FaCD Online Syndrome Fact Sheet

Last updated: 26 May 2009

Name: Bladder Cancer, Multiple Primary Malignancies in Patients with

Tumor features

laryngeal cancer
lung/bronchial cancer
prostate cancer
renal cell cancer
urinary bladder cancer


Salminen et al.[1] studied the incidence of a subsequent primary cancer among 10,014 Finnish patients with cancer of the urinary bladder. The standardised incidence ratio (SIR) for lung cancer was 1.3 among males [95% CI 1.1-1.4] and 2.6 among females (1.4-4.5). An increased SIR for kidney cancer in females (3.6, 1.8-6.2) and for larynx cancer in males (1.7, 0.91-2.8) was also observed. The risk of a second cancer was greater among patients less than 60 years of age at the time of first diagnosis than among older patients. No consistent differences were observed by the authors in the risk of new cancer between bladder cancer patients treated with or without radiotherapy.

In a cohort of 8300 patients with early-stage bladder transitional cell carcinoma (TCC) studied by Rusthoven et al[2], the SIR was significantly increased for tumors of the lung (1.71), head and neck (1.32), and prostate (1.28). The 15-year incidence of and mortality from lung cancer were 8.8% and 8.6%, respectively. A study by Singh et al[3] confirmed that patients with prostate cancer have higher risk of bladder cancer and that those with bladder cancer have a higher risk of prostate cancer.

General aspects to consider with respect to multiple primary tumors:
- Shared genetic (immune response, metabolic/hormonal/DNA-repair pathways) or non-genetic (chemical carcinogens, radiation, viruses, life-style) risk factors
- Therapy (radiation, chemotherapy, hormonal,...) related effects
- Possible bias because of increased surveillance and autopsy findings


[1] Salminen E, Pukkala E, Teppo L, Pyrhonen S. Subsequent primary cancers following bladder cancer. Eur J Cancer 1994; 30A(3):303-307.
[2] Rusthoven KE, Flaig TW, Raben D, Kavanagh BD. High incidence of lung cancer after non-muscle-invasive transitional cell carcinoma of the bladder: implications for screening trials.Clin Lung Cancer. 2008 Mar;9(2):106-11.
[3] Singh A, Kinoshita Y, Rovito PM Jr, Landas S, Silberstein J, Nsouli I, Wang CY, Haas GP. Higher than expected association of clinical prostate and bladder cancers. J Urol.2008 May;179(5 Suppl):S2-5.