• General Considerations
  The urinary system lined by transitional cell epithelium (urothelium) extends from the most proximal calyces to the proximal urethra. In this section, attention is given to the tumors of the renal collecting system and the ureter. It is important that they be understood in the broad context of transitional cell carcinoma (TCC), which is discussed in greater detail in the section on bladder cancer.
• Incidence
  • Account for 7 percent of all renal tumors.
  • Overall, urothelial tumors are distributed as follows:
    • Bladder: 90 percent
    • Urethra: 7 percent
    • Ureter or renal collecting system: 3 percent
  • Patients with a history of bladder cancer have 2 to 4 percent chance of developing upper tract tumors (synchronous or asynchronous).
    • This figure increases up to 25 percent in patients with bladder carcinoma in situ.
  • Patients with a history of an upper tract tumor have a 15 to 50 percent chance of eventually developing TCC of the bladder.
    • Such patients also have a 2 to 4 percent chance of developing a contralateral lesion.
  • After cystectomy, there is an approximately 7 percent chance of developing upper tract TCC.
    • The risk is highest with the presence of carcinoma in situ (CIS) in the cystectomy specimen. The highest risk is within 3 to 4 years following cystectomy.
  • There is evidence to suggest that patients with high-grade superficial bladder tumors undergoing bacillus CalmetteGuerin (BCG) intravesical therapy have an increased tendency to develop upper tract lesions.
    • The entire urothelium must be routinely surveyed for the development of cancer once any part has undergone malignant transformation.

References

• Carroll PC, Dixon CM. Surgical anatomy of the male and female urethra. Urol Clin North Am 19:339-346, 1992.
• Cataluna WJ: Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous vein: Technique and preliminary results. J Urol 140:836, 1988.
• deKernion JB, Abi-Aad AS: Controversies in ilioinguinal lymphadenectomy for cancer of the penis. Urol Clin North Am 19:319-324, 1992.
• Forman JD, Lichter AS: The role of radiation therapy in the management of carcinoma of the male and female urethra. Urol Clin North Am 19:383-390, 1992.
• Gerbaulet A, Lambin P: Radiation therapy of cancer of the penis: Indications, advantages, and pitfalls. Urol Clin North Am 19:325-332, 1992.
• Johnson DE, Ames FC: Groin Dissection. Chicago, Yearbook Medical Publishers, 1985.
• Lowe FC: Squamous cell carcinoma of the scrotum. J Urol 130:423, 1983. Russo P, Gaudin P: Carcinoma of the penis: Diagnosis and staging. Cont Urol 4:12-31, 2000.
• Schellhammer PF, Jordan GH, Schlossberg SM: Tumors of the penis. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, eds. Campbell's Urology, 6th ed. Philadelphia, Saunders, 1992, pp 1264-1298.
• Skinner EC, Skinner DG: Management of carcinoma of the female urethra. In: Skinner DG, Lieskovsky G, eds. Diagnosis and Management of Genitourinary Cancer. Philadelphia, Saunders, 1988, pp 490-497.

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