Bilharzial and Nonbilharzial Bladder Cancer in Asir: A Comparative Clinicopathological Study

Abstract

A total of 48 bladder cancer patients out of 96 consecutive genitourinary cancer cases were divided into bilharzial and nonbilharzial groups on a histological basis in order to investigate the impact of bilharziasis on tumor behavior. Despite being a bilharzial endemic area, only 10/48 (21%) of our patients had bilharzial cancer (BC) of whom 8 (80%) had squamous cell carcinoma (SCC) and 2 (20%) had adenocarcinoma. Out of 38 patients with nonbilharzial cancer (NBC), 35 (92%) had transitional cell carcinoma (TCC), and 3 (8%) had SCC. BC in males presented at a younger age than NBC (P<0.05). All ten patients with BC presented with deeply invasive (T3 and T4) tumors as compared to 22/38 (58%) with NBC (P<0.05). Comparison of clinical and laboratory features in both groups did not reveal any significant difference. We conclude that in the Asir region, TCC is the most common bladder cancer. However, with bilharziasis, bladder cancer tends to be of the squamous type and presents at an earlier age and at an advanced stage. SD Shetty, AIA Ibrahim, KP Patil, NA Morad, N Anandan, P Khurana, Bilharzial and Nonbilharzial Bladder Cancer in Asir: A Comparative Clinicopathological Study. 1993; 13(2): 151-154 The association between urinary bilharziasis and bladder cancer is well documented [1][2][3][4][5]. The high incidence of bladder cancer with urinary bilharziasis in Egypt contrasts with the lower figures from other bilharzial endemic areas such as Sudan, Zambia,. Saudi Arabia is a vast country where the prevalence of urinary bilharziasis varies from one region to another [8,9]. A previous study indicated that among 254 bladder biopsies carried out at this center, 35% were associated with bilharziasis. Scarcity of studies comparing bilharzial to nonbilharzial bladder cancer from regions such as ours prompted us to look into the impact of bilharziasis on the behavior of bladder cancer. We report our experience in this communication. Material and MethodsAsir Central Hospital in Abha is a referral hospital for the Asir Province of Saudi Arabia and receives most of the cancer patients of the region. Out of a total of 96 consecutive genitourinary cancer cases seen during the past five years, 48 were bladder cancers. The patients' age, sex, history of bilharziasis, living habitat, clinical and important laboratory features were noted. The radiological evaluation was performed using intravenous urography, ultrasonography and computed tomography (CT) scan. Staging was carried out by examination under anesthesia and histology of cystoscopic bladder biopsy and cystectomy specimens. TNM staging was used and tumor grading was carried out according to the World Health Organization (WHO) classification [10,11]. Patients were divided into Bilharzial and Nonbilharzial Bladder Cancer bilharzial and nonbilharzial groups according to the histological finding of ova of schistosoma hematobia within the tumor or in the adjacent bladder biopsy. Tumor type, tumor stage, and age at presentation were compared in both groups in addition to clin...