CLINICO-PATHOLOGICAL PATTERN, CLASSIFICATION AND STAGING OF URINARY BLADDER CARCINOMAS - A FIVE YEARS EXPERIENCE AT A TERTIARY CARE HOSPITAL IN CENTRAL PUNJAB

Authors

  • Amjad Naeem
  • Nadia Naseem
  • Sadia Anwar
  • Seema Butt
  • Abdul Hanan Nagi

Abstract

Background: In Pakistan, urinary bladder carcinoma is the 8th commonest malignancy while being the fourth commonest cancer in men. The relative occurrence of a particular histological type of bladder carcinoma depends on the clinical setting. Both grade and stage of these cancers are highly correlated with recurrence, progression and patient survival rates. Methods: This cross-sectional study comprised of 122 patients with newly diagnosed operable primary bladder carcinomas who underwent cystoscopy associated transurethral resection of bladder tumour at the Urology Department of Punjab Employees Social Security Hospital, Lahore. All participants completed a detailed questionnaire and underwent an in-depth interview to obtain data. The surgical specimens were referred to the Pathology department. Gross observations of the tumour recorded. Result: A total of 114 cases, classified according to WHO/ISUP criteria, low-grade papillary lesions, comprising Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) and Papillary Low Grade carcinomas, accounted for 43% of tumours. Male to female ratio being 5.3:1 (74%). Lateral walls were involved in 44%, posterior wall in 25.3%, trigone in 10.7%, bladder neck in 7.2%, dome in 5.8%, ureteric orifice in 4.13%, anterior wall in 2% and left ureter in 0.87% cases. Tumour staging revealed an overall 11.5% of tumours with stage Ta and 31.5% with stage T3-4. About 29% tumours were non invasive. About n=13 of low-grade carcinomas and n=68 of high-grade carcinomas were invasive. For tumours classified by WHO/ISUP criteria, the percentage of women was larger for PUNLMP than for the other categories of urothelial tumours (p-value 0.006); no statistically significant difference was found by age or gender with respect to tumour stage (p-value 0.138 and 0.452). Conclusion: Transitional Cell Carcinoma (TCC) is the commonest among middle aged men.Keywords: Urinary bladder carcinoma, Tumour, transitional cell carcinoma, urinary bladder

References

Parkin DM. The global burden of urinary bladder cancer. Scand J Urol Nephrol Suppl 2008;218:12–20.

Ploeg M, Aben khk, and Kiemeney AL. The present and future burden of urinary bladder cancer in the world. World J Urol 2009;27:289–93.

Khan SM, Gillani J, Nasreen S, Zia S. Cancer in North West Pakistan. Pak J Med Res 1996;35:167–9.

Ahmad J, Hashmi MA, Naveed IA, Hussain A, Amin D. Spectrum of malignancies in Faisalabad. Pak J Pathol 1992;3:103–10.

Landis SH, Murray T, Bolden S, Wingo PA. Cancer Statistics. Cancer J Clin 1999;9:8–31.

Hasan MS, Imtiaz F. Frequency of transitional cell carcinoma in local suburban population of Karachi. J Liquat Uni Med Health Sci 2007;2:83–5.

Schned AR, Andrew SA, Marsit JC, Kelsey KT, Zens SM, Karagas RM. Histological classification and stage of newly diagnosed bladder cancer in a population-based study from the Northeastern United States. Scand J Urol Nephrol 2008;42:237–42.

Vineis P, Simonato L. Proportion of lung and bladder cancers in males resulting from occupation: a systematic approach. Arch Environ Health 1991;46:6–15.

Johansson SL, Cohen SM. Epidemiology and etiology of bladder cancer. Semin Surg Oncol 1997:13:291–8.

Epstein JI, Amin MB, Reuter VR, Mostofi FK. The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol 1998;22:1435–48.

Greene LF. AJCC cancer staging handbook: from the AJCC cancer staging manual. American Joint Committee on Cancer, American Cancer Society. Boston: Birkhäuser; 2002. p. 368–70.

Khan AH, Khan SA, Chaudrhy NA, Tayyab M. Argyrophilic Nuclear Organiser Regions (AgNORs). Pattern in Different Grades of Transitional Cell Carcinoma of Urinary Bladder. Annals 2008;14:186–90.

Goonewardena SAS, De Silva WAS, De Silva MVC. Bladder cancer in Sri Lanka - Experience from a tertiary referral center. Int J Urol 2004;11:969–72.

Rafique M. Clinico-pathological features of bladder carcinoma in women in Pakistan and smokeless tobacco as a possible risk factor. World J Surg Oncol 2005;3:53.

Ather MH, Alam Z, Sulaiman MN, Khurrum JA, Siddique M. Patient's Outcome of bladder cancer managed by radical cystectomy. J Pak Med Assoc 2007;57:536–8.

Huben RP, Mounzer AM, Murphy GP, Tumour grade and stage as prognostic variables in upper tract urothelial tumours. Cancer 1988;62:2016–20.

Cheng L, Montironi R, Davidson DD, Lopez-Beltran A. Staging and reporting of urothelial carcinoma of the urinary bladder. Mod Pathol 2009;22:70–95.

Wolf H, Olsen PR, Hojgaard K. Urothelial dysplasia concomitant with bladder tumours: a determinant for future new occurrences in patients treated by full-course radiotherapy. Lancet 1985:1(8436):1005–8.

Ploeg M, Katja K, Aben H, Kiemeney AL. The present and future burden of urinary bladder cancer in the world. World J Urol 2009;27:289–93.

Johansson SL, Cohen MS. Epidemiology and etiology of bladder cancer. Semin. Surg Oncol 1997;13:291–8.

Published

2015-03-01

Issue

Vol. 27 No. 1 (2015): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.