Squamous Cell Carcinoma of the Bladder and the Challenges of Treatment for Rarer Histological Variants

Case Study

Abstract

Bladder Cancer (BC) is the 9th most common cancer worldwide and the 10th most common in the UK in terms of incidence.¹ It is more common in men, accounting in the UK for 4% of all new male cancer cases and only 2% in women.² Due to differences in aetiology, progression, and treatment, BC can be divided broadly into non-muscle-invasive bladder cancer (NMIBC, T1) and muscle-invasive bladder cancer (MIBC, T2-4­); often considered separate entities that are stratified during transurethral resection of a bladder tumour (TURBT) which may be curative for NMIBC.³ Patients in whom BC is suspected are investigated with a CT urogram, flexible cystoscopy, and TURBT if the prior findings are positive. For MIBC T2-3, radical cystectomy (RC) often with neo-adjuvant chemotherapy (NAC) is the gold-standard treatment, although variations are discussed in this article. Trimodal therapy (TMT) involving maximal TURBT + chemoradiotherapy is a regimen designed to spare the bladder and is developing an evidence base as an oncologically equivalent treatment.^4,5 MIBC T4 has by definition invaded adjacent structures, and therefore RC is often not possible nor adequate and palliation is offered. BC 10-year mean survival with current best treatment is 50%, with 1-year mean survival ranging from 95% for NMIBCs to 35% for MIBC T4.⁶