CHAPTER 42 Squamous Cell Carcinoma and Adenocarcinoma of the Bladder
Non-transitional cell carcinoma (non-TCC) makes up what percentage of bladder cancers in developed nations?
Less than 10% of all bladder cancers in developed nations are non-TCC.
Are non-TCCs considered more aggressive or less aggressive than TCC of the bladder and by how much?
Non-TCCs of the bladder typically present at a more advanced stage and setting than TCC and are almost always invasive. The 5-year relative survival of squamous cell carcinoma (SCC) patients is less than half the figure for TCC, while the survival for adenocarcinoma is roughly 25% lower than TCC.
Why is SCC of the bladder an important public health problem in Egypt?
In Egypt, where schistosomiasis is endemic, about 80% of SCCs of the bladder are caused by Schistosoma haematobium.
Is schistosomiasis only associated with SCC?
No, schistosomiasis also increases the incidence of TCC of the bladder.
Can SCC coexist with TCC?
Yes, transitional epithelium has tremendous metaplastic potential and therefore SCC elements are also frequently seen with invasive TCC.
What is the difference between SCC and TCC with squamous differentiation?
The diagnosis of SCC should be reserved for tumors with exclusive or predominant squamous differentiation.
How does SCC of the bladder typically present?
Most patients have irritative voiding symptoms with or without gross hematuria.
What are the cystoscopic and histological characteristics of SCC of the bladder?
SCCs of the bladder are almost always solitary lesions and tend to be sessile and ulcerated. They are well differentiated and have a low incidence of lymph node and distant metastases. Bilharzial lesions are less likely to be stage T4 and are usually bulky, nodular, and located in the upper hemisphere of the bladder.
What are the proposed risk factors nonbilharzial squamous cell cancers?
Reported risk factors include African American race, cigarettes smoking, chronic irritation of the bladder mucosa from bladder calculi or long-term indwelling Foley catheters, chronic urinary infectious, bladder diverticula, cyclophosphamide exposure, and intravesical bacillus Calmette–Guerin (BCG).
What is the proposed carcinogenic mechanism?
This is not completely understood, but could be the result of formation of nitrite and N-nitroso compounds that result from parasitic and bacterial metabolism.
What other patients are found to have squamous epithelium in their bladder?
Vaginal type nonkeratinizing stratified squamous epithelium is commonly found in the trigone of many women and in men receiving estrogen for prostate cancer. These patients should not be diagnosed with squamous metaplasia.
What patient populations are at greatest risk for the development of squamous metaplasia?
Eighty percent of paraplegic patients are found to have squamous metaplasia of the bladder.
In squamous metaplasia, is keratinization considered a good or bad prognostic sign?
Keratinization is somewhat ominous because it is more closely associated with carcinoma; 21% progress to malignancy.
What is the name of the above condition?
Leukoplakia.
How should these patients be followed?
Patients with biopsy-proven keratinizing squamous metaplasia of the bladder should have periodic (at least yearly) cystoscopy and urine cytology examinations.
What percentage of paraplegic patients with squamous metaplasia will go on to develop SCC?
Approximately 5% of paraplegics with squamous metaplasia will go on to develop SCC and 21% if keratinization is present.
What other patient populations are at risk for SCC of the bladder?
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