Bladder cancer in spinal cord injury patients

Abstract

Objective: Spinal cord injury is a known risk factor for bladder cancer. The risk of bladder cancer has been reported at 16-28 times higher than the general population. Earlier studies have identified indwelling catheters as risk factors. We examined the characteristics of bladder cancers in a spinal cord injury (SCI) population. Setting: Long Beach VA Hospital Spinal Cord Injury Unit, Long Beach, California Methods: We reviewed SCI patients seen and diagnosed with bladder tumors between January 1983 and January 2007. Data collected included time since diagnosis, method of diagnosis, form of bladder management, pathologic type, treatment of the tumor, and outcome. Results: A total of 32 patients with bladder cancer were identified out of 1319 seen. Tumors found were 46.9% squamous cell carcinoma (SCC), 31.3% transitional cell carcinoma (TCC), 9.4% adenocarcinoma, and 12.5% mixed TCC and SCC. The primary form of bladder management was 44% urethral catheter for a mean of 33.3 years, 48% external catheter for a mean of 37.4 years, and 8% intermittent catheterization for a mean of 24.5 years. Nineteen patients had a known method of cancer detection with 42% found on screening cystoscopy. Conclusions: The pathologic makeup of the tumors is similar to that reported earlier. Over 50% of patients diagnosed with bladder cancer in our population did not have an indwelling catheter. This suggests that the neurogenic bladder, not the indwelling catheter, may be the risk factor for bladder cancer. Urologists should consider diligent, long-term screening of all patients with SCI for bladder cancer and not just those with indwelling catheters.

Squamous cell carcinoma of the suprapubic tract: A rare presentation in patients with chronic indwelling urinary catheters

“…The late presentation of his disease is in keeping with observed trends of bladder cancer development in the SCI population. 3,5,6 In contrast, the female patient in this series developed SCC at the suprapubic tract only 9 months after catheter placement. In the latter case, it is difficult to explain such an early presentation of SCC.…”

“…1 In the setting of chronic indwelling catheters in the SCI population, it accounts for 10 times more cases of bladder cancer, with an estimated incidence of 2% to 10%. [3][4][5][6] Rarely, in the setting of chronic suprapubic catheterization, SCC may arise primarily from the suprapubic cystotomy tract. Similar to primary SCC of the bladder, SCC of the suprapubic tract likely arises from chronic irritation and inflammation of the tract and surrounding skin.…”

“…2 A higher incidence of SCC in the spinal cord injury (SCI) population has been documented on the order of 2% to 10% beyond 10 years of catheterization. [3][4][5][6] Among patients with SCI, about 50% of cases of primary bladder cancer are SCC. 5 The risk is thought to stem from irritation and inflammation related to the chronic use of both urethral and suprapubic catheters, 3,7 chronic infections, 8 bladder stones 8 or, possibly, the inherent pathology of the neurogenic bladder itself.…”

“…[3][4][5][6] Among patients with SCI, about 50% of cases of primary bladder cancer are SCC. 5 The risk is thought to stem from irritation and inflammation related to the chronic use of both urethral and suprapubic catheters, 3,7 chronic infections, 8 bladder stones 8 or, possibly, the inherent pathology of the neurogenic bladder itself. 5 Although patients requiring long-term indwelling catheters are at increased risk of developing SCC, those with suprapubic catheters may more rarely develop SCC arising primarily from the suprapubic tract itself.…”

“…[10][11][12][13] The average time from catheter placement to presentation was 31 years, which is in concordance with the typical time of presentation of SCC in the chronic indwelling catheter population. 3,5,6 Only 1 case demonstrated evidence of intravesical disease, 13 while another demonstrated extension, but not penetration of SCC into the detrusor muscle.12 Four cases were treated with wide excision 9,10,12,13 and either partial 9,10 or radical 12,13 cystectomy, with or without neoadjuvant radiotherapy. Palliative radiotherapy was provided to the remaining patient who had positive nodal and metastatic disease on CT.…”