Does Bladder Cancer Pathology Matter in Prognosis and Treatment

Context: Neuroendocrine tumors of the bladder are rare, accounting for 0.35- 0.7% of all bladder cancers. Small cell carcinoma of the bladder is a type of neuroendocrine tumor, and it accounts for 0.5- 1% of all tumors of the bladder in some reports, and 0.53% other reports. It is a highly aggressive tumor that presents with nonspecific symptoms. Overall survival of non-metastatic disease is estimated to be about 20.7 month. The survival rate becomes much lower in metastatic disease, with 1-year survival rate about 30%. Case Report: A 74-year-old ex- smoker male patient presents to the hospital with the chronic complaint of back pain, and a new complaint of urine retention and dark urine. Lumbar spine MRI showed extensive vertebral metastasis and spinal canal stenosis. Cystoscopy showed a large bladder tumor with evident muscle invasion (clinical T3 stage by cystoscopy). Further evaluation showed liver, osseous, adrenal and retroperitoneal metastasis in addition to diffuse bony involvement. The patient received palliative radiotherapy in addition to 4 cycles of chemotherapy (carboplatin- etoposide) with subsequent progression. The patient was planned to start Nivolumab immunotherapy, however, he passed away before that. Conclusion: SCCB is a highly malignant NET, usually presenting with symptoms suggestive of advanced disease. Bad prognostic factors include age >60 ears, metastatic disease, local vascular and perineural invasion. Clinical trials addressing specifically SCCB and its treatment are rare. SCCB is often treated according to small cell lung cancer guidelines with platinum-based and etoposide chemotherapy, with poor outcomes in metastatic disease. Some clinicians consider immunotherapy with (Nivolumab) as a last resort in addition to palliative radiotherapy.