Intestinal adenocarcinoma arising in urinary conduits

Abstract

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...

An unusual diverticulum adjacent to two large colonic polyps; a case report

“…The shortest and longest reported latencies are 3 and 53 years respectively [ 3 , 4 ]. Whilst no specific risk factors have been linked to the shorter latency tumours, smoking and tobacco-derived urinary carcinogens might play a role in some cases especially if the diversion has been performed subsequent to bladder cancer resection [ 5 ].…”