Familial Transitional Cell Carcinoma Among the Population of Iceland

Sexual dimorphism in bladder cancer: a review of etiology, biology, diagnosis, and outcomes

Bladder carcinoma represents a prevalent malignancy, wherein the influence of sex extends across its incidence, biological attributes, and clinical outcomes. This scholarly exposition meticulously examines pertinent investigations, elucidating the nuanced impact of sex on bladder cancer, and posits cogent avenues for future research and intervention modalities. In the initial discourse, an exhaustive scrutiny is undertaken of the etiological underpinnings of bladder cancer, encompassing variables such as tobacco consumption, occupational exposures, and genetic aberrations. Subsequently, a comprehensive dissection unfolds, delving into the intricate biological disparities inherent in sex vis-à-vis the initiation and progression of bladder cancer. This analytical framework embraces multifaceted considerations, spanning sex hormones, sex chromosomal dynamics, metabolic enzymatic cascades, and the intricate interplay with the microbiome. Lastly, a synthesized exposition encapsulates the ramifications of gender differentials on the diagnostic and prognostic landscapes of bladder cancer, underscoring the imperative for intensified investigative endeavors directed towards elucidating gender-specific variances and the formulation of tailored therapeutic strategies.

Inherited forms of bladder cancer: a review of Lynch syndrome and other inherited conditions

Environmental factors that play a role in the urothelial carcinogenesis have been well characterized. Current research is continuously exploring potential heritable forms of bladder cancer. Lynch syndrome is a well-known inheritable disease that increases the risk for a variety of cancers, including urothelial carcinomas. Screening of patients with known Lynch syndrome is important to evaluate for development of new primary tumors. Further study may provide more information on what level of follow-up each patient needs. Recent data suggest that mismatch repair mutations confer a greater risk for urothelial cancer. Additional large patient series as well as advancement of molecular testing may provide triage for Lynch syndrome patients in regards to the frequency and type of screening best suited for individual patient.

Family history of cancer and the risk of bladder cancer: A case-control study from Italy

BACKGROUND

A family history of bladder cancer has been associated with the risk of bladder cancer, but quantification of the excess risk in different populations is still a relevant issue. Further, the role of a family history of other cancers on the risk of bladder cancer remains unclear.

METHODS

We analyzed data from an Italian case-control study, including 690 bladder cancer cases and 665 hospital controls. Odds ratios (ORs) were estimated through unconditional logistic regression models, adjusted for sex, age, study center, year of interview and further for education, smoking and sibling's number.

RESULTS

The OR for family history of bladder cancer was 2.13 (95% confidence intervals (95%CIs) 1.02-4.49) from the model with partial adjustment, and 1.99 (95%CI 0.91-4.32) after additional adjustment for smoking and siblings' number, based on 23 cases (3.3%) and 11 controls (1.7%) with a family history of bladder cancer. The fully adjusted OR was 3.77 when the relative was diagnosed at age below 65years. Smokers with a family history of bladder cancer had a four-fold increased risk compared to non-smokers without a family history. Bladder cancer risk was significantly increased among subjects with a family history of hemolymphopoietic cancers (OR=2.97, 95%CI 1.35-6.55). Family history of cancer at other sites showed no significant association with bladder cancer risk.

CONCLUSION

This study confirms an approximately two-fold increased risk of bladder cancer for family history of bladder cancer, and indicates a possible familial clustering of bladder cancer with cancers of the hemolymphopoietic system.

[Urothelial tumors in children]

Urothelial tumors are very rare in children (to date, only about 150 cases have been reported worlwide). Only 20% occur before the age of ten. The aim of this study is to specify the clinicopathologic features of urothelial tumor in young patients, which require a slightly different approach to treatment. On the basis of the WHO/ISUP (World Health Organisation/International Society of Urological Pathology) consensus classification report, these lesions are usually low-grade lesions, non invasive, and rarely recurrent. The sex ratio is three boys to one girl. These tumors are located preferentially in the low urinary tract, especially in the bladder. The main symptom is the macroscopic hematuria, which requires ultrasound examination in all cases. Cystoscopy is indicated in case of lesion of the bladder wall, or in case of persistent or recurrent hematuria, to obtain definitive diagnosis and biopsies. The tumors are mainly located on the posterior or lateral bladder wall above the trigone or near the ureteral orifices. Treatment is based on the transurethral resection of the lesion. The subsequent monitoring is sparsely codified, due to the exceptional occurrence of these tumors in the paediatric age group. These patients are likely to have better outcome than older patients, but it is due to the predominance of noninvasive papillary urothelial tumors. Tumor recurrences are not uncommon. In case of invasive, high-grade urothelial carcinomas, metastases or even lethal outcome may occur in rare cases.

