Etiopathogenesis and ultrastructure of bilharzia bladder cancer

ABSTRACT

4742 cases of bladder cancer out of 48080 cancer cases, which were registered at Iraqi Cancer Registry Centre in Baghdad during 1976-1987, were studied histopathologically and analysed epidemiologically, concerning sex, age, occupation and association with bilharziasis. Surgical and biopsy materials as well as urine sediments of some patients with bilharzia bladder cancer were prepared for scanning electron microscopy. Male to female ratio was 31 with high incidence at age of 60-69, being most common among farmers[88%]. Squamous cell carcinoma[SCC] was dominant [46.5%] during the years 1976-1985 when compared with transitional cell carcinoma[TCC][37.7%]. SCC with bilharziasis to TCC with bilharziasis ratio was 41. But the number of TCC surpassed SCC cases [87] during 1986 and 1987, indicating possible environmental factors other than schistosomiasis, after successful antibilharziasis campaigns for the past 30 years. Ultrastructural study revealed pleomorphic microvilli and cilia on the surface of malignant urothelium, while normal one showed reticular microridges only. A quick dipping method was developed in order to utilize scanning electron microscopy for early detection of bladder cancer in high risk people. Annual urine analysis with combined light and scanning electron microscopy are suggested. Preventive measures were recommended including continuous anti-bilharziasis campaign and avoidance of nitrate contamination in rural areas, where chemical fertilizers and insecticides are widely used nowadays