Genitourinary Cancer

As there are multiple organs that make up the genitourinary system, the genitourinary cancers are a broad category for the cancers that can arise in any of these organs. They arise as a result of uncontrolled growth and proliferation of the cells that are found in any of these organs.

The types of cancers that arise in the genitourinary system are categorised based on the organ and the cell type from where it begins.

Renal cancer (cancer of the kidney)

In Singapore, renal cancers account for 1 to 2 percent of all cancers. Cancers of the kidney are classified based on the cell type they arise from, as well as their appearance under the microscope. The main cell type of the kidney are the renal cells. Renal cell carcinomas are the most common type of cancers that arise out of the kidney. Also known as renal cell adenocarcinoma, about 9 of 10 renal cancers are of this type. Cancers of the kidney include:

• Renal cell carcinoma (RCC)
  • Clear cell renal cell carcinoma – most common, 70 percent of patients with RCC have this subtype
  • Non-clear cell renal cell carcinoma
    • Papillary renal cell carcinoma – second most common subtype of RCC, makes up 10 percent of RCC
    • Chromophobe renal cell carcinoma – makes up about 5 percent of RCCs
• Transitional cell carcinoma – accounts for about 5 percent of renal cancers. It is also known as urothelial carcinomas, and originates not from the kidney, but the lining of the renal pelvis. The renal pelvis is where the ureters meet the kidney, and the cells lining this area are known as transitional cells. They look less like renal cells, and instead more like the cells of the ureter and bladder.
• Wilm’s tumour – also known as nephroblastoma, these tumours arise in children and rarely in adults.
• Renal sarcoma – a rare type of cancer of the kidney, sarcomas arise from the blood vessels and connective tissue of the kidney.

Bladder cancer

In Singapore, bladder cancer is one of the ten most common cancers among males. In its early stages, it can often be cured. Although most common in the bladder, bladder cancer can also occur in other parts of the urinary tract. Cancers of the bladder include:

• Urothelial carcinoma (transitional cell carcinoma) – the most common type of bladder cancer, arising from the urothelial cells which line the urinary tract. Also can be found in the renal pelvis of the kidney
• Squamous cell carcinoma – much less common than urothelial carcinoma. Microscopically the cells of this cancer look like the flat cells found on the surface of the skin
• Adenocarcinoma – less common, accounting for about 1 percent of bladder cancers. These cancers arise from gland-forming cells
• Small cell carcinoma – less common, accounting for about 1 percent of bladder cancers. This cancer begins in the neuroendocrine cells of the bladder (nerve-like cells)
• Sarcoma – very rare.These cancers begin in the muscle cells of the bladder

These above lists contain just a few examples of the different cancers that can develop in the organs of the genitourinary system (see also: prostate and gynaecological cancers). The different types of cancer have different prognoses and outlooks, as well as treatment plans.

The lists below include a comprehensive list of other symptoms that may present each category of cancer.

Renal cancer

• Haematuria (blood in the urine – may appear pink, red or a dark brown)
• Lower back pain on one side that persists and not caused by injury
• Lump on the side or lower back
• Tiredness
• Loss of appetite
• Unexplained weight loss
• Intermittant and persistent fever not caused by an infection
• Anaemia

Bladder cancer

• Haematuria (blood in the urine – may appear pink, red or a dark brown)
• Changes in bladder habits
  • Higher frequency of urination
  • Pain or burning sensation during urination
  • Sense of urgency even when bladder is not full
  • Difficulty urinating/weak urinary stream
• Abdominal pain
• Back pain
• Tiredness
• Loss of appetite
• Unexplained weight loss
• Swelling in the feet

These symptoms may also present in other less serious conditions. If you are experiencing any of these symptoms, it is important that you bring this to your doctor’s attention. Some cancers may present with non-specific or few symptoms that are easily missed, and as a result, they may go undetected. Your doctor will be able to help you find the cause of the symptoms you are experiencing.

