Carcinoma of the Urinary Bladder in Patients Receiving Cyclophosphamide

Abstract

Hemorrhagic cystitis is a common side effect of cyclophosphamide therapy not observed with other alkylating agents. In five patients receiving cyclophosphamide by mouth for prolonged periods with large cumulative dosage urinary-bladder tumors fatal to four and requiring cystectomy in the lone survivor developed. These observations strongly suggest chemical carcinogenicity of this drug in the production of these tumors. Increasingly, cyclophosphamide is being used for non-neoplastic disease. These circumstances suggest careful follow-up observation of patients in whom hemorrhagic cystitis from this drug develops for evidence of bladder cancer, as well as restraint in use of cyclophosphamide for non-neoplastic diseases if alternative therapy is available.

Biological Degradation of Cyclophosphamide and Its Occurrence in Sewage Water

“…Besides its cytotoxic effects, CP possesses teratogenic and mutagenic properties (Nau et al, 1982) and is a known human carcinogen (IARC, 1975;IARC, 1981). Therefore, numerous studies were conducted to determine the potential health risk for cancer patients and medical personnel involved in chemotherapy with CP (Wall and Clausen, 1975;Jagun et al, 1982;Evelo et al, 1986;Haas et al, 1987;Sessink et al, 1992;Nieweg et al, 1994;Travis et al, 1995). In their review on disposal of antineoplastic waste Vaccari et al (1984) raised the question of how far antineoplastic drugs eliminated via the patient excreta do pose a threat to man and environment.…”

Urothelial toxicity following conditioning therapy in bone marrow transplantation and bladder cancer: Morphologic and morphometric comparison by exfoliative urinary cytology

“…'7-20 Although to our knowledge there have been no cases of bladder cancer developing in subjects undergoing conditioning therapy for BMT, there are various cases reported in the literature of urothelial carcinoma resulting from cyclophosphamide administration for other diseases. 17,20 After this therapy an increased risk of bladder cancer of 9-45 times has been found, with the incidence assessed at 1.8-2.7 percent in patients treated with this drug. '&I9 A recent review attributed 34 cases of bladder tumor to cyclophosphamide treatment.…”

A Rare Case Report of Pure Squamous Cell Carcinoma of Urinary Bladder

“…Squamous cell carcinoma occurs in a background of chronic cystitis [3] . Various reason for chronic cystitis are congenital anomalies like exostrophy, chronic infection, lithiasis, chronic indwelling catherization and parasitic infection [4] . Chronic cystitis leads to marked squamous metaplasia, which slowly undergoes dysplasia and develops into invasive malignancy.…”