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Kidney and Bladder Cancer

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Abstract

Urothelial cancer consists of tumors of the bladder, ureters, and renal pelvis. Bladder cancer accounts for ∼ 4% of all cancers in the USA (∼ 70,000 cases), while cancers of the renal pelvis and ureters occur in 5,400 patients. Renal cell carcinoma occurs in about 53,000 adults. The most common histological subtype of bladder cancer is transitional cell while the common cell types for renal cell cancer are clear cell, papillary, and chromophobe. Twenty-five to thirty percent of patients are asymptomatic, and the primary lesion is found on incidental imaging studies. The most common presentations are hematuria, flank pain, and palpable mass in the flank or abdomen. However, symptoms usually appear when the tumor is large and metastatic.

Preoperative imaging in renal cell carcinoma is used to differentiate benign from malignant lesions, to assess tumor size, location, and organ confinement, to identify lymph node and/or visceral metastases, and to determine the presence and extent of any thrombus of the vena cava. CT is widely used to differentiate benign lesions, such as renal oncocytoma and angiomyolipoma, from malignant lesions but also for tumor staging (local invasiveness, lymph node involvement, or other metastases).

MRI may be used when contrast allergy, functional renal impairment, and pregnancy are present. However, CT and MRI perform relatively poorly in N-staging.

[18F]FDG PET is not used in the detection of primary RCC mainly because of the high rate of false-negative results, but it is effective in both staging and restaging of renal cell carcinoma and especially for the identification of visceral and bone metastases. [18F]-FDG PET/CT appears to be an effective surveillance tool in high-risk renal cell carcinomas to develop recurrences or metastases. [18F]FDG PET/CT is useful for the early evaluation of response to antiangiogenesis therapy in metastatic renal cell carcinoma.

Larger studies are needed to evaluate the role of [11C]acetate, 18F-MISO, 18F-fluorothymidine, and 124I-cG250 in renal cell carcinoma. A promising alternative to conventional therapy is targeted tumor therapy with chimeric antibodies such as 131I-cG250 or 177Lu-DOTA-cG250.

Bladder cancer is the most common cancer of the urinary system. Transitional cell carcinoma (TCC) is by far the most common epithelial tumor of the bladder. Painless microscopic or gross hematuria is usually the initial symptom. The standard method of diagnosing bladder cancer continues to be based on direct visualization of the bladder with cystoscopy and subsequent biopsy/resection. Cystoscopy and biopsy reveal the tumor’s cell type, grade, and depth of invasion. As regards imaging, MRI is superior to CT for assessing depth of bladder wall infiltration while CT and MRI yield similar results in demonstrating invasion of perivesical structures. MR imaging is considered to be the modality of choice for primary staging. CT and MRI reliably detect lymph node enlargement within the pelvis and abdomen in patients with bladder cancer, although microscopic metastatic disease can be missed. MRI with lymphatic contrast agents may improve nodal staging. Both conventional abdominal/pelvic CT and computed tomography urography (CTU), which may be combined with chest CT, can be performed to detect distant metastases. Because of urinary excretion of [18F]FDG, detection of primary tumor in the urinary bladder is difficult. The pooled activity in the urinary bladder makes the evaluation of bladder wall lesions impossible.

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Authors and Affiliations

  1. Department of Nuclear Medicine and PET Center, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus, DK-8000, Denmark

    Kirsten Bouchelouche MD, DMSc

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  1. Kirsten Bouchelouche MD, DMSc
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Correspondence to Kirsten Bouchelouche MD, DMSc .

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  1. Dept. Radiology, Div. Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, York Ave. 1275, New York, 10021, New York, USA

    H. William Strauss

  2. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Giuliano Mariani

  3. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Duccio Volterrani

  4. Cancer Center, Department of Radiology, Memorial Sloan-Kettering, York Ave. 1275, New York, 10021, New York, USA

    Steven M. Larson

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Bouchelouche, K. (2013). Kidney and Bladder Cancer. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-48894-3_20

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  • DOI: https://doi.org/10.1007/978-0-387-48894-3_20

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