Bladder cancer in individuals with spinal cord injuries

Abstract

Study design: Prospective scoping review. Objectives: To conduct a scoping review of all the literature related to bladder cancer in individuals with spinal cord injuries (SCI). Methods: Literature search of the databases Pubmed, CINAHL, ProQuest, PsychINFO and Scopus up to and including August 2012. Articles related to bladder cancer among SCI patients were identified, and data pertaining to epidemiology, risk factors, screening, prevention and management was reviewed and summarized. Results: An association between bladder cancer and SCI was first reported in the 1960s, with some case reports suggesting an alarmingly high rate among SCI patients. More recent epidemiological studies have reported this risk to be substantially lower. However, bladder cancer in SCI patients tends to present at an earlier age and at a more advanced pathological stage than bladder cancer in the general population. Presenting symptoms may be atypical, and early recognition is important to improve prognosis with surgical resection. Several risk factors have been identified, including indwelling catheters, urinary tract infections and bladder calculi. Screening of SCI patients for bladder cancer is routinely recommended in many SCI management guidelines and by expert consensus; however, evidence for screening tools and protocols is lacking. Conclusion: Bladder cancer is a rare, and potentially lethal occurrence in SCI patients. Physicians need to have a high index of suspicion for bladder cancer, particularly among SCI patients managed with long-term indwelling catheters.

Bladder Cancer Mortality after Spinal Cord Injury over 4 Decades

“…This finding corresponds with numerous prior studies that reported a range of 16 to 34 years from injury to time of diagnosis. 5 Our nonsignificant finding for those with a SCI of less than 10 years is also consistent with a recent Taiwanese cohort study that followed 54,401 patients with SCI for an average of 6 years (range less than 1 to 13 years) and found no increased risk of bladder cancer diagnosis compared with the nonSCI control group. 20 These findings imply a dose-response relationship between potential SCI related risk factors and bladder cancer.…”

“…4 Prior studies found that bladder cancer develops in people with SCI earlier than normal, at a mean age of 48 to 61 years, 5 and about 24% were diagnosed at less than 40 years old. 13 Our finding of a SMR of 20 in patients with SCI age 30 to 59 years is largely consistent with previous studies, and suggests that patients with SCI are exposed to risk factors earlier or to risks that are more pernicious.…”

“…4 The current estimate of bladder cancer incidence, calculated as the number of new bladder cancer cases identified during the study period divided by the total number of SCI cases, is highly variable (0.1% to 10.0%). 5 However, the mortality risk of bladder cancer has not been consistently addressed in the SCI literature. Groah et al calculated a standardized mortality ratio based on 12 bladder cancer deaths in a study of 3,670 patients with SCI, resulting in a 70 times increased mortality risk compared to the general population.…”

Immunological basis in the pathogenesis and treatment of bladder cancer

“…The production of oxygen species in inflamed tissues has also been shown to promote the formation of mutations in cancer cells. Inflammation of the urethra and bladder is seen in infection, like schistosomiasis, but there are several non-infectious causes, including benign prostatic hyperplasia (BPH), extended use of indwelling catheters and bladder, kidney and ureter stones [14,16–19]. Both schistosomiasis and indwelling catheters are believed to promote the development of bladder cancer due to the induction of epithelial hyperplasia, which results from chronic irritation (Figure 1).…”

A case report of squamous cell carcinoma in a suprapubic urinary catheter tract: surgical excision and simultaneous colostomy formation

“…However, the incidence increases with concomitant spinal cord injuries particularly in those with long-term catheters [1, 2]. …”