Urothelial carcinoma of the urinary bladder in pediatric patients: a long-term follow-up

OBJECTIVES

To report our experience and long-term follow-up data on pediatric patients with urothelial carcinoma (UC) of the urinary bladder.

METHODS

In this retrospective study, perioperative and long-term follow-up data of nine pediatric patients with neoplasms of urothelial origin within the urinary bladder between 1980 and 2014 were analyzed. Cystoscopy was performed under general anesthesia, and transurethral resection of the bladder tumors was carried out in the same session. Adult follow-up protocols were used for all patients.

RESULTS

Urothelial carcinoma of the urinary bladder was histologically verified in five male (66%) and three female (33%) patients. In one patient, papillary urothelial neoplasm of low malignant potential was detected. Median patient age at the time of diagnosis was 12 years (4-18 years). Mean tumor size was 2.2 cm (1.5-4 cm). After a median follow-up of 60 months (10-121 months), no recurrence was observed among our patients.

CONCLUSION

Urothelial carcinoma of the urinary bladder in pediatric patients is a rare condition. Due to lack of substantial data, it is difficult to establish tailored management strategies. Most patients present with low-grade, low-stage disease. Being the most common symptom, macroscopic hematuria should be clarified with cystoscopy in pediatric age group.

Urothelial neoplasms of the urinary bladder occurring in young adult and pediatric patients: a comprehensive review of literature with implications for patient management

Bladder urothelial carcinoma is typically a disease of older individuals and rarely occurs below the age of 40 years. There is debate and uncertainty in the literature regarding the clinicopathologic characteristics of bladder urothelial neoplasms in younger patients compared with older patients, although no consistent age criteria have been used to define "younger" age group categories. Use of the World Health Organization 2004/International Society of Urological Pathology 1998 grading nomenclature and recent molecular studies highlight certain unique features of bladder urothelial neoplasms in young patients, particularly in patients below 20 years of age. In this meta-analysis and review, the clinical, pathologic, and molecular features and risk factors of bladder urothelial neoplasms in patients 40 years or less are presented and analyzed according to decades of presentation. Similar to older patients, bladder urothelial neoplasms in patients 40 years or younger occur more common in male patients, present mainly with gross painless hematuria, and are more commonly located at bladder trigone/ureteral orifices, but in contrast have a greater chance for unifocality. Delay in diagnosis of bladder urothelial neoplasms seems not to be uncommon in younger patients probably because of its relative rarity and the predominance of benign causes of hematuria in this age group causing hesitancy for an aggressive work-up. Most tumors in patients younger than 40 years were low grade. The incidence of low-grade tumors was the lowest in the first 2 decades of life, with incremental increase of the percentage of high-grade tumors with increasing age decades. Classification according to the World Health Organization 2004/International Society of Urological Pathology grading system identified papillary urothelial neoplasms of low malignant potential to be relatively frequent among bladder tumors of young patients particularly in the teenage years. Similar to grade, there was marked predominance of low stage tumors in the first 2 decades of life with gradual inclusion of few higher stage and metastatic tumors in the 2 older decades. Bladder urothelial neoplasms occurring in patients <20 years of age lack or have a much lower incidence of aberrations in chromosome 9, FGFR3, p53, and microsatellite instability and have fewer epigenetic alterations. Tumor recurrence and deaths were infrequent in the first 2 decades and increased gradually in each successive decade, likely influenced by the increased proportion of higher grade and higher stage tumors. Our review of the literature shows that urothelial neoplasms of the bladder occurring in young patients exhibit unique pathologic and molecular features that translate to its more indolent behavior; this distinction is most pronounced in patients <20 years. Our overall inferences have potential implications for choosing appropriate noninvasive diagnostic and surveillance modalities, whenever feasible, and for selecting suitable treatment strategies that factor in quality of life issues vital to younger patients.

Hereditary bladder cancer

First degree relatives of patients with bladder cancer have a two-fold increased risk of bladder cancer but high-risk bladder cancer families are extremely rare. There is no clear Mendelian inheritance pattern that can explain the increased familial risk. This makes classical linkage studies for the mapping of susceptibility genes impossible. The disease is probably caused by a combination of exposure to exogenous carcinogens and a large number of susceptibility genes with modest effects. Genome-wide association studies are better suited to identify these genes. Three such studies are currently underway and are expected to report their results in 2008.

