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Epidemiology and Presentation

  • Muhammad S. Choudhury
Chapter

Abstract

Upper Urinary Tract (UUT) urothelial malignancy, a relatively uncommon urologic cancer, is defined as a neoplastic growth affecting the urothelial lining of the renal pyelocalyceal system and the ureter and likely represent a “field defect”, in that the entire urothelium is exposed to carcinogen and susceptible to malignant transformation (Sagalowsky in Campbell-Walsh Urology. Saunders Elsevier, Philadelphia, PA, 2011 [13]). Like patients with bladder transitional cell cancer, patients with UUT transitional cell cancer, have a similar age, sex, and race distribution in that the majority of the patients are older than 60 years, male and caucasian (David et al. in Cancer 1:1435–47, 2009 [1]). They also share some of the same risk factors such as smoking and occupational carcinogen exposure but UUT urothelial malignancy have some unique risk factors of its own, for example, being part of certain genetic syndrome and exposure to Aristolochic Acid (Colin et al. in BJU Int. 104:1436–40, 2009 [19]). In this chapter, the epidemiology, presentation and risk factors for upper urinary tract urothelial malignancy are discussed.

Keywords

Upper urinary tract cancer Epidemiology Hematuria Lynch syndrome Smoking Aristolochic acid Analgesic abuse Bladder cancer 

Notes

Acknowledgements

Author acknowledges the contribution of Michael Stern, MD, Westchester Medical Health Network, New York Medical College, Valhalla, NY and thanks him for his helpful comments and feedback.

