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Urothelkarzinom

Urothelial carcinoma

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Zusammenfassung

Urotheliale Karzinome der Harnblase zählen zu den häufigsten urothelialen Neoplasien des harnableitenden Systems. Ihr Auftreten ist geschlechts- und altersspezifisch, der typische Patient männlich und älter als 45 Jahre. Zu den Hauptrisikofaktoren zählen Rauchen und die Exposition gegenüber aromatischen Aminen. Makrohämaturie, Harnstau und -verhalt können ebenso wie die Mikrohämaturie Symptom des Urothelkarzinoms sein. Bei Auftreten letzterer sollte, nach Ausschluss einer Glomerulonephritis, eines Harnwegsinfekts oder Steinleidens, die urologische Abklärung erfolgen. Das Therapieregime ist abhängig von der Tumorinvasivität, nicht-invasive Tumoren werden durch transurethrale Resektion und lokale Instillation mit Immunmodulatoren wie BCG therapiert, invasive Tumoren hingegen durch eine radikale Zystektomie entfernt und mit einer adjuvanten cisplatinhaltigen Polychemotherapie behandelt. Nicht-invasive Tumoren sind mit einer deutlich höheren 5-Jahres-Überlebensrate als invasive Tumoren assoziiert (88% vs. 58%).

Abstract

Urothelial carcinomas of the bladder are one of the most frequent neoplasms of the urinary tract. The occurrence is gender and age-specific and they are typically encountered in males over 45 years old. Major risk factors include smoking and exposure to aromatic amines. Macrohematuria, urinary obstruction and retention are evocative of urothelial carcinoma but this diagnosis also needs to be considered in patients with microhematuria when glomerulonephritis, urinary tract infections and urinary stones have been excluded by urine sediment analysis and ultrasound scanning. The diagnosis of urothelial carcinoma requires histological examination of biopsies obtained during cystoscopy. The therapy depends on the level of invasiveness of the tumor and comprises transurethral resection of the bladder, local instillation of immunomodulators, e. g. BCG for non-invasive tumors and radical cystectomy with adjuvant polychemotherapy containing cisplatin for invasive tumors. Non-invasive tumors are associated with a much higher 5-year survival rate ( 88%) than invasive tumors (58%).

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Literatur

  1. Fajkovic H, Halpern JA, Cha EK et al (2011) Impact of gender on bladder cancer incidence, staging, and prognosis. World J Urol 29(4):457–463

    Article  PubMed  Google Scholar 

  2. Dorp F vom, Kausch I, Jocham D (2007) Diagnostik und Therapie des nichtinvasiven Harnblasenkarzinoms. Dtsch Ärztebl 104:A797–A802

    Google Scholar 

  3. Pashos CL, Botteman MF, Laskin BL, Redaelli A (2002) Bladder cancer: epidemiology, diagnosis, and management. Cancer Pract 10(6):311–322

    Article  PubMed  Google Scholar 

  4. Lawrentschuk N, Lee ST, Scott AM (2013) Current role of PET, CT, MR for invasive bladder cancer. Curr Urol Rep 14(2):84–89

    Article  PubMed  Google Scholar 

  5. Vineis P, Marinelli D, Autrup H et al (2001) Current smoking, occupation, N-acetyltransferase-2 and bladder cancer: a pooled analysis of genotype-based studies. Cancer Epidemiol Biomarkers Prev 10(12):1249–1252

    CAS  PubMed  Google Scholar 

  6. Hauptverband der gewerblichen berufsgenossenschaften (HVBG) (2005) Dokumentation des Berufskrankheiten-Geschehens in Deutschland: Beruflich verursachte Krebserkrankungen, 8. Aufl. Sankt Augustin. http://www.dguv.de/medien/inhalt/zahlen/documents/krebs2003.pdf

  7. Rübben HH (2014) Uroonkologie. Springer, Berlin, S 883

  8. Golka K, Goebell PJ, Rettenmeier AW (2007) Ätiologie und Prävention des Harnblasenkarzinoms. Dtsch Ärztebl 104:A719–A723

