Genitourinary cancers.

The literature regarding SPC following urological cancers is limited. The main sites of interest include the kidney, the upper urinary tract in general and the bladder. Regarding kidney cancer, the 2 most recent studies were based on a similar sample size. In 2006, Beisland et al. [1] investigated 1,425 patients with renal cell carcinoma. Only 3 types of SPC showed a significant excess risk (table 44). The results support the common understanding of bladder cancer as a key sequela to renal cancer. For instance, Rabbani and colleagues found that only bladder cancer was seen to exhibit an excess risk among a small series of renal carcinoma patients [2]. The common risk factor posited to explain this phenomenon involves smokingrelated carcinogens excreted through the kidneys and thence to the bladder and its tissues [3]. The other population-based study, from 2003, specifically focused on papillary kidney cancer (n 1,733). It demonstrated a slightly wider range of SPCs with a significant excess risk – though the most dramatic result was still for bladder cancer (table 45) [4]. Augmenting these results, Thompson and colleagues noted in a 2006 report that patients with papillary renal cell carcinoma have an overall greater risk of a SPC, particularly related to colon and prostate cancer, than patients with clear cell renal carcinoma [5]. The theory concerning tobacco smoking and increased bladder cancer noted earlier may also explain any excess of second primary lung cancers. Consequently, smoking cessation could be an effective preventive measure. In the studies just described, prostate cancer joins the list of sites with excess risk, a result that has been confirmed by other research [3, 6]. No definitive explanation of this association has been offered.