engleski

Review: treatment and basic epidemiological consideration on patients treated for bladder and collecting system carcinoma over last 10 years at our department

Introduction: Both bladder cancer or cancer of kidney collecting system and urether have always been a specific issue at our department. An incidence of bladder cancer is on high rise in last few years in Croatia showing a 2-3 fold rise in number of new cases. Relatively known toxic agents that can cause bladder cancer, together with better understanding of gene aberrations have given us a needed perspective of this problem. Symptoms are relatively specific, and what is more important are very obvious. A wide spectrum of treatment options can assure us that every patient will get best and specific care for its disease, modeled by every patient life style and of course a disease itself. An endemic nephropathy is a disease specific for our region and it’ s shown that a greater risk for urothelial carcinoma is common with this condition. All above is a warning for better control and understanding of our patients treated for bladder or collecting system urothelial cancer. Materials and methods: Operating protocols, patient’ s charts, ambulance charts and other associated material of each operated patient at our clinic has been used. We included in our analysis selected tumors: 1.Urothelial cancers of the kidney in last 10 years. 2. Cancer of the bladder in last 10 years for those treated with TUR and in last 20 years for those treated with cystectomy. Results: A total of 84 patients have been operated for urothelial tumor of kidney collecting system and urether with average age of 70, 2 years for all patients, average age is same for male and female patients, and slight predominance of female patients (52 F: 31 M). In all patients a transitiocellulare carcinoma was found. Transurethral resection, electro coagulation or cystectomy due to bladder cancer was reason for operation in 1079 cases. In 41 patients a cystectomy was performed with high predominance of male population (34 vs. 7 female) with average age 58, 6 years. Formation of ileum conduit was done in 34 patients ; one neo bladder was made, while other types of urine derivation were done (Coffey, ureterocutaneostomy) in 6 patients. A transitocellulare carcinoma was found in 81, 5 % and in 18, 5% a planocellulare carcinoma. Total of 1038 operations was made by means of transurethral resection or electro-coagulation (EC). Of those TUR was made in 802 cases and EC in 236 cases, EC is in more then 85% done when a small recidive tumor is found. We had high predominance of male population in sample: 619 male patients and 183 female. Average age of those treated by TUR or EC was same: 66, 3 years. Grading and TNM staging for patients treated with different types of operations is shown on table 1. and table 2. In 10, 5% of patients treated with cystectomy a positive regional lymph nodes were found. We had two postoperative deaths in patients with cystectomy performed. Recurrence rate is over 60%. Discussion: Incidence of bladder cancer is not high, but it is on constant rise. We have a small but constant number of 2-3 cystectomies per year. More than one fact is account for that: long preclinical period of disease, following co morbidity, patients’ refusal to a radical procedure… In those in whom we perform a radical operation, often a local invasion is found thus making ileum conduit ideal choice for urine derivation. All data for bladder cancer are as expected, but recurrence rate of 60% is somewhat higher then cited (1, 2, 3). Explanation for a high recurrence rate can be found in different postoperative therapy protocols within hospitals, since a significant number of outside patients are treated within our clinic, but discharged for later care in primary hospital. A large number of urothelial carcinomas of kidney collecting system and urether could be explained by presence of endemic uropathy in our region (1, 2).

bladder cancer; transitional epithel; epidemiology; treatment

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