Having a risk factor does not mean you will get the disease, and some who do may not have any known risk factors. However, there are factors that can increase an individual’s risk of genitourinary cancers.

Renal cancer

• Smoking
• Older age
• Obesity
• High blood pressure
• End-stage kidney disease, especially those in need of dialysis
• Family history of kidney cancer
• Genetic and inherited syndromes
  • Von Hippel-Lindau disease
  • Birt-Hogg Dube syndrome
  • Tuberous sclerosis
  • Hereditary papiliary renal cell carcinoma
  • Familial renal cancer
• Chronic intake of certain medications such as acetaminophen (paracetamol)

Bladder cancer

• Smoking
• Workplace exposures – to chemicals known as aromatic amines which are used in the dye industry. Working in the rubber, leather, textiles, paint products and printing industries may increase exposure to higher risk organic chemicals
• Certain medicines or herbal supplements – such as chemotherapy drug cyclophosphamide for a long period of time
• Radiation exposure to the pelvis
• Insufficient consumption of fluids
• Chronic bladder irritations and infections
• Older age
• Individuals of caucasian descent
• Males are more likely to develop bladder cancer
• Genetics and family history
  • Mutation of the retinoblastoma (RB1) gene
  • Cowden disease
  • Lynch syndrome (non-polyposis colorectal cancer)
• Bladder birth defects

Individuals with an increased risk of developing cancers of the genitourinary system should consult and let their doctor know about the specific risk factors they may have. Your doctor will then be able to plan the necessary measures to monitor your health, so that in the case that the cancer does develop, it may hopefully be detected earlier where it will be more treatable.

When an individual has any signs or symptoms of genitourinary cancers, the doctor will first want to know a full medical history of the patient to discern any risk factors the patient may have. A physical examination of the abdomen and pelvis may also help to reveal any signs of cancer, such as an abnormal lump. If the symptoms or results of the physical examination point towards genitourinary cancer, more tests may be conducted.

Blood tests may also point to a kidney problem, and will also help the doctor to get a good picture of the patient’s overall health. As anaemia is common in patients with renal cancer, a complete blood count (a blood test) may be conducted. Some patients may also have too many red blood cells as well, as the kidney cancer cells produce erythropoietin, a hormone that stimulates the bone marrow to produce more red blood cells. Other blood chemistry tests may also be conducted.

Urine samples may also be collected to see if there is blood or other substances, and to evaluate if the level of these are abnormal. In certain types of genitourinary cancers, cancer cells may also be found in the urine – urine cytology, a special type of test on the urine sample, may be done to find these. For bladder cancer, there are several urine marker tests that may help.

If bladder cancer is suspected, doctors may recommend a cytoscopy. This involves the use of a long, thin and flexible tube, with a light and camera attached to it. This will allow the doctor to see if there is a tumour in the urinary tract.

If there are any abnormalities, your doctor may conduct a biopsy. This is the removal of a small sample of tissue to be examined under the microscope.

The use of imaging will also help your doctor to determine the diagnosis, as well as to stage the cancer. Your doctor will want to see if the cancer has spread, and if it has, to which other parts of the body. Computerised tomography (CT) scans, magnetic resonance imaging (MRI), angiography, ultrasound scans are some of the imaging modalities the doctor may use.

The tests used to diagnose genitourinary cancer depends on the location and type of cancer. It is important to consult your doctor to understand what he/she may plan to use in order to rule out or diagnose cancer.

Treatment options for genitourinary cancers depends on the location and stage of the cancer, as well as the patient’s age and overall health.

There are a variety of treatment options available, and is personalised to each patient. Sometimes, different options may be used in combination as well. The options include:

• Surgery
• Chemotherapy
• Radiation therapy
• Targeted drug therapy
• Immunotherapy

Once the diagnosis is made, a consultation with an oncologist is essential in order to understand which treatment options are the most suitable.