Urological implications of concurrent bladder and lung cancer.

BACKGROUND Multiple primary malignancies are increasingly being detected among cancer patients. OBJECTIVES To investigate 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 patients (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.