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. 2016 Jan;8(Suppl 1):S2–S5.

Genitourinary Cancer (GUC)

PMCID: PMC4850758
Urol Ann. 2016 Jan;8(Suppl 1):S2–S5.

Urinary tract neoplasms in Sudan

A. Hidayatallia

Department of Radiotherapy and Oncology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan

Urinary tract neoplasms constitute 5% of all malignant neoplasms seen at the Sudan Cancer Registry (SCR) and 4.5% of those seen at the Radiation and Isotopes Centre, Khartoum (RICK).

In this study the clinical and epidemiological features of 244 bladder cancers and 179 kidney cancer referred for treatment at RICK during the period 1967-1968 are described. The geographical distribution and histological pattern of bladder cancer in Sudan suggests close association with bilharzial haematobium infection.

A relatively high ratio of nephroblastoma compared to renal cell carcinoma is noted. However, this appears to be the results of the young age structure of the population.

Presented at the: 5th Saudi Urological Conference King Fahd Military Medical Complex 22-23 March 1989

Urol Ann. 2016 Jan;8(Suppl 1):S2–S5.

Gamma/delta t-cells and immune response in urological cancers

S. Raziuddin, A. Ibrahim

Department of Urology, King Saud University, College of Medicine, Abha and Asir Central Hospital, Abha, Saudi Arabia

The immune system is an ideal weapon against cancer and infectious disease. Carcinoma of urinary bladder (CB) and carcinoma of the prostate (CP) are very often associated with schistosomiasis infection (S. haematobium) that affects a large population in Saudi Arabia in certain endemic areas. T-cells play a central role in orchestrating cell-mediated and humoral immune response in human disease through the release of specific cytokines. We demonstrate that two functionally different sub-populations of T-cells, alpha/beta T-cells and gamma/delta T-cells, distinguished by their pattern of cytokine/interleukin production might contribute to the immune response and disease pathogenesis in CB and CP. In particular, significant elevation of gamma/delta T-cells and their production of tumor necrosis factor-alpha (TNF) in circulation is an important factor in the multipotential cytokine involved in the mediation of a wide range of immunologic functions. It may exert its function in an autocrine, paracrine or endocrine fashion. Therefore, we believe that gamma/delta T-cells and TNF participate in the inflammatory response observed in these urological cancers.

Presented at the: 8th Saudi Urological Conference King Fahd Military Medical Complex 9-10 November 1993

Urol Ann. 2016 Jan;8(Suppl 1):S2–S5.

Urologic and male genital cancers: The Riyadh armed forces hospital experience

O. M. Koreich, K. E. Al Otaibi, F. Ammar

Department of Oncology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Urinary tract and male genital tract cancers are among the most frequent malignancies in the West. They account for over 28% of malignancies in the USA. In addition, cancer bladder accounts for over 25% of cancers in nearby Egypt, with the high incidence of Bilharziasis. In Saudi Arabia, the incidence is less frequent. At RKH, 412 cases of Urologic and Male Genital Malignancies were seen in the Oncology Department. It accounted for just over 7.5% of all cancers. Due to the structure of the society, and the open eligibility of cancer care at RKH, non-Saudi patients accounted for 32% of cases. The male to female ratio was 5:1 in Saudi and 6:1 in non-Saudi's. The distribution according to primary site and nationality was as follows:

graphic file with name UA-8-2-g001.jpg

Most cases of Bladder Cancer were referred from the southern region of Saudi Arabia, mostly associated with Bilharziasis and of transitional cell carcinoma histology. The rarity of prostatic cancer remains unexplained, though circumcision and good genital hygiene may be contributory factors. The relatively high incidence of testicular cancer in the non-Saudi could be explained by the young age group of the working foreign population. Factors involved in the aetiology and management will be discussed.

Presented at the: 7th Saudi Urological Conference Riyadh Armed Forces Hospital 11-12 November 1992

Urol Ann. 2016 Jan;8(Suppl 1):S2–S5.

Genito-urinary cancer in Saudi Arabia

M. S. Abomelha, A. A. Shaaban, M. T. Said, S. A. Orkubi, K. E. Al Otaibi

Department of Urology, Armed Forces Hospital, Riyadh, Saudi Arabia

The Saudi population is a young one. 49% of the inhabitants are below 15 years of age. The percentage of population above the age of 65 is only 2.6%. The incidence of genito-urinary cancer (GUC) is very low compared to developed countries. GUC accounts for only 9.2% of all cancer cases reported by the National Cancer Registry (NCR) in its 1994 report. None of the GUC is among the commonest ten cancers in the country.

We present our 15 years experience with 508 GUC patients between 1980 and 1994. Out of the 508 cancers, 49.6% were bladder, 21.6% kidney, 20.4% prostate, 6.4% testicular and 1.7% other cancer cases. Our presentation is in agreement with GUC reports by Koreich 1992, Shetty 1993, and NCR 1994.

