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UROGENITAL CANCER PROFILE

S V Joshi*, H L Dhar**
*Technical Officer; **Director Research, Medical Research Centre, Bombay Hospital Trust, Mumbai 20.

Results show that incidence of urogenital cancers varies with age and the organs involved. Peak occurs in 5th to 7th decades. Lymph node metastasis is maximum in cancer of penis, bone metastasis in cancer of prostate and that of liver and omentum in ovarian cancer. Most of the tumours were resected and treated with either radiotherapy and chemotherapy. LDH was elevated in cancer of ovary, prostate, kidney and cervix while alkaline phosphatase in kidney, prostate and ovary. Anaemia was evident in patients suffering from carcinoma of prostate, cervix, uterus, ovary as well as kidney, bladder and penis. PSA was raised in 26.92% of cases of cancer prostate. Mortality was higher in carcinoma of prostate (5.77%) as compared to ovary (2.28%), bladder (2.28%) and kidney (1.96%).

INTRODUCTION

By the year 2001, the risk of developing cancer for Indian males will be one in eighteen and for females one in fifteen. [1] Cancers of the genital organs predominate in females, whereas cancer of urinary tract predominates in males. [2] Increased lactate dehydrogenase (LDH) and alkaline phosphatase (non specific tumour markers) in prostate and ovarian cancer has been reported in literature; [3,4] while raised serum CA 125 concentration is a powerful index in risk of ovarian and fallopian tube cancer in asymptomatic menopausal women. [5] Prostate specific antigen (PSA) is considered as an excellent tool for monitoring treatment failures following prostatectomy. [6]

Present work is the analysis of hospital data of urogenital cancers including biochemical parameters and assessment of specific tumour markers viz. CA 125 and PSA as well as postoperative therapy.

PATIENTS AND METHODS

289 consecutive cases of urogenital cancers admitted in the Medical Research Centre (in one year 1995) were included in this study. Data was analysed according to age, sex and grades of malignancies. Coding system devised by the WHO was followed (ICD 9th revision). [7]

The information was collected regarding surgical interventions, postoperative therapy, occurrence of metastases, relevant biochemical parameters - viz. lactate dehydrogenase (LDH), PSA, CA (125), alkaline phosphatase and haemoglobin.

RESULTS

Results show that incidence of urogenital cancers differ with different age groups and the organs involved. In case of bladder, kidney, cervix, ovary and uterus, peak was observed between 50-59 years while maximum involvement of prostate and penis occurred between 60-69 years. (Table 1). However, prostatic cancer was more common (17.99%) than penile cancer (5.19%). In females, incidence of cancer cervix and ovary was similar (15.92% and 15.22%) with less involvement of uterus (3.11%). Cancer of bladder and kidney showed male preponderance. Lymph node metastasis resulting from urogenital cancer varies widely with the organ involved, maximum being the penis followed by kidney, bladder, prostate and ovary. However, bone metastasis was maximum in the prostate while that of liver and omentum in the ovarian cancer (Table 2).

Maximum tumour resection was done with cancer of prostate (80.77%) followed by uterus

TABLE 1
Age related incidence
Type of Cancer 20-29 30-39 40-49 50-59 60-69 70-79 80-89 Total
  M F M F M F M F M F M F M F  
Kidney 2 1 3 2 5 2 13 2 7 6 5 1 2 — 51
% 5.9 9.8 13.7 29.4 25.5 11.8 3.9  
Bladder — — — — 2 2 24 8 14 2 10 3 4 3 72
% — — 5.5 44.4 22.2 18.0 9.7  
Prostate — — — — — — 6 — 21 — 20 — 5 — 52
% — — — 11.5 40.4 38.5 9.6  
Penis — — 1 — 4 — 3 — 7 — — — — — 15
% — 6.7 26.7 20.0 46.7 — —  
Cervix — 6 — — — 13 — 16 — 9 — 2 — — 46
% — 13.0 28.3 24.8 19.6 4.3 —  
Ovary — 3 — 6 — 11 — 17 — 6 — 1 — — 44
% 6.8 13.6 25.0 38.6 13.6 2.3 —  
Uterus — 1 — — — 3 — 4 — — — 1 — — 9
% 11.1 — 33.3 4.4 — 11.1 —  

 

TABLE 2
Metastases in urogenital cancers
Type of Cancer Bone Lymph nodes Liver Lung Omentum Total No. Total%
Prostate 20 2 1 — — 23 44.2
(52) % 38.5 3.9 1.9 — —    
Kidney 6 9 2 1 — 19 37.3
(51) % 11.8 17.6 3.9 2 —      
Bladder 2 11 2 2 — 17 23.6
(72) % 2.8 15.3 2.8 2.8 —      
Cervix 1 — — 1 1 3 6.5
(46) % 2.2 — — 2.2 2.2     
Ovary — 1 7 2 6 16 36.4
(44) % — 2.3 16.0 4.5 13.6     
Penis — 7 — — — 7 46.5
(15) % — 46.7 — — —    
Uterus (9) % — — — — — — —
Total % 29 30 12 6 7 85  

(77.77%), kidney (62.74%), bladder (34.72%), penis (53.33%), ovary (45.45%) and cervix (15.22%). Majority of ovarian cancer (52.27%) was treated with chemotherapy prior to admission compared to those during hospital stay (20.45%) while radiotherapy was given earlier in 26.1% and 6.52% during hospital stay.

