Carcinoma
of the urinary bladder is the most prevalent cancer in most African countries.
In Egypt, bladder cancer represents the most common malignancy among Egyptian
males and previously has been attributed to Schistosoma infection, a major risk factor for
squamous cell carcinoma (SCC). Recently, urothelial carcinoma (UC) incidencehas been increasing while SCC has declined. About 85% of patients with
urothelial bladder carcinoma present with nonmuscle invasive urothelial tumours
(NMIUC) at first presentation, whereas the remaining 15% of primary tumours are
already muscle invasive (MIUC). After being removed by transurethral resection
(TUR), NMIUC will recur in up to 70% of patients and up to one third of pT1
tumours will eventually develop a progression to muscle invasive disease. Patients
with bladder cancer therefore have to be monitored thoroughly for disease
recurrence and progression. This makes bladder cancer one of the most expensive
cancer types for the health care system.
Early
detection of recurrent cancer is crucial to improve the treatment outcome.
Consequently, regular follow-up for patients with NMIUC is mandatory. The tension
on patients and the burden on health-care providers for life-long follow-up are
great. There are classical methods for follow-up purposes as urine cytology and
regular cystoscopy. Although cystoscopic biopsy is the most accurate diagnostic
tool for detection of recurrent cancer, and currently is the standard of choice,
cystoscopy may still miss tiny tumors, and also lead to false-negative results.
Also, importantly, cystoscopy is invasive, and associated with morbidity, which
is the main reason preventing patients from being regularly followed-up. Voided
urine cytology is the most commonly used noninvasive follow-up diagnostic tool.
In urine cytology, cells present in voided urine are examined and described as
being positive or negative for the presence of malignant cells, atypical or having
suspicious cells present.(Read more)
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