الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
~Cancer of the bladder is a major problem in those I parts of the world where bilharziasis is COwmon. Although the incidence varies in different countries it is safe to. oy that bladder cancer constitutes a world wide problem. This work designed to study patients of bladder ~ncer attending in the radiotherapy department of Alexandria Uni versi ty Hospi tal. The study aiwed at studying some factors which may play a role in the developwent of tumours of urinary bladder. provide a comparative statistical study of the results of different lines of therapy. To achieve this purpose all records of patients presenting with walignant neoplasms of urinary b ladder and , ~ferred to the radiotherapy department over a period of 10 years starting January 1, 19~O till Decewber 31, 1979 ”re studied and the needed data were collected from these records. The total sawple size amounted to 1211 cases. Inforwations related to the patient himself, diagnosis, treatilJ.ent methods, result of treatilJ.ent and follo~up were collected. Classification by clinical stage and his tology type applied. Follow-up information was obtained from the patient’s record in case of patient wao were still attending the ~diotherapy dep8rtllient; Unfollowed cases by the radio t~rapy department were checked for follow-up at Alexandria ~ncer Registery. For all patients lost to follow-up, a letter was sent asking the patient to attend the follow-up clinic at the radiotherapy department and asking’about the patient condi tion and date of death. The actuarial or life table approach for treated bladder cancer cases was used in the calculation of 8~vival of these patients. In this method the proportion dying and the life ta ble . survival rates were calculated according to sex, bilhar ~asis, clinical stage and management. Analysis of the results: 1- General description of cases: The results of the study showed that bladder cancer ” constituted 11.3of all cancer cases who attended the radiotherapy d epartllien t d urine’; the st udy period. The total series of 1211 bladder cancer patients showed a male/female ratio of 4.9:1, of which 899 bladder cancel’ patients with previous urinary bilharziasis had a sex ratio of 5.7 to 1, while the 312 non-bilharzial bladder cancer patients nad a ratio of 3.5 to 1. ’l’his Diarked iliale preponderance in the bilharzial group is explained by the hii,i1er expos ure of men to b ilharzial infection during their work in infested fields. The waxiwal frequency of bladder cancer occured in the fifth decade in bi Iharzial patients in contrast to the seventh decade in the non-bilharzial cases. 60.5 of bilharzial patients as cOllipared to 20.5 of non bilharzial patients with vesical neoplasws were below the ~ge of 50 years. The average age for bilharzial patients with bladder cancer was 48.3 years for wales and 44.1 years for fewales, where as the wean age for non-bilharzial pa tien ts with vesical t uwours was 57.9 ~ars for wales and 57.6 years for fewales. ’rh us in both sexes, bladder cancer develops at a significantly younger age in bilharzial than non-bilharzial patients. Patients cowi.ng frow ru.ral areas forllied 56.0 of the cases. The majority of bilharzial bladder cancer patients (69.4) cawe frou. rural areas in contJ:’ast to 17.3 in non-bilharzial bladder cancer cases. Cigarette swokers constituted 80.0 of bilharzial # bladder cancer cases and 69.~ of non-bilharzial cases. In bilharzial bladder cancer, the wost frequent site of origin, in the pOoterior wall (40.2) while in 1 1 non-bilharzial bladder c~ncer, the location was more 4 t freq~ent in the trigone (32.4). I ~ ~ Most bilharzial bladder tUilIours are nodular fungat ing lesions (71.1). In contrast, 59.6 of non-bilharzial bladd.er tumours are papillary lesions. . 19.7 of cases were of unknown pathology, at the I ,Bwe tiwe, squawous cell carcinoma constituted the majority ’” of the pathological types (8J.0) of bilharzial bladder t~ours where as higher frequency of transitional cell ~rcinoma (62.J) in non-bilharzial one. 70.9 of cases were of unknown T.N.M. classification. Clinical stage TJ and rr4 accounted for more than half of the cases (68.8) in bilharzial bladder cancer cases. Clinical stage T2 acpounted for 47.1 in non-bilharzial ca se s . Distant metastasis accounted for 2.J. The most hequent site of metastasis in non-bilharzial bladder cancer cases were lung (50.0) while metastasis in the pelvic b.ones constituted 50.0 in bilharzial cases. II- Management of cases: Treated cases constituted 1080 (89.2) out of 1211 studied cases and untreaoted formed 10.8. Hadiation and Radiation combined with surgery and surgery were the main types of treatu.ent frequently used. aa ~diation -only was the line of treatment for 72.2 of cases followed by radiation and surgery (19.1) followed by surgery only (8.7). The main type of surgery used, partial cystectomy (49.5) of cases treated by surgery combined wi th radia tion and total cys tectolliY (79.8) of cases trea ted by surgery only. The mean period between presentation and treatwent was 16.2 days in cases treated by radiation only and 19.0 days in cases treated by radiation and surgery.. The radiation dose was approximately 4500 rad for cases treated by radiation only and 5000 rad for cases treated by cOllibined.. radiation and surgery. In~ediate end results showed that 6.7 of cases were D alive wi th no evidence of disease at the end of treatment ~ cOllipared to 60.3 were alive and still had a disease and 9.9 d’ied from the disease. . 111- Survival of treated cases: The general overall survival rate (all caseo, both sexes, all ages, all stages, all treatulents) was 15.4 at 5-years. Males did not differ significantly from fe~ales in their survival rates in all years of observations. Bilharzial bladder cancer cases did not differ significantly from non-bilharzial cases in their survival rates in all years of observat~ons except in the first year (Z = 2.618, P<O.Ol). The life table wethod showed variation between the different clinical stage of the disease (T2 and TJ) in all’years of observations except in the fifth year (Z = 5.5J5, P<O.Ol - 2 = 5.266, P<O.Ol - Z = 2.447, p(O.05 - Z = 2.111, P<0.05). A significant difference was observed in the life table survival rates by type of treatffient between cases treated by radiation alone and those treated by radiation ” cOilibined with surgery in all years of observations except in the fourth and fifth year (Z = 10.069, P < 0.01 z = 6.586, P.(O.Ol - 2::3.305, P< 0.01). # Bilharzial bladder cancer cases treated by radical treatwent exhibited tIle .best survival rate than those trea ted by pallia ti ve trea.tillent in the first and second year of observations (Z :: 5.194, P<O.Ol - Z :: 3.034 , P{O.Ol) . The survival rate was significantly higher for cases who completed treatu.ent than those who discontinued treatment in all years of observations (Z :: 7.152, P<O.Ol - Z :: 8.860 , P< 0.01 - Z :: 3.051, P<’O.Ol).