Clinical Factors Associated with Urinary Tract Cancer in Individuals with Lynch Syndrome

Wischhusen, Jonathan W.; Ukaegbu, Chinedu; Dhingra, Tara G.; Uno, Hajime; Kastrinos, Fay; Syngal, Sapna; Yurgelun, Matthew B.

doi:10.1158/1055-9965.epi-19-0213

Cited by 11 publications

(12 citation statements)

References 33 publications

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“…7 It is plausible that the increased risks of second ureteral (4.85) and pelvic (1.88) cancers after endometrial cancer were contributed by Lynch syndrome. 10 , 11 The reason for the higher associations of the Lynch syndrome‐related cancers in women compared to men may be due to the lower female population incidence of urothelial cancers, particularly of bladder cancer. The difference in population incidence was probably in part related to historic higher smoking level in men compared to women, as pointed out in Introduction.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 7 , 8 , 9 However, while smoking appears to be the main risk factor for bladder cancer compared to Lynch syndrome, the opposite may be the case for UUT cancers. 10 , 11 Colorectal cancer and endometrial cancers are traditional hallmarks of Lynch syndrome ( www.lscarisk.org ). 12 , 13 Few guidelines to date suggest urological follow‐up with Lynch patients.…”

Section: Introductionmentioning

confidence: 99%

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Bladder and upper urinary tract cancers as first and second primary cancers

Zheng

Sundquist

et al. 2021

Cancer Reports

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Background: Previous population-based studies on second primary cancers (SPCs) in urothelial cancers have focused on known risk factors in bladder cancer patients without data on other urothelial sites of the renal pelvis or ureter.Aims: To estimate sex-specific risks for any SPCs after urothelial cancers, and in reverse order, for urothelial cancers as SPCs after any cancer. Such two-way analysis may help interpret the results. Methods:We employed standardized incidence ratios (SIRs) to estimate bidirectional relative risks of subsequent cancer associated with urothelial cancers. Patient data were obtained from the Swedish Cancer Registry from years 1990 through 2015.Results: We identified 46 234 urinary bladder cancers (75% male), 940 ureteral cancers (60% male), and 2410 renal pelvic cancers (57% male). After male bladder cancer, SIRs significantly increased for 9 SPCs, most for ureteral (SIR 41.9) and renal pelvic (17.2) cancers. In the reversed order (bladder cancer as SPC), 10 individual FPCs were associated with an increased risk; highest associations were noted after renal pelvic (21.0) and ureteral (20.9) cancers. After female bladder cancer, SIRs of four SPCs were significantly increased, most for ureteral (87.8) and pelvic (35.7) cancers. Female bladder, ureteral, and pelvic cancers associated are with endometrial cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bladder and upper urinary tract cancers as first and second primary cancers

Zheng

Sundquist

et al. 2021

Cancer Reports

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“…42 Several studies have identified an increased risk of UUTC based on the specific gene mutation. Wischhusen et al 41 identified an increased preponderance of UUTC in those with a germline abnormality in EPCAM or MSH2 genes. Additional studies of LS-specific databases further confirm the importance of MSH2 gene mutations in UUTC.…”

Section: Upper Urothelial Tract Malignanciesmentioning

confidence: 99%

“…39,40 When evaluating individuals with LS, a family history of urinary tract cancers was strongly predictive for UUTC development. 41 As personal or family history may not be apparent, some authors have recommended reflexive MMR IHC screening followed by MSI testing of patients with UUTC in a similar fashion as for CRC and EC. 42 Several studies have identified an increased risk of UUTC based on the specific gene mutation.…”

Section: Upper Urothelial Tract Malignanciesmentioning

confidence: 99%

When to Consider Lynch Syndrome in Non-Colon and Non-Endometrial Malignancies

Arroyave

Good

Ward

et al. 2021

The American Surgeon™

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Lynch syndrome (LS) is a common genetic syndrome characterized by pathogenic mutations of DNA mismatch repair genes resulting in a hereditary predisposition to cancer. While typically associated with colonic and endometrial cancer, LS additionally influences the development of many other malignancies. The Amsterdam II and Revised Bethesda Guidelines are the established clinical criteria for diagnosing LS. These guidelines are based on the most general characteristics of LS and do not address specific characteristics of the less commonly LS-associated malignancies. For individuals that present initially with a non-colon and non-endometrial malignancy, recommendations and guidelines on when to consider screening for LS are limited. Therefore, it is essential that clinicians are familiar with distinct LS-associated patient- and tumor-specific characteristics, especially of the less common LS-associated cancers, so that LS’s diagnosis is not missed. In this review article, we focus on extra-colonic and extra-endometrial LS-associated cancers, paying particular attention to any established or currently investigated cancer features that help raise suspicion for LS and potentially lead to its earlier diagnosis. This review will also discuss current guidelines specific to each LS-associated malignancy.

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“…UUT cancers show also male excess and share risk factors with bladder cancer, including smoking, occupational exposures, family history and association with Lynch syndrome [ 1 , 6 – 9 ]. However, Lynch syndrome may be a relatively more important risk factor for UUT cancers than for bladder cancer [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Survival in bladder and upper urinary tract cancers in Finland and Sweden through 50 years

et al. 2022

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Survival has improved in bladder cancer but few studies have considered extended periods or covered populations for which medical care is essentially free of charge. We analyzed survival in urothelial cancer (UC, of which vast majority are bladder cancers) in Finland and Sweden over a 50-year period (1967–2016) using data from the NORDCAN database. Finland and Sweden are neighboring countries with largely similar health care systems but higher economic resources and health care expenditure in Sweden. We present results on 1- and 5-year relative survival rates, and additionally provide a novel measure, the difference between 1- and 5-year relative survival, indicating how well survival was maintained between these two periods. Over the 50-year period the median diagnostic age has increased by several years and the incidence in the very old patients has increased vastly. Relative 1- year survival rates increased until early 1990s in both countries, and with minor gains later reaching about 90% in men and 85% in women. Although 5-year survival also developed favorably until early 1990s, subsequent gains were small. Over time, age specific differences in male 1-year survival narrowed but remained wide in 5-year survival. For women, age differences were larger than for men. The limitations of the study were lack of information on treatment and stage. In conclusion, challenges are to improve 5-year survival, to reduce the gender gap and to target specific care to the most common patient group, those of 70 years at diagnosis. The most effective methods to achieve survival gains are to target control of tobacco use, emphasis on early diagnosis with prompt action at hematuria, upfront curative treatment and awareness of high relapse requiring regular cystoscopy follow up.

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Clinical Factors Associated with Urinary Tract Cancer in Individuals with Lynch Syndrome

Cited by 11 publications

References 33 publications

Bladder and upper urinary tract cancers as first and second primary cancers

Bladder and upper urinary tract cancers as first and second primary cancers

When to Consider Lynch Syndrome in Non-Colon and Non-Endometrial Malignancies

Survival in bladder and upper urinary tract cancers in Finland and Sweden through 50 years

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