In this blog we review the risks of subsequent urothelial cancer after a diagnosis of UTUC or bladder cancer.
UTUC after known Bladder CancerConsidering that approximately 300,000 patients have bladder cancer each year in the US, it is estimated that only 2-4% of bladder cancer patients will develop UTUC. However, the relative risk of developing UTUC is approximately 65-75% and highest in the first two years following a diagnosis of bladder cancer. That relative risk decreases to 40-50% but remains stable for more than 10 years following an initial diagnosis.
The risk of developing UTUC does vary with bladder cancer pathology and is highest in patients with:
- carcinoma in situ (CIS) of the bladder [3-5]
- patients with CIS have a higher risk of UTUC than patients with non-invasive cancers
- in patients undergoing radical cystectomy, patients with CIS have a higher risk of UTUC than patients with invasive cancers.
- these cancers are more likely to occur in the distal ureter
- recurrence is more likely if the patient was BCG-refractory
- high-grade tumors
- T1 versus Ta disease
- multifocal tumors
- the presence of ureteral reflux
- tumors located at the trigone or abutting the ureteral orifices [6,7]
Bladder Cancer after UTUC
- UTUC and bladder cancer are related.
- It is more likely for bladder cancer to develop after UTUC than UTUC to develop after bladder cancer.
- For patients with bladder cancer, cis, grade, stage and tumor location(s) increase the risk of recurrence.
- Routine bladder surveillance (cystoscopy and cytology) is recommended for any patient with UTUC due to the high risk of recurrence in the bladder.
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 Takahashi T, Mitsumori K, Kakehi Y,et al: Distinct microsatellite alterations between upper urinary tract tumors and subsequent bladder tumors. J Urol 2000; 163: 549A