Advanced squamous cell carcinoma of the bladder ,

What is next?

Advanced squamous cell carcinoma of the bladder ,

What is next?Saleh A. Binsaleh

IntroductionIntroduction

Squamous cell carcinoma of the bladder accounts for only 1% of all bladder cancers in England,up to 7% in the States, 75% in Egypt.

Bilharzial and non-bilharzial.

Bilharzial SCCBilharzial SCC

Bilharzial type associated with chronic infection with S.haematobium.

Pts usually 10-20 yrs younger than those with TCC.

Usually well-differentiated, with low incidence of lymph nodes and distant metastases.

Non-bilharzial SCCNon-bilharzial SCC

Caused by chronic irritation from urinary calculi,long-term indwelling catheters,chronic urinary infections,or bladder diverticula.

Up to 80% of paraplegics with chronic infections or indwelling catheters have squamous changes in the bladder.

About 5% develop SCC.

SCCSCC

Several reports suggest that stage for stage, the prognosis of SCC, is comparable to that of TCC.

But in general, SCC prognosis is poor because most pts have advanced disease at the time of diagnosis.

Advanced SCC, What is next ?Advanced SCC, What is next ?

Cystectomy. Effective adjuvant chemotherapy is not

available. Role of pre,and post op. radiotherapy? Little have been done to evaluate the

role of preop radiation for advanced SCC of the bladder.

Swanson, et alSwanson, et al

M.D. Anderson cancer center J.Urol 1990;143(1) 25 pts with muscle invasive SCC of the bladder

treated with preop. Radiation and cystectomy. Stages T2,T3a,T3b 5 yrs survival rate for all was 50%. Pelvic recurrence was the predominant cause

of death. Irradiation pre cystectomy may protect against

pelvic recurrence.

Wang ,et alWang ,et al

Chang Gung memorial hospital,Taiwan Changgeng Yi 1998; 21(4) Retrospective study of 22 pts with SCC

of the bladder, treated between 1986-1996,follow up period 12-111 months.

Treatment modalities included: TURBT,radical cystectomy,preop. Radiation then cystectomy,partial cystectomy.

Wang ,et al (cont.)Wang ,et al (cont.)

The overall 5yrs survival rate was 9% 2 yrs survival rate was only 27% Pre op RadRx then cystectomy resulted

in 5 yrs survival rate of 12.5% Total cystectomy alone resulted in 5 yrs

survival rate of 0% The difference between the 2 groups

was not statistically different.

Daehlin, et alDaehlin, et al

Gade Institute, University of Bergen, Norway.

Scand J Urol Nephrol 1991;25(4)13 pts with muscle-invasive SCC.

One third of the patients were irradiated, either before cystectomy or as a full course radiotherapy.

The 1-yr and 5-yrs survivals were 25 and 17%, respectively. Only cystectomized patients were alive after 5 years.

Maruf,et alMaruf,et al

J Urol 1982 Dec;128(6) Report of a case of stage D, poorly differentiated

invasive squamous cancer of the bladder. transurethral resection of the tumor (170 gm.). the patient received 6,500 rad external

radiation. After completion of radiation the bladder was

converted from an inoperable (fixed to the pelvis) to an operable (mobile) condition.

Maruf,et al (cont.)Maruf,et al (cont.)

A cystectomy was performed and the patient was without evidence of disease 4 years later.

ConclusionConclusion

SCC of the urinary bladder is a rare entity. The overall prognosis for pts with metastatic

or locally advanced disease is poor. Yearly cystoscopy inspection for spinal cord

injuried pts with chronic or recurrent UTI has been advocated.

Pre op. radiation treatment may protect against pelvic recurrence.

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