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Urinary bladder cancer (UBC) is a common disease globally, with highest incidence
in developed countries but the incidence rate is rising faster in developing countries
as a result of industrialisation and increasing prevalence of cigarette smoking.
Previously transition cell carcinoma was rare in Africa, but nowadays it is becoming
common on this continent. Non-muscle invasive transitional cell carcinoma (TCC)
of bladder has a tendency to recur and progress to advanced stage, this makes bladder
cancer most expensive cancer to manage because it requires long term surveillance.
Objective
The aim of the study was to describe clinicopathological characteristics of urinary
bladder cancer at KCMC.
Methodology
Retrospective descriptive, hospital based study from 2006 to 2013.
Results
A total of 120 subjects were included in the study. The majority (75%) had TCC
followed by SCC (18%). Forty nine percent (49%) of subjects with TCC presented
with non muscle invasive bladder cancer (NMIBC). The majority (87%) of subjects
with non-muscle invasive TCC of bladder experienced recurrence during one year of
follow up. Multifocality and recurrence in the first follow up cystoscopy are the
determinants of recurrence. A significant number 13(29.5%) of subjects with
NMIBC were lost to follow up during the period of one year of follow up.
Conclusion
TCC is still the most common (71%) histological type in our set up followed by SCC
(18%). Majority of patients with TCC presents with advanced cancer, moreover
intravesical recurrence after TURBT is high for those with non-muscle invasive TCC
and influenced by multifocality of the tumour and recurrence at first follow up
cystoscopy.
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Recommendation
We need to do random bladder biopsy in patients with non-muscle invasive TCC of
bladder to assess the extent of CIS.
A large prospective study is required to confirm recurrence, progression and
determinants of recurrence in our set up.
The KCMC hospital should create cancer registry database which can be accessed by
authorized individuals. This will help in making sure that we have complete and
accurate oncological information.
We need a study which will establish risk factors for TCC of the urinary bladder in
our set up.
Although we did not study effect of intravesical therapy on recurrence of superficial
TCC, other investigators have documented reduced recurrence rate with use of these
agents. Therefore we recommend use of intravesical chemo or immunotherapy so
that we can reduce the high recurrence observed in our population. The ministry of
health and social welfare of Tanzania should make sure that these agents are
available, affordable and accessible. |
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