Profile and treatment outcome of patients with carcinoma of bladder as seen at Muhimbili National and Tumaini Hospitals, in Dar es salaam, Tanzania

Abstract

Introduction -Bladder cancer is ninth in worldwide cancer incidence. Approximately 356,000 new bladder cancer cases occurred worldwide in 2002. Globally men are more commonly affected than women with a male/female ratio of 10:3. The incidence rate in Tanzania is projected to be more than 3.7/100, 000], but more than 90% of new cases occur in persons 55 years of age or higher [1]. Globally it is estimated that 145,000 patients die from bladder cancer annually. Cigarette smoking and occupational exposure to urothelial carcinogens are the main risk factors in the US and Europe, but Schistosoma haematobium infestation is the main risk factor in Schistosoma endemic areas. Bladder cancer presents with haematuria and irritative symptoms. Transitional cell carcinoma is the commonest histological finding in the developed world and squamous cell carcinoma is associated with Bilharzial bladder cancer are more in the developing countries. Objectives- This study documents on the profile and early treatment outcome of patients with carcinoma of the urinary bladder as seen in two hospitals (Muhimbili National hospital and Tumaini) in Dar es Salaam from March 2012 to December 2012. Methodology – A descriptive, prospective, hospital-based study involving observation of patients from admission to outcome of management at discharge or death was carried out. Consecutive admissions of patients with bladder cancer attended at urology unit at the department of surgery Muhimbili National Hospital, and Tumaini hospital were enrolled in the study. The study was conducted from March to December 2012. The data were analyzed using SPSS version 16 software. Results: A total of 67 bladder cancer patients were enrolled during the study period. Males were 25 and females were 42 with male to female ratio of 1:1.7. The age range was from 30 to 80 years with the mean age of 54.31 years. Twenty two patients (32.8%) were in the age group of 60 to 69. Fifteen (34.9%) of patients in age group between 60 and 69 lived in high risk areas and twenty one (35.6%) in the same age group had high risk occupation. Cigarette smoking and Schistosoma infestation were common associated factors among patients who had squamous cell carcinoma. All patients who had transitional cell carcinoma presented with blood in urine while 39(58.2%) of squamous cell carcinoma patients had blood in urine as their clinical presentation. The ultrasound scan was able to pick bladder mass in 60 patients among the 67.However cystoscopy detected tumour in all 67 patients. There were four histological types in all patients of bladder cancer, squamous cell carcinoma 47 (70.1%), transitional cell carcinoma 16(23.9%), Adenocarcinoma 3 and Adenosquamous 1. the tumours were either well or moderately differentiated. In this study nearly half of the patients presented with clinical stage 4 diseases (46.3%). Among all 67 patients 13 (26.5%) had cystectomy and 3 (6.1%) had TURBT, the rest had palliation either in the form of chemoradiotherapy or home palliative care (16(12.2%) and 27 (55.1%) respectively. Anaemia was the leading complication (30.5%). Among 67 bladder cancer patients 33 (49.3%) died. Five (15.2%) died of renal failure and 18 (54.5%) died of advanced bladder cancer. There was no patient who absconded as all patients were called using either their personal telephone number or their close relative’s telephone number. Conclusions: Women were more affected by the disease than men, Schistosoma infestation was the commonest risk factor for bladder cancer development. Haematuria was the commonest clinical presentation followed by irritative urinary symptoms; the disease was detected by ultrasound scan which was readily available, and affordable. Punch biopsy was the leading method of obtaining tissue specimen for histology diagnosis, and SCC was the leading histological type of bladder cancer. Most of the patients came at an advanced stage, thus few of them had surgical treatment. Wound sepsis and dehiscence were the commonest complication for those who underwent cystectomy and urinary diversion, and 49% of all patients died before treatment.

Recommendations: The findings of this study with limitation of short duration have come up with the following recommendations:  There is a need for a long duration study especially to get proper treatment outcome of a disease  Monitor for possible exposure to Schistoma heamatobium infestation and advice the prevention measures.  Mass campaign for possible elimination of Schistoma heamatobium infestation.  Early diagnosis of patients with bladder cancer will improve their treatment outcome.  Create awareness to primary and secondary referring health facilities on early diagnosis of bladder cancer.  CT scan for clinical staging of a disease can be used to supplement examination under anesthesia for clinical staging of a disease.