We conclude that the incidence of genito-urinary cancer in Saudi Arabia is as low as 9.2% of all cancer cases. The commonest GUC is bladder, followed by kidney, prostate and testicular cancer, Penile cancer is very rare. The majority of GUC cases are in advanced stage at time of diagnosis.

Presented at the: 11th Saudi Urological Conference King Fahd Military Medical Complex - Dhahran 24-26 February 1998 (27-29 Shawwal 1418)

Urol Ann. 2016 Jan;8(Suppl 1):S2–S5.

Evaluation and follow up of patients with urologic cancer

Peter Ekman

Department of Urology, Karolinska Hospital, Stockholm, Sweden

Following surgery and other therapeutic approaches for urological malignancies, a careful follow-up is essential. The follow-up aims at early detection of recurrencies but serve also the purpose of giving the patient a change to consult about possible complications to the treatment given. It is also of academic interest to study the results of various treatment alternatives. There is, however, no consensus how often check-ups should be made in various malignancies, nor exactly which tests and examinations should be done at each check-up. To the patient, the control gives a feeling of safety, provided everything seems OK. At the same time, every follow up visit causes anxiety with regard to the outcome. Therefore, check-ups should not be made more often than necessary, and not too seldom so possible recurrencies go beyond treatment. The following recommendations reflect the general attitude in Northern Europe.

Renal Cell Carcinoma: Unfortunately, following radical nephrectomy, possible recurrencies can not be cured by anything but repeat surgery. Since renal cell carcinoma can recur virtually in any organ in the body, check-ups can be made only with regard to the most common site, namely the lungs. Apart from this, only local symptoms can guide the patient and physician where to look for recurrencies. The recurrencies usually occur the first couple of years, but have also been reported beyond 10 years of follow-up. We recommend regular follow-ups at 3 months intervals the 2 first years, at 6 months intervals the next 3 years, thereafter on a yearly basis till 10 years follow-up. The check-ups include pulmonary x-ray and general physical examination, plus simple blood tests, including liver tests. However the last investigations are more of psychological character and could be omitted.

Prostate Cancer: Prostate cancer is even more disputable. If we know that early secondary treatment indeed led to a prolonged survival without impairing the quality of life, check-ups with PSA should indeed be an excellent help. However, since as of today, we have little indication that early treatment prolongs survival, but pretty clear cut data that it definitely interferes with quality of life, the patient could, indeed, be left without any check-ups until metastatic pain possibly occurs. However, since there are some data indicating that adjuvant radiotherapy, following radical prostatectomy, may benefit a few patients, a 3 monthly interval follow-up, including PSA and rectal examination, should be mandatory the first 1 or 2 years, thereafter only at a half-yearly basis. If no further curative therapeutic options exist, close follow-ups with PSA monitoring may enforce a significant psychological stress upon the patient. For academic reasons, however, we usually follow the patients on a yearly basis life-long.

Testicular Cancer: This malignancy is probably the one where some type of consensus really exists. When it comes to non-seminomatous germ cell tumors, either following only or orchidectomy and surveillance protocol or following chemotherapy and secondary retroperitoneal lymph node dissection, the patient should be closely monitored every 2 months the first year, every third month the second year, every 4 month the third year, thereafter, on a half-yearly basis till 5 years, then once a year till 10 years. Thereafter, no more controls are necessary. The controls include serum markers AFP and HCG, standard blood test, physical examination including palpation of the abdomen, lymph node stations and the remaining testicle. A pulmonary x-ray will be done at each control and a CT-scan of the abdomen the first 2 years. Thereafter some centers do it on a yearly basis up till 5 years.

The recurrence rate in seminoma is much more uncommon. Therefore, check-ups every 3 months the first 2 years are recommended every 6 month the next 2 years and thereafter on a yearly basis till 10 years. The check-ups are similar to non-seminomatous germ cell tumors, but no reliable markers exist. CT-scan of the abdomen could be restricted to patients with symptoms.

Penile Cancer: Cancer of the penis is usually a slow growing tumor and the patient can easily observe any changes of the organ himself. In cases with carcinoma in situ or very early stages, we usually see the patients on a half-yearly basis for 1 year, thereafter yearly of 2 years. At each occasion, we “paint” the organ with acetic acid and look upon a typical areas with fluorescence microscopy.

Bladder Cancer: Provided the bladder is still in place, regular check-ups with cystoscopy are mandatory, and at each occasion bladder washing is recovered for cytological examination. The check-up interval is partly depending on tumor grade. A grade III cancer should be checked every 3 months the first 2 years, thereafter on a half-yearly basis, while a grade I cancer could be checked on a half to one yearly basis already at start. Some data indicate that a tumor, which has not recurred within 5 years, will never recur while a bladder with a tumor continuing to recur over 5 years, has to be checked life-long.

Check-ups following radical cystectomy aim at controlling infections, functions of reservoirs, metabolic balance, kidney function, possible stenosis and the general condition of the patient. At a metastatic phase, the patient is usually lost even though some chemotherapeutic agents or regimens may prolong life.

