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Urinary tract cancer

Last updated: April 28, 2021

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Urinary tract cancer can involve the bladder (most common), renal pelvis, ureters, and urethra (rare). The most common histological type of urinary tract cancer is urothelial cancer; squamous cell carcinoma and adenocarcinoma are encountered rarer. Patients often present with painless gross hematuria or irritative voiding symptoms, although some cases are incidentally detected (microscopic hematuria on urinalysis). Urine cytology, cystoscopy, and CT urography are indicated in all patients with gross hematuria or in patients > 35 years of age with microhematuria and risk factors for urothelial cancer. Nonmuscle invasive bladder tumors are treated with transurethral resection of the tumor and intravesical instillation of BCG or chemotherapeutic agents. Muscle invasive bladder tumors are treated with radical cystectomy and chemotherapy or chemoradiation. Since cancers of the renal pelvis are often multifocal and have a high risk of recurrence, treatment requires nephroureterectomy. Metastatic urothelial cancer is treated with palliative chemotherapy and/or chemoradiation. Close follow-up post-treatment is necessary to identify and treat recurrent disease.

References:[5]

Epidemiological data refers to the US, unless otherwise specified.

A carcinogen ACTS on the bladder: Aniline dye, Cyclophosphamide, Tobacco, Schistosomiasis

References:[1][2][7][8][9]

Clinical features of urinary tract cancer
Location Symptoms Features of advanced/metastatic disease
Bladder carcinoma

Carcinoma of the renal pelvis and ureteral carcinoma

Urethral carcinoma

References:[10][11][12]

Laboratory investigations

Imaging and biopsy

CT urography and cystoscopy are indicated in all patients with gross hematuria and in patients > 35 years with asymptomatic microhematuria; . Physicians may consider cystoscopy and/or CT urography in patients < 35 years with asymptomatic hematuria who also have risk factors for CIS. These procedures enable diagnostic evaluation of the entire urinary tract, as well as follow-up.

Since urothelial tumors can be multifocal, the entire urinary tract must be evaluated!

Staging

References:[10][11][14][15][16][17][18]

Other causes of hematuria and flank pain

References:[14][19]

The differential diagnoses listed here are not exhaustive.

Treatment of urothelial cancers involves surgical resection with neoadjuvant chemotherapy and/or radiation. All cases of metastatic disease are managed with palliative systemic chemotherapy and palliative surgery, if needed (e.g., removal of urethral obstructions).

Bladder cancer

Carcinoma of the renal pelvis and ureters

Urethral carcinoma

Follow-up

  • Follow-up procedures depend on the grade and stage of the tumor.
  • In general, follow-up includes:

References:[21][22][23]

  • 5-year survival of bladder, ureteral, and pelvic cancer is 90–95% for noninvasive disease and ∼ 12% for metastatic disease.
  • Prognosis of urethral cancer is poorer (5-year survival of ∼ 45%).

References:[24]

References:[22]

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  2. Martin JW, Carballido EM, Ahmed A, et al. Squamous cell carcinoma of the urinary bladder: Systematic review of clinical characteristics and therapeutic approaches. Arab Journal of Urology. 2016; 14 (3): p.183-191. doi: 10.1016/j.aju.2016.07.001 . | Open in Read by QxMD
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  9. DeGeorge KC, Holt HR, Hodges SC. Bladder Cancer: Diagnosis and Treatment.. Am Fam Physician. 2017; 96 (8): p.507-514.
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  11. Hematuria. https://www.auanet.org/education/hematuria.cfm. Updated: July 1, 2016. Accessed: February 15, 2017.
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  13. Transitional cell carcinoma (ureter). https://radiopaedia.org/articles/transitional-cell-carcinoma-ureter. Updated: February 15, 2017. Accessed: February 15, 2017.
  14. Transitional cell carcinoma (bladder). https://radiopaedia.org/articles/transitional-cell-carcinoma-bladder. Updated: February 15, 2017. Accessed: February 15, 2017.
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  21. Urachal Cancer. https://rarediseases.org/rare-diseases/urachal-cancer/#general-discussion. . Accessed: January 21, 2021.
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  24. Bladder cancer: Risks and causes. http://about-cancer.cancerresearchuk.org/about-cancer/bladder-cancer/risks-causes. Updated: July 20, 2015. Accessed: March 2, 2017.