26th June 2023

Urinary Tract Tumours

Common cancers of the renal tract

Renal Cancer

Benign renal tumours include angiomyolipomas, hamartomas and renin-secreting tumours.

Renal cell carcinoma arises from the tubular epithelium. Risk factors include smoking, obesity, hypertension, acquired cystic renal disease and genetic conditions such as Von Hippel Lindau syndrome or tuberous sclerosis. It can present with flank pain and, once the collecting duct system has been invaded, haematuria. It may also present with non-specific symptoms such as weight loss or fevers.

Renal cell carcinoma has a propensity to invade the renal veins with two possible complications: emboli to the lung or occlusion of the left testicular vein causing left varicocele.

Other complications include those of associated paraneoplastic syndromes, such as:

• Hypercalcemia (secondary to parathyroid hormone-related peptide)
• Hypertension (secondary to increased renin levels)
• Erythrocytosis (secondary to increased erythropoietin levels)

Bladder Cancer

The predominant histological type is transitional cell carcinoma. Risk factors include smoking, nitrosamines, aniline dyes, phenacetin, and cyclophosphamide. Schistosoma haematobium is a parasite that increases the risk of squamous cell carcinoma. The most common presentation is painless haematuria, either microscopic or macroscopic. Pain suggests invasive and/or metastatic disease. Haematuria towards the end of voiding suggests bladder neck or prostatic urethra source. Lower urinary tract symptoms can also be present such as urgency, frequency, and dysuria. Gold standard imaging for diagnosis and staging is cystoscopy. Provided the tumour does not invade muscle, surgical treatment is via transurethral resection of bladder tumour.

Prostate Cancer

The most common prostate malignancy is adenocarcinoma, which typically occurs in the posterior lobe of the prostate. Risk factors include increasing age and family history. It is asymptomatic in most cases but can present with lower urinary tract symptoms, including urinary retention. Digital rectal examination might identify asymmetry, lack of sulcus, induration and/or nodules of the prostate. The blood marker, prostate specific antigen, is not specific for malignancy and so, if only mildly raised, is typically repeated after six weeks before investigation for malignancy. Metastatic prostate cancer can cause spinal cord compression from bony metastases.