LDH was elevated in cancer of ovary, prostate, kidney and cervix while alkaline phosphatase in kidney, prostate and ovary. Creatinine level was highest in kidney followed by bladder, prostate, uterus, penis and cervical cancers (Table 3).

Anaemia was evident in patients suffering from cancer of prostate (34.61%), cervix (23.91%), uterus (22.22%), ovary (20.45%), kidney (17.64%), bladder (12.5%) and penis (6.67%). PSA was raised (26.92%) in cancer of prostate.

Three out of fifty two patients (5.77%) suffering from carcinoma of prostate died while two each of ovary and bladder (2.28%) and one of kidney (1.96%) died during hospitalization.

TABLE 3
Biochemical investigations
Type of Cancer Creatinine Alk. Phosp. LDH Hb < 10 gm PSA
Bladder 19 4 1 9  
% 26.39 5.55 1.39 12.5  
Prostate 12 11 7 18 14
% 23.7 21.15 13.46 24.61 26.2
Kidney 23 12 5 9  
% 45.10 23.53 9.80 17.64  
Cervix 1 2 6 11  
% 2.17 4.35 13.04 23.91  
Ovary — 6 13 9  
% — 13.64 29.54 20.45  
Penis 1 — — 1  
% 6.67 — — 6.67  
Uterus 1 — — 2  
% 11.11 — — 22.22  

DISCUSSION

Results show that incidence of urogenital cancer both in males and females are maximum during 60-69 years of age, while kidney and bladder are primarily involved in men 50-59 year age group. However, incidence of prostatic cancer was higher in this series (17.99%) compared to those reported from Greater Bombay (12.05%). [2] It is possible that in the present series more patients of lower age group (60-69) were admitted compared to higher age group (70-80) in Greater Bombay. Similar reason might be involved for higher prevalence of carcinoma of kidney (17.64%) and bladder (24.91%), compared to 6.34% and 10.9% respectively in Greater Bombay.

Incidence of prostatic cancer rises after the age of 50 years, [8-10] however, in the present study incidence declined after maximum rise during 60-69 years. Mortality due to surgery (7.14%) was similar (6%) as reported by Agarwal et al. [11]

LDH and alkaline phosphatase are nonspecific tumour markers [12] both of which were raised and bone metastasis could be a contributory factor. [13] PSA values as a tumour marker [14] were also raised in prostatic cancer.

Bladder cancer occurred in the age group 60-69, similar to those reported from elsewhere in Mumbai [2] but with lower mortality (2.77%) during hospital stay. Involvement of lymph nodes has been associated with survival rate, [15] and lower lymph node involvement (10.4%) in this series might have contributed to reduced mortality. Chemotherapy following cystectomy has also been reported to reduce progression and increased survival [16] as in the present study.

There is male preponderance (2.64 : 1) in renal cell carcinoma with significant difference between involvement of right (33.33%) and left (66.66%) kidneys which is in accord with the report from USA. [17] Lymph node metastasis (17.64%) was similar (12.22%) to these reported by Hermanek et al. [18] Both alkaline phosphatase and LDH was found to be raised which is in confirmity with those reported by others. [3,4]

The incidence of cancer penis (5.9%) was also similar (7.84%) to those reported from Jaipur [19] as well as from Greater Bombay (3.59%). [2] Metastasis occurred only in lymph nodes (46.66%) and surgery was performed in 53.33%. Biochemical tumour markers were unchanged and no one diedwhile admitted in the hospital.

Incidence of cancer cervix (15.92%) was however lower compared to those reported from Greater Bombay (40.17%) [2] and Jaipur (27.67%), [19] but maximum incidence occurred at 50-59 years against 41-48 years reported by Coppleson. [20] LDH and alkaline phosphatase were raised in 29.54% and 13.64% of cases and 34.8% underwent hysterectomy and 7% received radiotherapy.

Peak incidence of ovarian cancer (50-59) was similar to cancer of cervix (45-49) reported from Greater Bombay. [2] Maximum metastasis occurred in liver (16%) followed by omentum (13.63%) against 7.1% reported by Moore from USA. [21] It is possible that our patients reported for treatment at a later stage. Most patients received chemotherapy (52.3%), followed by salpingo-oopherectomy a definite surgical procedure performed in 3.63% of cases. Similar procedure but used more frequently (15.%) was reported by Tazelaar. [22] LDH activity and alkaline phosphatase however was elevated in (13.04%) of cases which were more or less similar to those reported from Jaipur [3] and Pondicherry. [4]

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