Urological implications of concurrent bladder and lung cancer

Background: Multiple primary malignancies are increasingly being detected among cancer patients. Objectives: To investgate the co-occurrence of primary bladder cancer and primary lung cancer, two established smoking-related neoplasms characteristically associated with increased risk of secondary cancers. Methods: A retrospective search of the patient registry in our institution identified 25 patents (23 men and 2 women) who were diagnosed with both bladder cancer and lung cancer during the period 1990-2005. Medical records were reviewed and clinical and pathological data were extracted. Results: In 21 patients (84%) bladder cancer was the first primary tumor and in 4 (16%) the second primary tumor. More than 90% of the patients had a history of smoking. Mean smoking exposure was 62.1 pack years (range 30-120). All bladder cancers were transitional cell carcinomas with the majority being superficial at presentation. Most lung cancers were of the non-small cell type. Second primary lung cancers were significantly more advanced at diagnosis. Overall, mean follow-up was 105.8 months (range 6-288). Seven patients (28%) were alive at the time of evaluation; 68% died of lung cancer, while none died of bladder cancer. Conclusions: Second primary lung cancer may occur in patients with bladder carcinoma and vice versa. In view of the relatively frequent involvement of the genitourinary tract as a site of multiple primary tumors, urologists may have a key role in the detection of second primary tumors arising in the genitourinary tract, or second primary tumors that occur in patients with primary genitourinary tract malignancies.