Carcinoma Of The Urinary Bladder In Maiduguri: The Schistosomiasis Connection

Background: A prospective study of all patients admitted to the University of Maiduguri Teaching Hospital (UMTH), with a provisional diagnosis of carcinoma of the urinary bladder in the six year period between January, 2001 and December, 2006. The object of this investigation was to determine the relationship between schistosomiasis and carcinoma of the urinary bladder in Maiduguri, North East of Nigeria. Method: All the patients were assessed clinically, and investigated by urine cytology, cystoscopy and biopsy for histology. Those confirmed at histology to have carcinoma were analyzed for age, gender, occupation, history of Schistosomiasis, tobacco use, pathological type, presence or absence of schistosoma ova in the specimen, stage of the disease, complications, treatment and outcome. Results: All but 13 of the 65 confirmed cases were males, giving a male to female ratio of 4 to 1. Squamous cell carcinoma (SCC) of the bladder (n=46) was significantly commoner than transitional cell carcinoma (TCC) cases (n=15), in those with past history of Schistosomiasis (p< 0.001), with a Relative Risk (RR) of 4.06. Also 65.2% of SCC showed Schistosomiasis in the histology specimen compared with 13.3% of TCC cases (P < 0.001) Four patients had undifferentiated carcinoma, 3 (75%) of which showed Schistosoma ova in their specimen. Patients with SCC were significantly younger (45.26 +/SD13.5years) than those with TCC (P< 0.001). Our patients were mostly farmers of low socio-economic class. Most presented with advanced disease, thus treatment was mostly palliative and the outcome quite poor. Conclusion: This result clearly shows that carcinoma of the bladder in Maiduguri, North East of Nigeria, is mainly SCC and strongly associated with Schistosomiasis. Therefore, a deliberate policy and effort to control Schistosomiasis in this region will lead to a reduction in the incidence of bladder cancer and the attendant morbidity and mortality.