Advanced Bladder Cancer in Senegal: Epidemiological and Clinical Aspects

Advanced bladder cancer remains particularly frequent in our practice. Aim: To evaluate the proportion of advanced bladder cancer at diagnosis and to describe the characterisitics at diagnosis. Materials and methods: We conducted a descriptive and retrospective study assessing 97 cases of advanced bladder cancer over a period of 10 years (January 2002 to January 2012) at the department of Urology of Hôpital Principal de Dakar and Hôpital Général de Grand Yoff. We included the records of all patients with a pathologic confirmation of locally advanced bladder cancer (T3, T4) and/or a visceral or lymph node metastasis. Results: Mean age was 47 years (Range: 25 80 years). The cohort comprised 69 men and 28 women with a sex ratio of 2.46. The reasons for referral were a hematuria (60.82%), pelvic mass (19.2%), irritative urinary symptoms (8.2%). Reported medical histories were: urinary schistosomiasis (13 patients), tobaccoo(10 patients), recurrent cystitis (8 patients). Indications of local extention were: inguinal lymph nodes (6 patients), tumoral hepatomegaly (5 patients), bone pain (15 patients). A cystoscopy was performed in 64.95% of patients in a mean time of 2.5 months. A Trans Urethral Resection of Bladder Tumour (TURBT) was performed in 77 patients with a mean time from referral of 4 months. Pathologic examination showed squamous cell carcinoma (42%), urothelial carcinoma (28%) and adenocarcinoma (9%). Thoraco-abdomino pelvic CT scan showed a loco regional extension in 18 patients, extension to the peri vesical fat in 3 patients and metastasis in 25 patients. Conclusion: Delayed diagnosis of bladder cancer is still common in Africa with a high mortality rate. A better management requires an improvement of the equipment in the hospital with an emphasis on the access to endoscopy allowing for an early diagnosis.