Late malignant change in an ileal conduit

Wielding, Sally; Fineron, Paul; Driscoll, P; Anderson, D. N.

doi:10.1111/j.1442-2042.2007.01930.x

Cited by 5 publications

(4 citation statements)

References 10 publications

(14 reference statements)

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“…The literature prior to 2004 has been summarized by Austen and Kälbe (25). Our literature search yielded four case reports of intestinal adenocarcinoma arising in a urinary conduit created from an isolated segment of intestine since 2004 (46)(47)(48)(49). It seems likely that the overall incidence of such second cancers is increasing.…”

Section: Discussionmentioning

confidence: 99%

Intestinal adenocarcinoma arising in urinary conduits

Moyer

Grubb²,

Johnson

2011

Oncol Rep

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Abstract. It is estimated that >10,000 patients who undergo cystectomy for bladder cancer in the US each year receive a conventional ileal conduit and that >2,000 receive a continent urinary diversion. Case reports of primary intestinal adenocarcinomas in urinary conduits have been published recently, mainly in the urology literature. An epidemic of such cancers in this small, high-risk population seems to be emerging, particularly in conduits that utilize the colon. A case report and literature review was carried out. We describe a patient with a new primary adenocarcinoma arising in a colonic neobladder. We summarize prior literature describing intestinal adenocarcinomas that developed in an intestinal segment used for urinary diversion. Patients with urinary conduits of all types (particularly those utilizing colon rather than ileum) are at high risk of developing a second primary intestinal adenocarcinoma in the conduit. This population is likely to benefit from surveillance measures aimed at detecting such cancers. The primary form of therapy remains adequate surgical resection. General surgeons should be aware of such patients as they may be involved in the diagnosis of, and surgery for, the cancer in the conduit. IntroductionIn 2008, the World Health Organization projected that cancer would become the leading cause of death in the world (1). Carcinoma of the urinary bladder is the ninth most commonly diagnosed type of cancer in the world (2). Over 70,000 people in the US develop this cancer every year (3) and the incidence is projected to increase (4). Comparable data are reported from other wealthy nations (5). In the US and most other countries, tobacco abuse is the main known environmental risk factor for the development of bladder cancer (6-8). The incidence in smokers is estimated to be two to three times as great as the incidence in non-smokers. In countries where S. haematobium is endemic, bladder infestation is the leading cause (2). In river basins draining the Himalayas (e.g., India, Pakistan, Myanmar, Vietnam), the groundwater contains high concentrations of arsenic, which is a major cause of bladder carcinoma (9). Additional known etiologic agents include exposure to certain aromatic amines such as those found in dyes and rubber, the chemotherapeutic agent cyclophosphamide, ionizing radiation, and various textiles and metals (7,10,11).Colorectal carcinoma is the third most commonly diagnosed type of cancer in the world (1). Over 150,000 people in the US develop cancer of the colon or rectum every year (12). Adenomas arising in subjects without known polyposis syndromes are the most common precursor lesion. Hamartomas are also welldescribed precursor lesions, as in Peutz-Jehgers syndrome. Other known causes of colorectal cancer include hereditary polyposis syndromes, Li-Fraumeni syndrome, inflammatory bowel disease, and ionizing radiation (13,14). Charred food and diets high in red meat and low in fiber, fruits and vegetables have been implicated as causative environmental agents (15-17). There...

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Section: Discussionmentioning

confidence: 99%

Intestinal adenocarcinoma arising in urinary conduits

Moyer

Grubb²,

Johnson

2011

Oncol Rep

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“…Mangels eines solchen Krebsregisters kann das Risiko bislang nur durch "case reports" und Tiermodelle [18, 19] abgeschätzt werden. Wenngleich tierexperimentelle Studien ein ähnliches Tumorrisiko kontinenter Harnableitungen mit und ohne Trennung von Stuhl und Urin [18] und ein reduziertes Tumorrisiko unter Verwendung von Ileum [19, 20, 21] nahelegen, können die klinischen Fallberichte dahingehend interpretiert werden, dass Harnableitungen unter Verwendung von Ileum und Kolon [5,9,10,11,12,16,17] ein ähnliches Karzinomrisiko haben und lediglich Zystoplastiken und Ureterosigmoideostomien bezüglich des Karzinomrisikos herausragen [3,4,6,7,8,14,15].Vor diesem Hintergrund wurde vorliegende retrospektive Multicenterstudie initiiert mit dem Ziel, die Häufigkeit sekundärer Tumoren verschiedener Formen der Harnableitung unter Berücksich-tigung der Zahl der bislang durchgeführ-ten Harnableitungen zu vergleichen. …”

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“…Unterschiedlich beurteilt wird bislang das Tumorrisiko in anderen Formen der Harnableitung über isolierte Darmsegmente wie Conduits, Zystoplastiken, kontinente Ersatzblasen und Ileumharnleiterersatz, wonach bislang ca. 100 benigne und maligne Tumoren beobachtet wurden [8,9,10,11,12,13,14,15,16,17].…”

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Sekundärmalignome in Harnableitungen

Kälble

Hofmann

Thüroff

et al. 2012

Urologe

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In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.

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“…Die Frage, ob die etwa 100 publizierten Fallberichte über Tumore in Conduits, Zystoplastiken, Pouches, kontinenten Ersatzblasen und nach Harnleiterersatz ein ähnlich erhöhtes Risiko bedeuten, kann bislang deshalb nicht beantwortet werden, da der Bezug dieser publizierten Fälle zu den tatsächlich operierten jeweiligen Formen der Harnableitung fehlt [7,8,9,10,11,12,13,14,15]. Von 44 großen deutschen Kliniken wurden die Operationsbücher von 1970-2007 ausgewertet.…”

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