Genitourinary Tract Neoplasm

Genitourinary tract neoplasms are a group of cancers affecting the urinary system and reproductive organs, accounting for nearly one-quarter of all cancer diagnoses. While these cancers can range from slow-growing to highly aggressive, advances in detection and treatment have led to declining death rates for most types.

Table of contents

• What Is Genitourinary Tract Neoplasm?
• Types of Genitourinary Cancer
• Organs and Systems Affected
• How Common Are These Cancers?
• Signs and Symptoms
• Risk Factors
• Diagnosis
• Treatment Options

What Is Genitourinary Tract Neoplasm?

Genitourinary tract neoplasm refers to cancers that develop when a malignant tumor (cancerous growth) forms from cells in the genitourinary system, which includes both the urinary tract and reproductive organs^[1][2]. The term combines both organ systems because they exist in close physical connection with each other, and in some cases, certain organs have functions in both systems^[9][20].

These neoplasms comprise biologically distinct tumors that can behave very differently from one another. Some may be highly aggressive and fast-growing, while others are slow-growing and less likely to spread^[1][13]. The behavior of the cancer depends on its specific type, location, and characteristics.

It’s important to note that in women, cancers developing in the ovaries, uterus, cervix, or vagina are classified separately as gynecologic cancers rather than genitourinary cancers^[2][5].

Types of Genitourinary Cancer

When cancer develops in the genitourinary system, it is typically named for the specific organ or gland where it began^[20]. The main types include:

• Bladder cancer — develops when cells in the bladder lining begin to multiply uncontrollably
• Kidney cancer (also called renal cancer) — forms in the lining of the kidneys
• Prostate cancer — occurs when cells in the prostate gland grow out of control
• Testicular cancer — develops in the testicles
• Penile cancer — a rare cancer affecting the penis
• Urethral cancer — forms in the urethra, the tube that carries urine out of the body
• Adrenal cancer (also known as adrenocortical carcinoma) — develops in the adrenal glands
• Renal pelvis cancer — affects the part of the kidney where urine collects
• Ureter cancer — forms in the tubes that connect the kidneys to the bladder

Organs and Systems Affected

• Bladder
• Kidneys
• Prostate gland
• Testicles
• Penis
• Urethra
• Ureters
• Adrenal glands
• Renal pelvis

The genitourinary tract consists of organs and structures that work together to remove waste from the body and enable reproduction. In men, some organs serve dual purposes — for example, the penis and urethra function in both urinary and reproductive systems^[20].

The urinary system includes the kidneys, which filter blood and remove waste; the ureters, which are tubes carrying urine from the kidneys; the bladder, which stores urine; and the urethra, which carries urine out of the body. The male reproductive system includes the prostate gland, testicles, and penis^[2][10].

How Common Are These Cancers?

Genitourinary neoplasms are quite common. They account for 23% of all cancer diagnoses and 7% of cancer deaths^[1][13]. An estimated 438,580 new cases occur each year in men and women combined, with approximately 65,980 people (15%) dying from these diseases^[1][13].

From 1971 to 2019, death rates have declined for prostate cancer (by 11.9%), bladder cancer (by 1.5%), and kidney cancer (by 0.9%). These improvements are partly due to earlier detection and better treatments^[1][13]. Testicular cancer has particularly good outcomes, with survival rates remaining stable at over 90%^[1][13].

Bladder cancer is the sixth most common cancer in the United States. Of the approximately 84,000 new cases annually, about 65,000 occur in men and about 19,000 in women. Men are four times more likely to develop bladder cancer than women^[4].

Signs and Symptoms

Symptoms of genitourinary cancers vary depending on which organ is affected. Many symptoms can also be caused by conditions other than cancer, so it’s important to see a healthcare provider for proper evaluation.

Common symptoms of bladder cancer include:

• Blood in the urine (this may be the most noticeable sign)
• Frequent need to urinate
• Pain or burning when urinating
• Lower back pain

Kidney cancer may cause:

• Blood in the urine
• A lump in the abdomen
• Pain in the side that doesn’t go away
• Loss of appetite
• Unexplained weight loss
• Anemia (low red blood cell count)

It’s worth noting that kidney cancer may have no symptoms in its early stages, with signs appearing only as the tumor grows^[10].