Familial and genetic risk of transitional cell carcinoma of the urinary tract

Environmental exposures, including tobacco smoke and occupational exposure to aromatic amines, have been implicated in bladder cancer etiology. However, the pathogenesis of urinary bladder transitional cell carcinoma remains incompletely defined. In epidemiologic studies, family history confers a 2-fold increase in bladder cancer risk, but it is uncertain whether this represents evidence of a genetic and/or a shared environmental basis for familial aggregation. Polymorphisms in genes involved in the metabolism of environmental toxins (e.g., NAT2) clearly modify individual susceptibility to bladder cancer. A genetic predisposition has also been suggested by case reports describing multiple-case families, and the development of bladder cancer in association with several well-described Mendelian disorders (e.g., HNPCC, retinoblastoma). Here we update a previously reported family, report a new multiple-case kindred, critically review previously reported bladder cancer families, and the epidemiologic literature related to family history of transitional cell carcinoma of the urinary tract (TCCUT) as a risk factor, as well as provide a brief summary of genetic factors that have been implicated in TCCUT risk. We conclude that familial TCCUT is either very uncommon or significantly under-reported, perhaps on the assumption that this is an environmental rather than a genetic disorder. The interaction between multiple genetic and environmental factors has made it challenging to identify genetic components responsible for many common diseases; therefore, a proposed genome-wide association study (GWAS) for urinary bladder cancer may help to clarify the etiologic role of the candidate genetic pathways reviewed here, as well as characterize gene/environment interactions that contribute to TCCUT carcinogenesis.

Bladder cancer risk as modified by family history and smoking

BACKGROUND

The familial risk of bladder cancer (BC) is not well understood and, to date, little attention has been paid to the joint effect of smoking and family history in modifying the risk of BC. The authors investigated the role of family history in association with the risk of BC.

METHODS

Case and control probands were identified as part of an on-going BC case-control study. The relative risk associated with a family history of BC was estimated.

RESULTS

In total, 713 cases and 658 controls were included. In a case-control analysis, compared with individuals who never smoked and who had no family history of BC, probands who had smoked and who also had a positive family history were at 5.31-fold increased risk of BC (P for interaction = .04). The 713 case probands and the 658 controls reported 5160 and 4816 first-degree relatives, respectively. Compared with never-smoking relatives who had probands diagnosed with BC at an older age (age >65 years), ever-smoking relatives who had probands diagnosed at a younger age (ages 40-65 years) showed a 6.89-fold (95% confidence interval, from 2.25-fold to 21.12-fold) increased risk. Similar results were obtained for the joint effects of family history of BC and smoking. CONCLUSIONS. The current results indicated that a positive family history of BC may have interacted with smoking habits to increase the risk of BC in the study population.

Segregation analysis of urothelial cell carcinoma

A family history of urothelial cell carcinoma (UCC) confers an almost two-fold increased risk of developing UCC. It is unknown whether (part of) this aggregation of UCC has a Mendelian background. We performed complex segregation analyses on 1193 families ascertained through a proband with UCC of the bladder, ureter, renal pelvis or urethra, who were newly diagnosed between January 1, 1995 and December 31, 1997 and registered by two population-based cancer registries in the southeastern part of the Netherlands. Data were reported on 10 738 first-degree relatives by postal questionnaire; 101 of these relatives had UCC. All reported occurrences of UCC were verified (if possible) using medical records. Analyses were performed with the S.A.G.E. segregation package. Five restricted models (Mendelian dominant, Mendelian recessive, Mendelian co-dominant, 'no major gene' model and environmental model) were tested against the general unrestricted model. Sex and smoking status were incorporated as covariates. Strong evidence of Mendelian inheritance of UCC through a single major gene was not found in these 1 193 families. However, since none of the Mendelian models could be rejected, an inherited subtype of UCC cannot be excluded. A major gene may segregate in some families but this effect may have been masked in a background of high sporadic incidence. The 'no major gene' (or sporadic) model appeared to be the most parsimonious one to describe the occurrence of UCC in these families.

Bladder cancer: epidemiology, diagnosis, and management

PURPOSE

The purpose of this article is to present an overview of the epidemiology diagnosis, and management of bladder cancer, with a focus on the early stage of this disease.

OVERVIEW

English-language articles published between 1990 and 2000, as well as selected abstracts published in non-English languages before 1990, were reviewed. Epidemiologic data clearly indicate that bladder cancer is much more common in men, White persons, and the elderly. Cigarette smoking appears to be the most significant environmental risk factor. Screening for the disease is currently not standard in the United States or Canada. Potential tests include urine cytology, hematuria dipstick, and the urinary biomarkers. Diagnosis is made most often on the basis of the findings of cystoscopy, tumor biopsy, and urine cytology. Transurethral resection (TUR) of the tumor is generally the first-line treatment for superficial disease. Cystectomy is the "gold standard" treatment for invasive disease in many countries, although trimodality therapy (TUR, radiation, systemic chemotherapy) has shown promise as a bladder-preserving strategy. Intravesical therapy is effective for preventing disease recurrence, although its role in slowing disease progression is uncertain. Chemotherapy and radiation also can be used with cystectomy to treat or prevent pelvic recurrence of invasive disease or to prolong life in patients with metastatic disease.