References

  1. 1.
    David KA, Mallin K, Milowsky MI, et al. Surveillance of urothelial carcinoma: stage and grade migration, 1993–2005 and survival trends, 1993–2000. Cancer. 2009;115(7):1435–47.PubMedCrossRefGoogle Scholar
  2. 2.
    Munoz JJ, Ellison LM. Upper tract urothelial neoplasms: incidence and survival during the last 2 decades. J Urol. 2000;164(5):1523–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Raman JD, Messer J, Sielatycki JA, et al. Incidence and survival of patients with carcinoma of the ureter and renal pelvis in the USA, 1973–2005. BJU Int. 2011;107(7):1059–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Margulis V, Shariat SF, Matin SF, Kamat AM, et al. Outcomes of radical nephroureterectomy: a series from the upper tract urothelial carcinoma collaboration. Cancer. 2009;115(6):1224–33.PubMedCrossRefGoogle Scholar
  5. 5.
    Jeldres C, Sun M, Lughezzani G, et al. Highly predictive survival nomogram after upper urinary tract urothelial carcinoma. Cancer. 2010;116(16):3774–84.PubMedCrossRefGoogle Scholar
  6. 6.
    Ressequie LT, Nobrega FT, Farrow GM, et al. Epidemiology of renal and ureteral cancer in Rochester, Minnesota, 1950–1974, with special reference to clinical and pathologic features. Mayo Clin Proc. 1978;53(8):503–10.Google Scholar
  7. 7.
    Murphy DM, Zincke H, Furlow WL. Management of high grade transitional cell cancer of the upper urinary tract. J Urol. 1981;125(1):25–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Guinan P, Vogelzang NJ, Randazzo R, et al. Renal pelvic cancer: a review of 611 patients treated in Illinois 1975–1985. Cancer incidence and end results committee. Urology. 1992;40(5):393–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Raabe NK, Fossa SD, Bjerkehagen B. Carcinoma of the renal pelvis. Scand J Urol Nephrol. 1992;26(4):357–61.PubMedCrossRefGoogle Scholar
  10. 10.
    Babaian RJ, Johnson DE. Primary carcinoma of the ureter. J Urol. 1980;123(3):357–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Richie JP. Carcinoma of the renal pelvis and ureter. In: Skinner DG, Lieskovsky G, editors. Diagnosis and management of genitourinary cancer. Philadelphia: WB Saunders; 1988. p. 323–36.Google Scholar
  12. 12.
    Melamed MR, Reuter VE. Pathology and staging of urothelial tumors of the kidney and ureter. Urol Clin North Am. 1993;20(2):333–47.PubMedGoogle Scholar
  13. 13.
    Sagalowsky AI, Jarrett TW, Flanigan RC. Urothelial tumors of the upper urinary tract and ureter. In: Wein AJ, editor. Campbell-Walsh urology. 10th ed. Philadelphia, PA: Saunders Elsevier; 2011 (Chapter 53).Google Scholar
  14. 14.
    Hall MC, Womack S, Sagalowsky AI, et al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30 year experience in 252 patients. Urology. 1998;52(4):594–601.PubMedCrossRefGoogle Scholar
  15. 15.
    Mork M, Hubosky SG, Roupret M, et al. Lynch syndrome: a primer for urologists and panel recommendations. J Urol. 2015;194(1):21–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Barrow P, Khan M, Lalloo F, Evans DG, et al. Systematic review of the impact of registration and screening on colorectal cancer incidence and mortality in familial adenomatous polyposis and Lynch syndrome. Br J Surg. 2013;100(13):1719–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Crockett DG, Wagner DG, Holmang S, et al. Upper urinary tract carcinoma in Lynch syndrome cases. J Urol. 2011;185(5):1627–30.PubMedCrossRefGoogle Scholar
  18. 18.
    Hubosky SG, Boman BM, Charles S, et al. Ureteroscopic management of upper tract urothelial carcinoma (UTUC) in patients with Lynch Syndrome (hereditary nonpolyposis colorectal cancer syndrome). BJU Int. 2013;112(6):813–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Colin P, Koenig P, Ouzzane A, et al. Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract. BJU Int. 2009;104(10):1436–40.PubMedCrossRefGoogle Scholar
  20. 20.
    McLaughlin JK, Silverman DT, Hsing AW, et al. Cigarette smoking and cancers of the renal pelvis and ureter. Cancer Res. 1992;52(2):254–7.PubMedGoogle Scholar
  21. 21.
    Mazeman E. Tumors of the upper excretory urinary tract, calices, renal pelvis and ureter. J Urol Nephrol (Paris). 1972;78(Suppl. 9):1–219.Google Scholar
  22. 22.
    Bamias G, Boletis J. Balkan nephropathy: evolution of our knowledge. Am J Kidney Dis. 2008;52(3):606–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Tatu CA, Orem WH, Finkelman RB, et al. The etiology of Balkan endemic nephropathy: still more questions than answers. Environ Health Perspect. 1998;106(11):689–700.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Petkovic SD. Epidemiology and treatment of renal pelvic and ureteral tumor. J Urol. 1975;114(6):858–65.PubMedCrossRefGoogle Scholar
