Predictive value of excretory urography, ultrasonography, computerized tomography, and liver and bone scan in the staging of bilharzial bladder cancer in Saudi Arabia

Abstract

The role of ultrasonography, computed tomography (a), and radioisotopic scanning in the staging of bilharzial bladder cancer has not been reported previously. Forty patients with invasive bladder cancer seen at the King Faisal Specialist Hospital and Research Centre between January 1978 and June 1981 underwent complete preoperative workup for staging of their tumors prior to radical cystectomy. The preoperative radiologic investigations included excretory urography (IVP), ultrasonography (US), CT of the pelvis, and liver and bone scans. The results of these investigations were compared with the operative and pathologic staging. Ninety‐three percent of the patients with bilharzial cancer had evidence of ureteric obstruction on IVP compared with 22% of the nonbilharzial cancer patients. The presence of ureteric obstruction in these patients did not correlate with the stage of the disease with 83% of the patients with superficial tumors (TI and T2) having hydroureteronephrosis. Ultrasonography and CT had an 83% accuracy in the staging of superficial tumors. Stage T3 tumors were understaged in 14% of the cases. Ultrasonography did not differentiate Stages T3 and T4 tumors while CT scan differentiated these two stages in 57% of the cases. Bone scan failed to reveal evidence of metastatic disease in any of the bilharzial cancer patients. Liver scan was suspicious for liver metastases in two patients with bilharzial cancers in whom open liver biopsy revealed only hepatic bilharziasis. Of all the radiographic studies, US or preferably CT scan seem to be of some value in the staging of bilharzial tumors localized to the bladder. Bone and liver scans are probably of no cost effective benefit.

Schistosomiasis in Saudi Arabia

“…Subsequent studies [11][12][13][14][15][16][17] have been of a clinical nature. They shed light on some features of the pathology, diagnosis, and epidemiology of the disease.…”

“…On the contrary, Hanash et al 17 reported 30 patients with bilharzial bladder cancer. Cutajar 15 found that schistosomiasis does not appear to be a significant etiologic factor in urolithiasis, which has a high incidence in Saudi Arabia.…”

Cancer in Saudi Arabia

“…The authors attributed the difference to the endemicity of schistosomiasis in Asir. Hanash et al 29 reported bilharzial bladder cancer in 30 of 40 bladder cancer patients seen at King Faisal Specialist Hospital (1978)(1979)(1980)(1981).…”

Urological Cancers in Asir Region

“…Advanced disease was seen in 80%, 85%, 57%, and 71% of bladder, prostate, kidney, and testis, respectively, which compares with the findings of Hanash et al [4].…”