Different Treatment Strategies for End Stage Renal Disease in Patients With Transitional Cell Carcinoma

Abstract

Patients with transitional cell carcinoma on dialysis had a higher recurrence rate in the upper urinary tract than patients not on dialysis. Most cases were at an early stage but with high grade tumor behavior. In 11 patients (36.7%) total exenteration of the urinary tract except the urethra was eventually done. The final bilateral nephroureterectomy rate was 56.7%. Since the rate of total exenteration and bilateral nephrectomy was abnormally high at such a short followup, 1-step bilateral nephroureterectomy and radical cystectomy are a recommended treatment for patients with transitional cell carcinoma on dialysis.

Long-term outcome of radical cystectomy in ESDR patients with bladder urothelial carcinoma

“…In our ESRD patients with recurrent or invasive bladder urothelial carcinoma, these patients have high risk of combined with UUT-urothelial caicinoma (86.7%), and bilateral site cancer patients were even more than unilateral site cancer patients (71.8 vs. 28.2%).Previous studies have indicated that toxic nephropathies, uremic immune suppression, dialysis procedure, and primary kidney diseases are the pathogenic conditions for the development of urothelial carcinoma in patients on dialysis [13]. Wu et al reported that dialysis patients with UUTurothelial caicinoma have a higher rate of recurrence and metachronous tumors, or even multiple, early synchronous tumor characteristics that may be missed by imaging [14].…”

Screening, Diagnosis, and Treatment of Cancer in Long-Term Dialysis Patients

“…One study that addressed different treatment strategies for patients with ESRD and transitional cell cancers suggested that dialysis patients have higher recurrence rates of upper urinary tract cancers than nondialysis patients (51). These authors therefore recommended one-step bilateral nephroureterectomy and radical cystectomy in dialysis patients with transitional cell carcinoma (51). Precise recommendations for treating dialysis patients with cancer can be made only when data on prognosis become available; the lack of clinical trials in this population precludes definitive recommendations.…”

“…The sparse available literature suggests that dialysis patients should not be denied usual treatments for lung cancer. One study that addressed different treatment strategies for patients with ESRD and transitional cell cancers suggested that dialysis patients have higher recurrence rates of upper urinary tract cancers than nondialysis patients (51). These authors therefore recommended one-step bilateral nephroureterectomy and radical cystectomy in dialysis patients with transitional cell carcinoma (51).…”

Higher risk of urothelial carcinoma in the upper urinary tract than in the urinary bladder in hemodialysis patients

“…They also emphasized the risk of UTUC in patients with uremia. 20 With regards to the etiology of UTUC, the reported risk factors include the use of herbal remedies (aristolochic acid; AA), analgesics (phenacetin and nonsteroidal anti-inflammatory drugs), heavy metals (arsenic), and tobacco smoking. 21 AA is thought to be the underlying cause of Chinese herbal nephropathy, which is a rapidly progressive interstitial fibrotic renal disease that frequently results in urothelial malignancies.…”