Prostate cancer symptoms may include:

• Difficulty urinating
• Weak or interrupted urine flow
• Frequent urination, especially at night
• Blood in urine or semen
• Pain in the hips, back, or pelvis

Testicular cancer often presents as:

• A painless lump or mass in a testicle
• Swelling or heaviness in the scrotum
• Dull ache in the lower abdomen or groin

Risk Factors

Several factors can increase the risk of developing genitourinary cancers. These vary by cancer type but some common risk factors include:

For bladder cancer:

• Smoking cigarettes (smokers are three times more likely to develop bladder cancer)^[4]
• Age over 55
• Being male
• Exposure to harmful chemicals at home or work, such as paints, dyes, metals, or petroleum products
• Previous cancer treatments with radiation to the pelvis or certain anticancer drugs
• Chronic bladder inflammation
• Family history of bladder cancer

For kidney cancer:

• Smoking
• Long-term misuse of certain pain medicines
• Being overweight
• High blood pressure
• Family history of renal cell cancer
• Certain genetic conditions

For prostate cancer:

• Older age (about 60% of cases are diagnosed in men aged 65 or older)^[10]
• Being non-Hispanic Black (prostate cancer is more likely to develop in this population)^[10]
• Family history of prostate cancer

Diagnosis

Diagnosing genitourinary cancer typically begins with a thorough physical examination and a review of your personal and family medical history^[23]. Your doctor may investigate more common causes of symptoms first or may refer you to a specialist, such as a urologist (a doctor who specializes in urinary system disorders) or an oncologist (a cancer specialist)^[4].

Diagnostic tests may include:

• Urine tests — to check for blood, abnormal cells, or other signs of disease
• Blood tests — to look for markers that may indicate cancer
• Imaging tests — such as ultrasound, CT scans (computed tomography), or MRI scans (magnetic resonance imaging) to create detailed pictures of internal organs
• Cystoscopy — a procedure where a thin tube with a camera is inserted through the urethra to examine the bladder
• Biopsy — removal of a small tissue sample for examination under a microscope to determine if cancer cells are present

For prostate cancer specifically, doctors may use a digital rectal exam or a prostate-specific antigen (PSA) blood test as part of screening^[23].

Surgery is essential not only for treatment but also for accurate diagnosis and staging (determining how far the cancer has spread)^[1][13].

Treatment Options

Treatment for genitourinary cancers depends on several factors, including the type of cancer, its stage, where it’s located, and the patient’s overall health and preferences. The main principle is to aggressively treat patients who need it while avoiding unnecessary treatment for those who don’t^[1][13].

Treatment options can include local therapies (which target the specific tumor site) or systemic therapies (which treat cancer cells throughout the entire body)^[5][12].

Surgical Treatment:

Surgery is essential for diagnosis, staging, and cure of genitourinary cancers^[1][13]. Modern surgical approaches often use minimally invasive techniques, such as laparoscopic surgery (using small incisions and special instruments) or robotic surgery (using computer-assisted technology for greater precision)^[15][16]. These approaches can result in less pain and faster recovery compared to traditional open surgery.

For bladder cancer, surgery may involve removing part or all of the bladder. For kidney cancer, doctors may remove the affected portion of the kidney, and patients can often live with just part of one working kidney^[10].

Other surgical options include cryosurgery (using extreme cold to freeze and destroy cancer cells) and radiofrequency ablation (using heat to destroy abnormal tissue)^[16][20].

Radiation Therapy:

Radiation therapy uses high-energy rays to target and damage cancer cells, preventing them from reproducing^[10]. It can be delivered from outside the body (external beam radiation therapy) or from inside the body (brachytherapy, where radioactive material is placed near or in the tumor)^[16][20].

Advanced techniques like intensity-modulated radiation therapy (IMRT) allow doctors to match radiation beams to the unique shape of a tumor, minimizing damage to surrounding healthy tissue^[16][20].

Chemotherapy:

Chemotherapy uses medication to kill cancer cells or slow their growth. It can be given as pills or delivered directly into the veins^[16][20]. For bladder cancer, chemotherapy may be placed directly into the bladder (intravesical chemotherapy). Chemotherapy can be used alone, before or after surgery, or combined with radiation therapy^[15].

Immunotherapy:

Immunotherapy helps activate the body’s own immune system to find and attack cancer cells more effectively^[10][16]. This approach is also called biologic therapy or biotherapy.

Hormone Therapy:

Hormone therapy is typically used for localized genitourinary cancer, particularly prostate cancer. It may be the best option if surgery or radiation is not suitable^[16][20].

Targeted Therapy:

Targeted therapy uses drugs or other substances designed to identify and attack specific cancer cells based on their molecular characteristics, without harming normal cells^[10][16]. These therapies are personalized based on the tumor’s unique makeup.

In many cases, doctors will recommend combining different types of treatment. Research trials continue to explore new treatments and combinations to improve outcomes for patients with genitourinary cancers^[5][12].