CLINICAL IMPLICATIONS

Bladder cancer is a commonly occurring disease. Prevention efforts must focus on the avoidance or cessation of cigarette smoking and on public education relating to known environmental risk factors. Patient and disease factors must be considered in making treatment decisions and determining prognosis. Careful follow-up after treatment is essential. It is hoped that ongoing research on potential tumor markers and tumor-specific therapies ultimately will result in improved clinical outcomes for patients with this malignancy.

Familial aggregation of urothelial cell carcinoma

Urothelial cell carcinoma (UCC) is not considered to be a familial disease. Familial clustering of UCC was described in several case reports, however, some with an extremely early age at onset suggesting a genetic component. Epidemiological studies yielded inconsistent evidence of familial UCC, possibly because of low power and the inability to adjust for strong confounding. In our study the existence of a familial subtype of UCC was evaluated, as well as familial clustering of UCC with other types of cancer. A population-based family case-control study was performed including patients newly diagnosed with UCC of the bladder, ureter, renal pelvis or urethra, between January 1995 and December 1997, in the southeastern part of the Netherlands. Information on the patients' first-degree relatives was collected by postal questionnaire and subsequent telephone calls. The patients' partners filled out a similar questionnaire on their relatives. All reported occurrences of UCC were verified using medical records. Disease occurrence among case-relatives and control-relatives was compared to obtain the familial risk. Random effect proportional hazards regression analyses were used to calculate this familial risk while adjusting for age, gender and smoking behavior. In 95 families of the 1,193 patients and in 36 families of the 853 partners at least 1 relative was diagnosed with UCC. This yielded an adjusted hazard ratio (HR) of 1.8 (95% CI: 1.3-2.7). An increased risk was also found for cancer of the hematolymphopoietic system (hazard ration = 1.9, 95% CI: 1.2-3.1) among case-relatives. These results indicate that UCC has a familial component with an almost 2-fold increased risk among first-degree relatives of patients with UCC, which cannot be explained by smoking. Future segregation analyses may indicate whether this clustering can be attributed to genetic susceptibility.

Absence of karyotype abnormalities in patients with familial urothelial cell carcinoma

OBJECTIVES

In a previous pilot study, a constitutional balanced translocation t(5;20)(p15;q11) was identified in a family with urothelial cell carcinoma (UCC). The purpose of this study was to find (additional) constitutional chromosomal abnormalities in selected families to obtain an indication for genome location(s) of UCC susceptibility gene(s).

METHODS

UCC families were selected through an ongoing study on familial clustering of UCC, the largest study on this subject ever performed. This study included 1193 new patients with UCC of the bladder, ureter, and renal pelvis, identified from the population-based cancer registries of the Dutch Comprehensive Cancer Centers East and South. Information on demographic factors, smoking habits, and family history of UCC was collected by postal questionnaires. UCC in the families was verified with pathology reports. Thirty families were selected in which 2 or 3 individuals were affected, preferably diagnosed at a relatively young age. Blood samples were obtained from all probands, and routine cytogenetic analysis was performed on 23 male and 7 female UCC patients. Subsequent spectral karyotyping was performed in 4 patients from families, which were most suggestive for an inherited etiology.

RESULTS

No aberrant chromosomal features were found by either classical or spectral karyotype analyses.

CONCLUSIONS

It is conceivable that genetic germline abnormalities do exist in the patients in our study but are below the detection limit of the explorative methods used in this study.

Molecular mechanisms and pathways in bladder cancer development and progression

BACKGROUND

The basis for bladder cancer development and progression is complex and involves genetic abnormalities. These abnormalities yield phenotypic changes that allow normal transitional cells to become cancerous and finally acquire the "malignant phenotype."

METHODS

The authors review the most common genetic alterations in bladder cancer and the molecular mechanisms and pathways involved in the conversion of normal transitional cell into malignant transitional cancer cells.

RESULTS

There are several potential genetic changes of the urothelium that eventually cause bladder cancer initiation and tumor progression. Some of these alterations are also found in other malignancies suggesting that key common pathways exist in the development of cancer.

CONCLUSIONS

As the roles of certain genes or proteins are further elucidated, a better understanding of cancer development can aid in the prevention, diagnosis, and treatment of bladder cancer.