Carcinoma of the colon arising at ureteral implant sites despite early external diversion: Pathogenetic and clinical implications

Abstract

Colon carcinomas develop at the site of implantation in approximately 6% of patients who undergo ureterosigmoidostomy for benign conditions. Generally, the obstruction of a long-functioning ureterosigmoidostomy heralds the presentation of the malignancy. The development of a carcinoma of the colon at the site of the ureteral stump 22 years after conversion to ileal conduit in a ureterosigmoidostomy, which had been in place for only nine months, raises fundamental questions about the pathogenesis of the tumor. The long-assumed role of urine in the induction of these iatrogenic tumors must be questioned. This issue and suggestions for management and prevention are discussed.

Abnormalities of Colonic Mucin Secretion and Metabolic Changes after Internal Urinary Diversion for Bladder Exstrophy

“…It may be that alterations in the mucus, which reflect the metabolic derangement of goblet cells, become relevant only in the presence of factors produced locally at the ureteric sites, perhaps by the ureteric mucosa, which may behave synergically. This view is supported by the observation that after diversion of urine ("dry IUD"), the site of implantation of the ureters may undergo malignant transformation (Schipper and Decter, 1981), thus suggesting that the role of luminal factors is not essential.…”

“…Internal urinary diversion (IUD) is associated with an increased risk of colonic carcinoma. This risk has been assessed with particular reference to ureterosigmoidostomy (Crissey et al, 1980;Stewart et al, 1982;Schwab et al, 1986), but there is growing evidence that other types of IUD (colon conduit, ileal conduit) should also be regarded as pre-neoplastic conditions (Moorcraft et al, 1983;Marchetti etal., 1984; Stone and Stephenson, 1987; Strand and Alfert, 1987). Since IUD is frequently performed in infants and young children as part of a reconstructive procedure of the genitourinary tract, it is important to identify a marker of colonic pre-malignancy.…”

Induction of Carcinoma at Ureterosigmoid Anastomosis–with and without Faecal Stream

“…Some case reports dealing with the induction of tumours after ureterosigmoidostomy pointed out that ureterosigmoidostomy had been converted into another urinary diversion after some time (Eraklis and Folkman, 1978;Schipper and Decter, 1981 ;Uehling et al, 1982;Starling et al, 1984;Schwab et al, 1986;Miersch et al, 1989). If-as mentioned in these cases-ureteric stumps were left in the sigmoid, the missing urine would not influence and prevent the development of neoplasia.…”

Changes in the Mucosa of Colon Conduits with Particular Reference to the Risk of Malignant Change

“…Similarly, the importance of the urine stream must also be questioned following a recent case report of a carcinoma developing at the site of the ureteric stump 22 years after conversion to an ileal conduit of a ureterosigmoidostomy which had only been established for 9 months (Schipper and Decter, 1981).…”