The lower urinary tract comprises all the structures that are lined by specialized transitional epithelium called urothelium: renal pelves, ureters, bladder, and urethra. Transitional cell carcinoma is the most common form of lower urinary tract cancer, most commonly involving the bladder.
Long term use of cyclophosphamide is a well-known risk factor for urothelial carcinoma.
A useful mnemonic to remember the risk factors for urothelial carcinoma is the acronym: P-SAC. Phenacetin: a banned analgesic. Smoking: primary risk factor. Aniline: compound used in rubber/dye manufacturing. Cyclophosphamide: cytotoxic medicine used in cancer and autoimmune conditions.
Cigarette smoke is the major risk factor (due to the presence of polycyclic aromatic hydrocarbons and also due to the presence of naphthylamine).
Additional risk factors includes: azo dyes, aniline exposure, alcohol abuse.
Urothelial carcinoma is generally seen in older adults, mostly occurring in those over 65 years of age.
Usually presents as painless hematuria. Terminal hematuria (end of voiding) suggests bleeding from the bladder. Other urinary symptoms, such as frequency, urgency, and dysuria, can also be seen, but most patients are asymptomatic in the early stages.
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