Transitional cell carcinoma of Kenyatta National Hospital

Abstract

This is a retrospective descriptive study of transitional cell carcinoma of the urinary bladder. This study presents a ten year retrospective review of the clinico-epidemiological patterns and management of this disease at Kenyatta National Hospital for the year January 1990 - December 1999. Over this period 99,028 patients were admitted to all surgical wards in the hospital. Of these, 224 patients were clinically diagnosed to have bladder cancer, of whom records were obtained for 127 patients. Of the later 52 patients fulfilled the study inclusion criteria and therefore were entered. An average of 5.2 patients per year were seen. The male to female ratio was 3.7:1. The mean age was 57.19 years with a range of 57years (27 years to 84 years). The incidence increased with age with the majority ofthe patients being found in the age group 60-69 years with 30.8% of patients. The least affected age group was 20-29 years with 3.8% of patients. The regional distribution (provincial) was; Central 46.2%, Eastern 30.8%, Nyanza 9.6%, Rift Valley 5.8%, while Nairobi, North Eastern, Western and Coast provinces had 1.9% each. In ethnic distribution, the Kikuyu tribe represented 51.9%, Kamba 17.3%, Meru 7.7%, and other tribes 17.3%. The prevalence of risk factors include: Alcohol in 28.8%, cigarette smoking in 25%. There was no positive family history. The types of occupations included; farming 65.4%, self employment 13.5%, salaried employment 9.6%. All of them were in the low income groups. The commonest sign and symptoms were haematuria 98. 1 %, lower abdominal pains 71. 1 %, dysuria 32.7% and pelvic mass in 36.5%. They occurred in multiple combinations. The main investigative procedures done in these patients included cystoscopy in 71.2%, ultrasound 46.2%, lVU 32.7% among others. Histologically, transitional cell carcinoma accounted for 67% of all the urinary bladder tumours. In this group, various stages were, muscle invasive stage 42.3%, superficial 38.5%, metastatic 17.3% Ca in situ 1.9%. Majority of the patients 60% had advanced disease. The treatment modalities were based on the stage of the disease and included surgery 48.1 %, combination therapy in 23.1 %, chemotherapy in 5.8% and radiotherapy in 3.8%. Surgery was the mainstay of treatment, cystectomy was done in 26.9%, cystostomy and resection of tumour 26.9%. Other surgical methods carried out were transurethral resection (TUR), cystectomy and bladder substitution, channel transurethral resection, cystectomy and ileoconduit. Nine (9) patients (17.3%) were not given any treatment because either the disease was too advanced and died before any treatment was instituted or were lost to follow up. Mortality and outcome of the disease was difficult to assess due to poor follow up, however 67.4 % of the patients were lost to follow-up, 25 % were alive two years after diagnosis and 7.6 % died within one year after of diagnosis. The Tee in this study patterned late advanced disease. It is suggested that early diagnosis, early surgery and combination of other treatment modalities should improve the outcome. This can only be possible with further training of health personnel, the education of the public and availability of improved diagnostic as well as treatment facilities especially cystoscopes.