  25. 25.
    Grollman AP, Shibutani S, Moriya M, et al. Aristolochic acid and the etiology of endemic (Balkan) nephropathy. Proc Natl Acad Sci USA. 2007;104(29):12129–34.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Markovic N, Ignjatovic I, Cukuranovic R, et al. Decreasing incidence of urothelial cancer in a Balkan endemic nephropathy region in Serbia. a surgery based study from 1969 to 1998. Pathol Biol (Paris). 1969;53(1):26–9.CrossRefGoogle Scholar
  27. 27.
    Radovanovic Z, Krajinovic S, Jankovic S, et al. Family history of cancer among cases of upper urothelial tumours in the Balkan nephropathy area. J Cancer Res Clin Oncol. 1985;110(2):181–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Cosyns JP. Aristolochic acid and ‘Chinese herbs nephropathy’: a review of the evidence to date. Drug Saf. 2003;26(1):33–48.PubMedCrossRefGoogle Scholar
  29. 29.
    Nortier JL, Vanherwegham JL. Renal interstitial fibrosis and urothelial carcinoma associated with the use of Chinese herb (Aristolochia fangchi). Toxicology. 2002;27(181–182):577–80.CrossRefGoogle Scholar
  30. 30.
    Gillerot G, Jadoul M, Arlt VM, et al. Aristolochic acid nephropathy in a Chinese patient: time to abandon the term “Chinese herbs nephropathy”? Am J Kidney Dis. 2001;38(5):E26.PubMedCrossRefGoogle Scholar
  31. 31.
    Cosyns JP, Jadoul M, Squifflet JP, et al. Chinese herbs nephropathy: a clue to Balkan endemic nephropathy? Kidney Int. 1994;45(6):1680–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Reginster F, Jadoul M, van Ypersele de Strihou C. Chinese herbs nephropathy presentation, natural history and fate after transplantation. Nephrol Dial Transplant. 1997;12(1):81–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Nortier JL, Martinez MC, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb (Aristolochia fangchi). N Engl J Med. 2000;342(23):1686–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Dickman KG, Fritsche HM, Grollman AP, et al. Epidemiology and risk factors for upper urinary urothelial cancers. In: Shariat SF, Xylinas E, editors. Upper tract urothelial carcinoma. New York: Springer Science & Business Media; 2015. p. 1–30 (Chapter 1).Google Scholar
  35. 35.
    National Toxicology Program. Aristolochic acids. Rep Carcinog. 2011;12:45–9.Google Scholar
  36. 36.
    IARC. Plants containing aristolochic acid. IARC Monogr Eval Carcinog Risk Chem Hum. 2012;100A:347–61.Google Scholar
  37. 37.
    Lai MN, Wang SM, Chen PC, et al. Population-based case-control study of Chinese herbal products containing aristolochic acid and urinary tract cancer risk. J Natl Cancer Inst. 2010;102(3):179–86.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Tan LB, Chen KT, Guo HR. Clinical and epidemiological features of patients with genitourinary tract tumour in a blackfoot disease endemic area of Taiwan. BJU Int. 2008;102(1):48–54.PubMedCrossRefGoogle Scholar
  39. 39.
    Yang MH, Chen KK, Yen CC, et al. Unusually high incidence of upper urinary tract urothelial carcinoma in Taiwan. Urology. 2002;59(5):681–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Chen CH, Dickman KG, Huang CY, et al. Aristolochic acid-induced upper tract urothelial carcinoma in Taiwan: clinical characteristics and outcome. Int J Cancer. 2013;133(1):14–20.PubMedCrossRefGoogle Scholar
  41. 41.
    Spuhler O, Zollinger HU. Chronic interstitial nephritis. Z Klin Med. 1953;151(1):1–50.PubMedGoogle Scholar
  42. 42.
    Hultengren N, Lagergren C, Ljungqvist A. Carcinoma of the renal pelvic in renal papillary necrosis. Acta Chir Scand. 1965;130(4):314–20.PubMedGoogle Scholar
  43. 43.
    Nanra RS. Renal effects of antipyretic analgesics. Am J Med. 1983;75(5A):70–81.PubMedCrossRefGoogle Scholar
  44. 44.
    Prescott LF. Analgesic nephropathy: a reassessment of the role of phenacetin and other analgesics. Drugs. 1982;23(1–2):75–149.PubMedCrossRefGoogle Scholar
  45. 45.
    McCredie M, Stewart JH, Carter JJ, et al. Phenacetin and papillary necrosis: independent risk factors for renal pelvic cancer. Kidney Int. 1986;30(1):81–4.PubMedCrossRefGoogle Scholar
  46. 46.
    McCredie M, Stewart J, Smith D, et al. Observations on the effect abolishing analgesic abuse and reducing smoking on cancers of the kidney and bladder in New South Wales, Australia, 1972–1995. Cancer Causes Control. 1999;10(4):303–11.PubMedCrossRefGoogle Scholar
  47. 47.
