Cancer screening in the pediatric cancer patient: a focus on genitourinary malignancies, and why does a urologist need to know about this?

INTRODUCTION: The long-term survival of a patient with childhood cancer now exceeds 80%. Unfortunately, as survivorship improves, the long-term consequences of the treatments used have become manifest. Specifically, the finding that development of a subsequent malignant neoplasm (SMN) is the leading cause of late mortality is concerning. In cancer survivors who are at high risk for developing an SMN, cancer screening protocols have well-documented survivorship benefits. Regrettably, 50% of these high-risk patients are non-compliant with these protocols, with studies revealing that inadequate patient compliance is in part because of insufficient knowledge of the physician regarding its need.

DISCUSSION: Urologists are in a unique position to correct this deficiency. Characteristically, survivors of childhood cancer present to urologists as an adult with complaints of infertility, erectile dysfunction, androgen deprivation, lower urinary tract symptoms or for follow-up of a urinary diversion. The urologist because of their specialty should be able to treat the patients presenting complaint, identify the high-risk patient, and re-establish them on their surveillance protocol.

SCREENING RECOMMENDATIONS FOR HIGH-RISK PATIENTS: The risk for developing an SMN is unequally expressed and is temporally biphasic. A minimal 10-year follow-up time span is recommended for patients who received alkylating agents or topoisomerase inhibitors. These agents can induce hematologic malignancies classically within the first 3-5 years after chemotherapy completion, with minimal risk existing after 10 years. Lifelong follow-up for SMN development is recommended under five distinct circumstances; if a genetic predisposition to tumor formation exists, a persistent post-treatment non-malignant mass is present if chemotherapy was received before 2 years of age, if the initial type of tumor predisposes to SMN, or if the patient received radiation therapy.

CONCLUSION: The urologists ability to identify the patient at high risk for developing an SMN and return them to a surveillance protocol is crucial for appropriate patient management.