    Google Scholar 

  9. Stewart JH, Hobbs JB, McCredie MR (1999) Morphologic evidence that analgesic-induced kidney pathology contributes to the progression of tumors of the renal pelvis. Cancer 86(8):1576–1582

    Article  CAS  PubMed  Google Scholar 

  10. McDougal WS, Cramer SF, Miller R (1981) Invasive carcinoma of the renal pelvis following cyclophosphamide therapy for nonmalignant disease. Cancer 48(3):691–695

    Article  CAS  PubMed  Google Scholar 

  11. Badawi AF (1996) Molecular and genetic events in schistosomiasis-associated human bladder cancer: role of oncogenes and tumor suppressor genes. Cancer Lett 105(2):123–138

    Article  CAS  PubMed  Google Scholar 

  12. Montironi R, Mazzucchelli R, Scarpelli M et al (2008) Morphological diagnosis of urothelial neoplasms. J Clin Pathol 61(1):3–10

    Article  CAS  PubMed  Google Scholar 

  13. Montironi R, Lopez-Beltran A (2005) The 2004 WHO classification of bladder tumors: a summary and commentary. Int J Surg Pathol 13(2):143–153

    Article  PubMed  Google Scholar 

  14. Schoenberg M, Kiemeney L, Walsh PC et al (1996) Germline translocation t(5;20)(p15;q11) and familial transitional cell carcinoma. J Urol 155(3):1035–1036

    Article  CAS  PubMed  Google Scholar 

  15. Hoglund M (2012) The bladder cancer genome; chromosomal changes as prognostic makers, opportunities, and obstacles. Urol Oncol 30(4):533–540

    Article  PubMed  Google Scholar 

  16. Lae M, Couturier J, Oudard S et al (2010) Assessing HER2 gene amplification as a potential target for therapy in invasive urothelial bladder cancer with a standardized methodology: results in 1005 patients. Ann Oncol 21(4):815–819

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Lindgren D, Sjodahl G, Lauss M et al (2012) Integrated genomic and gene expression profiling identifies two major genomic circuits in urothelial carcinoma. PLoS One 7(6):e38863

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Schulz WA (2006) Understanding urothelial carcinoma through cancer pathways. Int J Cancer 119(7):1513–1518

    Article  CAS  PubMed  Google Scholar 

  19. Molen AJ van der, Hovius MC (2012) Hematuria: a problem-based imaging algorithm illustrating the recent Dutch guidelines on hematuria. AJR Am J Roentgenol 198(6):1256–1265

    Article  PubMed  Google Scholar 

  20. Fritz GA, Schoellnast H, Deutschmann HA et al (2006) Multiphasic multidetector-row CT (MDCT) in detection and staging of transitional cell carcinomas of the upper urinary tract. Eur Radiol 16(6):1244–1252

    Article  PubMed  Google Scholar 

  21. Cowan NC, Turney BW, Taylor NJ et al (2007) Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour. BJU Int 99(6):1363–1370

    Article  PubMed  Google Scholar 

  22. Xue LY, Lu Q, Huang BJ et al (2013) Evaluation of renal urothelial carcinoma by contrast-enhanced ultrasonography. Eur J Radiol 82(4):e151–e157

    Article  PubMed  Google Scholar 

  23. Tetu B (2009) Diagnosis of urothelial carcinoma from urine. Mod Pathol 22(Suppl 2):S53–S59

    Article  PubMed  Google Scholar 

  24. Lokeshwar VB, Habuchi T, Grossman HB et al (2005) Bladder tumor markers beyond cytology: International Consensus Panel on bladder tumor markers. Urology 66(6 Suppl 1):35–63

    Article  PubMed  Google Scholar 

  25. Hosseini J, Golshan AR, Mazloomfard MM et al (2012) Detection of recurrent bladder cancer: NMP22 test or urine cytology? Urol J 9(1):367–372