    McCredie M, Stewart JH, Mathew TH, et al. The effect of withdrawal of phenacetin-containing analgesics on the incidence of kidney and urothelial cancer and renal failure. Clin Nephrol. 1989;31(1):35–9.PubMedGoogle Scholar
  48. 48.
    IARC. Phenacetin. IARC Monogr Eval Carcinog Risk Chem Hum. 2012;100A:377–98.Google Scholar
  49. 49.
    Rabbani F, Perrotti M, Russo P, et al. Upper-tract tumors after an initial diagnosis of bladder cancer: argument for long-term surveillance. J Clin Oncol. 2001;19(1):94–100.PubMedCrossRefGoogle Scholar
  50. 50.
    Herr HW. Extravesical tumor relapse in patients with superficial bladder tumors. J Clin Oncol. 1998;16(3):1099–102.PubMedCrossRefGoogle Scholar
  51. 51.
    Solsona E, Iborra I, Ricos JV, et al. Upper urinary tract involvement in patients with bladder carcinoma in situ (Tis): its impact on management. Urology. 1997;49(3):347–52.PubMedCrossRefGoogle Scholar
  52. 52.
    Millan-Rodriguez F, Chechile-Toniolo G, Salvador-Bayarri J, et al. Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol. 2000;164(4):1183–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Canales BK, Anderson JK, Premoli J, et al. Risk factors for upper tract recurrence in patients undergoing long-term surveillance for stage Ta bladder cancer. J Urol. 2006;175(1):74–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Hurle R, Losa A, Manzetti A, et al. Upper urinary tract tumors developing after treatment of superficial bladder cancer: 7-year follow-up of 591 consecutive patients. Urology. 1999;53(6):1144–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Wright JL, Hotaling J, Porter MP. Predictors of upper tract urothelial carcinoma after primary bladder cancer: a population based analysis. J Urol. 2009;181(3):1035–9.PubMedCrossRefGoogle Scholar
  56. 56.
    Oldbring J, Glifberg I, Mikulowski P, et al. Carcinoma of the renal pelvis and ureter following bladder carcinoma: frequency, risk factors and clinicopathological findings. J Urol. 1989;141(6):1311–3.PubMedCrossRefGoogle Scholar
  57. 57.
    Herr HW, Cookson MS, Soloway SM. Upper tract tumors in patients with primary bladder cancer followed for 15 years. J Urol. 1996;156(4):1286–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Sanderson KM, Cai J, Miranda G, et al. Upper tract urothelial recurrence following radical cystectomy for transitional cell carcinoma of the bladder: an analysis of 1069 patients with 10-year follow up. J Urol. 2007;177(6):2088–94.PubMedCrossRefGoogle Scholar
  59. 59.
    Tran W, Serio AM, Raj GV, et al. Longitudinal risk of upper tract recurrence following radical cystectomy for urothelial cancer and the potential implications for long-term surveillance. J Urol. 2008;179(1):96–100.PubMedCrossRefGoogle Scholar
  60. 60.
    Furukawa J, Miyake H, Hara I, et al. Upper urinary tract recurrence following radical cystectomy for bladder cancer. Int J Urol Off Jpn Urol Assoc. 2007;14(6):496–9.Google Scholar
  61. 61.
    Meissner C, Giannarini G, Schumacher MC, et al. The efficiency of excretory urography to detect upper urinary tract tumors after cystectomy for urothelial cancer. J Urol. 2007;178(6):2287–90.PubMedCrossRefGoogle Scholar
  62. 62.
    Volkmer BG, Schnoeller T, Kuefer R, et al. Upper urinary tract recurrence after radical cystectomy for bladder cancer—who is at risk? J Urol. 2009;182(6):2632–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Umbreit EC, Crispen PL, Shimko MS, et al. Multifactorial, site-specific recurrence model after radical cystectomy for urothelial carcinoma. Cancer. 2010;116(14):3399–407.PubMedCrossRefGoogle Scholar
  64. 64.
    Takayanagi A, Masumori N, Takahashi A, et al. Upper urinary tract recurrence after radical cystectomy for bladder cancer: incidence and risk factors. Int J Urol Off Jpn Urol Assoc. 2012;19(3):229–33.Google Scholar
  65. 65.
    Novara G, De Marco V, Dalpiaz O, et al. Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract. BJU Int. 2008;101(11):1368–74.PubMedCrossRefGoogle Scholar
  66. 66.
    Raman JD, Ng CK, Boorjian SA, et al. Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology. BJU Int. 2005;96(7):1031–5.PubMedCrossRefGoogle Scholar
  67. 67.
    Matsui Y, Utsunomiya N, Ichioka K, et al. Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract. Urology. 2005;65(2):279–83.PubMedCrossRefGoogle Scholar
  68. 68.
    Kang GH, Yu TJ, Hsieh HH, et al. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer. 2003;98(8):1620–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of UrologyWestchester Medical Health Network/New York Medical CollegeValhallaUSA

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