Cancer of the Bladder in South East Nigeria: Epidemiological Patterns in a Low Resource Region

Background: Bladder cancer (CAB) is a urological malignancy that significantly contributes to morbidity and mortality, especially when detected late. Aim: This study highlights the challenges of late presentation and changing histological trend of the condition in a low resource region. The objectives were to establish the relationship between demographic factors, and to elucidate some characteristics of histological patterns in our region. Methods: A retrospective cohort study of all cases of bladder cancer seen at our facility between 2011 and 2015 was carried out utilizing data from patient case notes. Extracted data was analyzed using descriptive statistics. Results: A total of 18 cases of histologically confirmed bladder cancer were reviewed-12 males (66.7%) and 6 females (33.3%), with a male to female ratio of 2:1. The patients were aged between 19 and 78 years. Majority were petty traders (44%). Transitional cell carcinoma (TCCAB) was confirmed in 12 cases (66.7%) and squamous cell cancer (SCCAB) in 6 cases (33.3%). Majority of the cases of SCCAB were seen in patients below 30 years of age (66.7%) while majority for TCCAB were above 50 years (91.7%). The commonest presenting complaint was total, painless haematuria with associated clots (77.8%) with average duration from time of onset to presentation at this facility of 2 months and 3 weeks for SCCAB and 17 months for TCCAB. Hemoglobin level at presentation was between 6-8 g/dl in 44.4% of cases. Majority seen on abdominal ultrasound scan and cystoscopy were flat masses (61.1%). Most cases were stage I for TCCAB (58.3%) and stage II for SCCAB (83.3%), while 11.1% were metastatic requiring chemotherapy. There was one case of recurrence (stage II) within the first year of follow up. Conclusion: TCCAB is taking an increasing prominence relative to SCCAB in the region. Effective treatment of bladder cancer is highly dependent on early presentation and diagnosis, and prevention entails prompt risk factor identification and intervention.