    PubMed  Google Scholar 

  26. Guo A, Wang X, Gao L et al (2014) Bladder tumour antigen (BTA stat) test compared to the urine cytology in the diagnosis of bladder cancer: a meta-analysis. Can Urol Assoc J 8(5–6):E347–E352

  27. Bonberg N, Pesch B, Behrens T et al (2014) Chromosomal alterations in exfoliated urothelial cells from bladder cancer cases and healthy men: a prospective screening study. BMC Cancer 14:854

    Article  PubMed Central  PubMed  Google Scholar 

  28. Fradet Y, Lockhard C (1997) Performance characteristics of a new monoclonal antibody test for bladder cancer: ImmunoCyt trade mark. Can J Urol 4(3):400–405

    PubMed  Google Scholar 

  29. Cheng L, Davison DD, Adams J et al (2014) Biomarkers in bladder cancer: translational and clinical implications. Crit Rev Oncol Hematol 89(1):73–111

    Article  PubMed  Google Scholar 

  30. Babjuk M, Burger M, Zigeuner R et al (2013) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol 64(4):639–653

    Article  PubMed  Google Scholar 

  31. Shelley MD, Kynaston H, Court J et al (2001) A systematic review of intravesical bacillus Calmette-Guerin plus transurethral resection vs transurethral resection alone in Ta and T1 bladder cancer. BJU Int 88(3):209–216

    Article  CAS  PubMed  Google Scholar 

  32. Otto W, Denzinger S, Fritsche HM et al (2011) The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer. BJU Int 107(3):404–408

    Article  PubMed  Google Scholar 

  33. Stenzl A, Cowan NC, De Santis M et al (2011) Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 59(6):1009–1018

    Article  CAS  PubMed  Google Scholar 

  34. Gschwend JE, Dahm P, Fair WR (2002) Disease specific survival as endpoint of outcome for bladder cancer patients following radical cystectomy. Eur Urol 41(4):440–448

    Article  PubMed  Google Scholar 

  35. Herr HW, Bajorin DF, Scher HI (1998) Neoadjuvant chemotherapy and bladder-sparing surgery for invasive bladder cancer: ten-year outcome. J Clin Oncol 16(4):1298–1301

    CAS  PubMed  Google Scholar 

  36. Sherif A, Holmberg L, Rintala E et al (2004) Neoadjuvant cisplatinum based combination chemotherapy in patients with invasive bladder cancer: a combined analysis of two Nordic studies. Eur Urol 45(3):297–303

    Article  CAS  PubMed  Google Scholar 

  37. Maase H von der, Sengelov L, Roberts JT et al (2005) Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 23(21):4602–4608

    Article  PubMed  Google Scholar 

  38. Hellenthal NJ, Shariat SF, Margulis V et al (2009) Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: results from the Upper Tract Urothelial Carcinoma Collaboration. J Urol 182(3):900–906

    Article  PubMed  Google Scholar 

  39. Matin SF, Margulis V, Kamat A et al (2010) Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer 116(13):3127–3134

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S.E.K. Fink, S. Pahernik, P. Hallscheidt und M. Zeier geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Nierenzentrum Heidelberg, Abteilung für Nephrologie, Universität Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Deutschland

    S.E.K. Fink & M. Zeier

  2. Abteilung für Urologie, Universität Heidelberg, Heidelberg, Deutschland

    S. Pahernik

  3. Radiologie Darmstadt, Darmstadt, Deutschland

    P. Hallscheidt

Authors
  1. S.E.K. Fink
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  2. S. Pahernik
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  3. P. Hallscheidt
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  4. M. Zeier
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Corresponding author

Correspondence to S.E.K. Fink.

Additional information

Dieser Beitrag erschien ursprünglich in der Zeitschrift Der Nephrologe 2015 3:239-247, DOI 10.1007/s11560-014-0975-9. Die Teilnahme an der zertifizierten Fortbildung ist nur einmal möglich.

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Fink, S., Pahernik, S., Hallscheidt, P. et al. Urothelkarzinom. Onkologe 21, 739–748 (2015). https://doi.org/10.1007/s00761-015-3014-1

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