Presented at the: 13th Saudi Urological Conference Riyadh Armed Forces Hospital 14-17 February 2000 (09-12 Dhu Al Qa’dah 1420)

Urol Ann. 2016 Jan;8(Suppl 1):S2–S5.

Trends of genito-urinary cancer among Saudis

M. S. Abomelha

Urology Clinic, Advanced Medicine for Subspecialties Center, Riyadh, Saudi Arabia

Introduction and Objective: Saudi Arabia is one of the countries with low incidence of cancer. The ASR of cancer is only 83/100000 compared to the world rate of 181/100000. Recent reports proved a yearly increase of cancer in general and of Genito-Urinary Cancer (GUC) in particular. The aim of the presentation is to assess the trends of GUC among Saudi nationals.

Methods: All available annual reports of the Saudi Cancer Registry (1994-2006) were analyzed and compared with worldwide data.

Results: Over a period of 13 years 7132 GUC were identified among Saudis, which makes 8.9% of all cancer reported, compared to 12.7% worldwide. The incidence rate of GUC increased over the studied period with most increase in Prostate and Kidney Cancer, 48% and 33% respectively. SEER summary stage data showed late presentation of GUC at time of diagnosis. Stage improvement was only found in testicular and prostate cancer, 79% and 50% respectively. While prostate and bladder cancer ranked 6th and 9th in the population, penile cancer continued to be a rare disease.

Conclusions: GUC incidence in Saudi Arabia is still low, however, a significant increase in prostate and kidney cancer were noted. More effort needs to be done to capture GUC at an earlier stage.

Presented at the: 23rd Saudi Urological Conference King Fahd Specialist Hospital - Dammam 21-24 February 2011

Urol Ann. 2016 Jan;8(Suppl 1):S2–S5.

Genito-urinary tumours of rare pathology

Elsawi Medani, Mohamed A. Gomha, Samir Amr, Irfan Khan, Riyad Al-Mousa

Department of Urology, King Fahd Specialist Hospital, Dammam, Saudi Arabia

Introduction: The main objective of this study is to identify and report all rare pathologies of genitor-urinary tumours that presented to KFSH, Dammam during last 4 years.

Materials and Methods: All histopathologically rare genitourinary (GU) tumours were identified using the histopathological registry data. Patients with GU tumours who presented with rare clinical or radiological manifestations had their details kept in a register by our urology department physicians between 01/01/2007 and 31/12/2010. A thorough review of all recorded cases medical notes, imaging and histopathology reports was carried out.

Results: A total of 11 patients, 9 of whom are males and 2 females with a median age of 43 years (range: 27-74) presented with GU tumours of rare pathology. These include 4 testicular, 2 adrenal, 2 bladder, 2 prostatic, one renal and one urethral tumours. All the testicular cases were primary Non-Hodgkin lymphoma, one of which is of the T-cell subtype which is even more rare than the other 3 large B-cell variant. All these patients presented with painless testicular swelling for which they underwent radical orchidectomy. 2 out of these 4 patients had 2nd line chemotherapy due to retroperitoneal and distant newly developed lesions after standard chemotherapy and they eventually died. With regards to the adrenal glands, 2 giant myelolipomas were detected, one of which is biopsy proven in a 26 years old male who presented with a palpable right sided abdominal mass. Another giant (14 × 14 cm) adrenal myelolipoma was incidentally found in 63 years old male who is on CT surveillance for high grade bladder TCC. It remained radiologically unchanged over 4 years. A case of bladder carcinosarcoma was diagnosed in a 40 years old lady who underwent palliative cystectomy. Due to the aggressive nature of this tumour, this patient developed pelvic recurrence within one month post operatively and died within 6 months from her initial presentation. The second bladder tumor was detected in a patient with high grade bladder TCC who presented with subcutaneous metastatic nodules on the chest wall and both thighs that were biopsy-proven to be identical histopathologically to the bladder tumour biopsy. Moreover, we identified f2 cases with adenocarcinoma of the prostate presenting with huge intra-abdominal masses (one of them is clinically palpable secondary to massive retroperitoneal as well as massive pelvic lymph nodes metastasis. The PSA for these patients was 5,000 in the first case and a record value of 16,250 in the second case. With regards to the kidneys we report a case with conventional RCC with granuloma in a 32 years old male who is known to have an associated lymphoma. Urethral leiomyoma polyp (benign neoplasm) was diagnosed in a 39 years old female presented with severe difficulty of micturation. This was completely resected from an area immediately adjacent to the sphincter with no negative consequences on continence and no recurrence during 3 years follow up.

Conclusion: Careful follow up of all patients’ histopathological reports and making attempts to correlate them with the clinical picture is of paramount importance as it reflects positively in the outcome of patients and make physician aware of rare conditions that may need special management approaches. Keeping a departmental registry of rare GU tumours is also valuable in this regard.

Presented at the: 23rd Saudi Urological Conference King Fahd Specialist Hospital - Dammam 21-24 February 2011

Articles from Urology Annals are provided here courtesy of Wolters Kluwer -- Medknow Publications

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