Urothelial cancer and the diagnosis of subsequent malignancies

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From: Canadian Urological Association Journal(Vol. 7, Issue 1-2)
Publisher: Canadian Urological Association
Document Type: Report
Length: 3,364 words
Lexile Measure: 1500L

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Author(s): Deepak K. Pruthi, MD, Zoann Nugent, PhD, Piotr Czaykowski, MD (corresponding author), Alain A. Demers, PhD


Studies have described the relationship between initial cancer diagnoses and diagnosis of subsequent primaries.1 -4 Multiple primaries, as defined by the International Agency for Research on Cancer (IARC), are those cancers which develop in several primary sites that are not an extension, recurrence nor metastasis of each other. Multiple primaries also include tumours arising from the same site but with different morphologies.5

Urothelial malignancies are unique and encompass cancers of the transitional cell epithelium found in the bladder, renal pelvis, and ureters (or BRPU). Despite a relatively stable incidence rate, urothelial cancers remain among the most frequently diagnosed cancers in Canada.6 This is concerning as bladder cancer, accounting for the vast majority of BPRU cancers, has been highly correlated with the diagnosis of subsequent primary malignancies of other sites.7,8 Indeed, a report using data from Surveillance Epidemiology and End Results (SEER) demonstrated the development of subsequent primary cancers in as many as 16% of bladder cancer patients - the highest percentage of any cancer site (except non-melanoma skin cancer and cancer of the upper aerodigestive tract).9

Urothelial cancers often present multifocally, complicating the ascertainment of second primary malignancies because newly identified BPRU cancers may be new manifestations of the original urothelial cancer (unless they have different histologies). This should be accounted for in calculations.

Knowledge of clustering malignancies should increase the likelihood of early detection of subsequent cancers and ultimately improve patient outcomes. The objective of the present study was to determine the risk of being diagnosed with a second primary malignancy subsequent to the diagnosis of a urothelial cancer, including histopathologic subanalysis. We sought to identify commonly diagnosed specific second primaries and to determine if there was an association by histology, age or sex. Furthermore, because of the frequent co-diagnosis of urinary bladder cancers and prostate cancer, and the fact that prostate-specific antigen (PSA)-screening often detects clinically insignificant prostate cancer, this study examines the risks of second malignancy both including and excluding prostate cancer.


All Manitoban subjects diagnosed with their first BRPU cancer (including bladder cancer in situ) between April 1, 1985 and December 31, 2007 were identified from the population-based Manitoba Cancer Registry. Developed in 1937, the Manitoba Cancer Registry became population-based in 1956. Cancer reporting is mandated by law in Manitoba, Canada, and information on all potential new cases must be forwarded to the Registry. The Manitoba Cancer Registry has been rated highly by the North American Association of Central Cancer Registries.10

The following ICD-10 histopathologic morphology codes were used: papillary transitional cell carcinoma (TCC) (ICD0/3 8130/3), TCC (8120/3), papillary TCC, non-invasive (8130/2), TCC in situ (8120/2) and basaloid carcinoma (8123/3); these make up more than 90% of the BRPU cancers in this study. Both invasive and non-invasive cancers can be papillary in morphology.

Autopsy and death certificate-only diagnoses were excluded from the analysis. Recurrent BPRU cancers or any second primary...

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Gale Document Number: GALE|A327700769