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Abstract
Superficial bladder tumors are an important entity since they form
the vast majority of bladder tumors, particularly in non-bilharzial
patients. Another important aspect is that these lesions are potentially
curable when recognized early and adequately treated.
Many factors arc reported to be causally related to bladder
cancers development and progression such as occupational exposure to
aromatic amines or dietary nitrites and nitrates, cigarette smoking (up to
fourfold higher incidence of bladder cancer ) and coffee and tea
drinking,analgesic abuse and chronic cystitis in the presence of
indwelling catheters, calculi or schistosoma haematobium cystitis.
Two variants of bladder carcinoma are recognized: The superficial
papillary and muscle invasive types. Urothelial carcinoma are further
classified according to the degree of cellular anaplasia i.e. the grade of
the tumor. This system depends predominantly on cytological features,
namely loss of polarity, variation in shape and size of cells, crowding of
cells, and nuclear changes. Grade I shows the least degree of atypia,
grade III shows the most degree of atypia while grade II is intermediate in
its cytological abnormalities.
The highest incidence of bladder carcinoma associated with
bilharziasis comes from Egypt. In Egyptian series, the median age is 46
years. There is a lag period of about 30 years between initial infestation
with bilharziasis and subsequent development of bladder carcinoma. The
male to female ratio is 5: I.
Diagnosis of bladder cancer involves not only establishment of the
presence of disease but also identification of factors that characterize its
behavior and predict its course to aid the clinician in the planning of
treatment. The most common presenting symptom of bladder cancer is
haematuria, which occurs in about 85% of patients.
Cystoscopy & biopsy make the diagnosis and initial staging of
bladder cancer.
Other investigations include urine cytological studies and imaging
techniques as excretory urography, ultrasonography, computed
topography, magnetic resonance imaging, chest radiography and bone
scan.
The treatment of superficial bladder tumors has three objectives:
Eradication of existing disease, prevention of recurrence and prevention
of progression to invasive disease.
Most patients with superficial bladder cancer can be adequately
treated with transurethral resection of the tumor. Adjuvant intrarvesical
chemotherapy as: thiotepa, epodyl, mitomycin-C and adriamycin or
intrarvesical immuotherapy using BeG, mterfcron. Other lines may also
be used in special circumstances include photodynamic and laser therapy.
The ideal follow up for patients with superficial bladder cancer
after endoscopic resection and treatment IS cystoscopy and urine
cytologic examination every 3 months for 18 to 24 months, every 6
months for the 2 years following that and annually thereafterWhen correctly managed, the overall survival rates for these patients are
excellent approximately 70% 5-ycar overall survival .with most patients
who expire doing so from non-bladder cancer causes ( Nichols and
Marshall /956; Barnes et al ; /l992 ). About these patients ultimately
require more aggressive therapy.