctor will determine the appropriate follow-up schedule based on your individual situation. It might involve repeating the cytology periodically to monitor for any changes.

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