1. Advanced squamous cell carcinoma of the bladder, What is next? Saleh A. Binsaleh

2. Introduction Squamous cell carcinoma of the bladder accounts for only 1% of all bladder cancers in England,up to 7% in the States, 75% in Egypt. Bilharzial and non-bilharzial.

3. Bilharzial SCC Bilharzial type associated with chronic infection with S.haematobium. Pts usually 10-20 yrs younger than those with TCC. Usually well-differentiated, with low incidence of lymph nodes and distant metastases.

4. Non-bilharzial SCC Caused by chronic irritation from urinary calculi,long-term indwelling catheters,chronic urinary infections,or bladder diverticula. Up to 80% of paraplegics with chronic infections or indwelling catheters have squamous changes in the bladder. About 5% develop SCC.

5. SCC Several reports suggest that stage for stage, the prognosis of SCC, is comparable to that of TCC. But in general, SCC prognosis is poor because most pts have advanced disease at the time of diagnosis.

6. Advanced SCC, What is next ? Cystectomy. Effective adjuvant chemotherapy is not available. Role of pre,and post op. radiotherapy? Little have been done to evaluate the role of preop radiation for advanced SCC of the bladder.

7. Swanson, et al M.D. Anderson cancer center J.Urol 1990;143(1) 25 pts with muscle invasive SCC of the bladder treated with preop. Radiation and cystectomy. Stages T2,T3a,T3b 5 yrs survival rate for all was 50%. Pelvic recurrence was the predominant cause of death. Irradiation pre cystectomy may protect against pelvic recurrence.

8. Wang,et al Chang Gung memorial hospital,Taiwan Changgeng Yi 1998; 21(4) Retrospective study of 22 pts with SCC of the bladder, treated between 1986- 1996,follow up period 12-111 months. Treatment modalities included: TURBT,radical cystectomy,preop. Radiation then cystectomy,partial cystectomy.

9. Wang,et al (cont.) The overall 5yrs survival rate was 9% 2 yrs survival rate was only 27% Pre op RadRx then cystectomy resulted in 5 yrs survival rate of 12.5% Total cystectomy alone resulted in 5 yrs survival rate of 0% The difference between the 2 groups was not statistically different.

10. Daehlin, et al Gade Institute, University of Bergen, Norway. Scand J Urol Nephrol 1991;25(4) 13 pts with muscle-invasive SCC. One third of the patients were irradiated, either before cystectomy or as a full course radiotherapy. The 1-yr and 5-yrs survivals were 25 and 17%, respectively. Only cystectomized patients were alive after 5 years.

11. Maruf,et al J Urol 1982 Dec;128(6) Report of a case of stage D, poorly differentiated invasive squamous cancer of the bladder. transurethral resection of the tumor (170 gm.). the patient received 6,500 rad external radiation. After completion of radiation the bladder was converted from an inoperable (fixed to the pelvis) to an operable (mobile) condition.

12. Maruf,et al (cont.) A cystectomy was performed and the patient was without evidence of disease 4 years later.

13. Conclusion SCC of the urinary bladder is a rare entity. The overall prognosis for pts with metastatic or locally advanced disease is poor. Yearly cystoscopy inspection for spinal cord injuried pts with chronic or recurrent UTI has been advocated. Pre op. radiation treatment may protect against pelvic recurrence.

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