Urological Cancers in Asir Region

Abstract

Letters to the EditorUrological Cancers in Asir Region Sugandh D. Shetty, MS, FRCSE, FRCS Ahmed I.A. Ibrahim, FRCSE Krishna P. Patil, MCh, FRCSE Nagalingam Anandan, FRCSE Suhayl Al-Kotob, and Fachartz Shafique R. MemonMBBS Sugandh D. Shetty Department of Surgery, Division of Urology, King Saud University - Abha Branch, College of Medicine Search for more papers by this author , Ahmed I.A. Ibrahim Department of Surgery, Division of Urology, King Saud University - Abha Branch, College of Medicine Search for more papers by this author , Krishna P. Patil Asir Central Hospital, Abha, Saudi Arabia Search for more papers by this author , Nagalingam Anandan Asir Central Hospital, Abha, Saudi Arabia Search for more papers by this author , Suhayl Al-Kotob Asir Central Hospital, Abha, Saudi Arabia Search for more papers by this author , and Shafique R. Memon Asir Central Hospital, Abha, Saudi Arabia Search for more papers by this author Published Online:1 Mar 1993https://doi.org/10.5144/0256-4947.1993.207SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: Due to the lack of a national cancer registry in Saudi Arabia, information on the incidence and prevalence of various cancers is, at present, unavailable [1]. However, reports from various hospital-based studies [2] such as ARAMCO, Al-Baha, and Asir [3] shed some light on the magnitude of the problem. We have retained an oncology registry in which all urinary neoplasms have been entered in the Department of Urology in Asir Central Hospital, Abha, during the past five years. We have analyzed the first 100 patients in an attempt to study the crude relative frequency and rank order. The registry represents the majority of patients with urological cancers in this region, although several patients were referred to other referral centers. Since all referring urologists are aware of the registry, most patients they see are referred to this hospital for cancer care with the size representative of the cancer pattern. All bladder, prostate, and renal cancers have been histologically confirmed and staged according to TNM classification. Bladder cancers were divided into bilharzial and non-bilharzial according to the presence of histological stigmata of bilharzial pathology. Prostate specimens were obtained by either transurethral resection or perineal/transrectal needle biopsies. The mean age and tumor stage at presentation were compared in the commonly seen urological malignancies.Table 1. Rank order and relative frequency of various urological cancers.Table 1. Rank order and relative frequency of various urological cancers.Common urological malignancies seen in order of frequency were bladder 50%, prostate 10%, renal 16%, and testicular 7%. Of all renal malignancies, renal cell carcinoma was the most common (69%) seen. Extensive scarring resulting from major genital skin degloving at circumcision i.e., “Tihama Circumcision” was the cause behind the occurrence of three penopubic squamous cell carcinomas. This is similar to Marjolin's ulcer which begins in the scar tissue following the ritual circumcision practiced in the lowlands of the Asir region called Tihama. The classical penile cancer seen elsewhere was not seen in this series.The mean ages for bladder, prostate, and kidney cancers were 65.5, 72.2, and 56.6 years, respectively. For bilharzial bladder cancers in males, mean age (50 ± 7.59 years) was significantly lower than that of non-bilharzial bladder cancer (62.36 ± 14.3 years), (P <0.05) and that for testicular cancer was 28 years. However, a 70-year-old patient with non-Hodgkin lymphoma of the testis was encountered. Male to female ratio for bladder and renal cancers were 5:1 and 1:1, respectively.As far as histological pattern of neoplasm, 74% of bladder cancer was transitional cell carcinoma (TCC) despite the region being endemic for bilharziasis, 22% squamous cell carcinoma (SCC), and 4% adenocarcinoma (ADC). Only 10 (20%) were bilharzial bladder cancers out of which eight (80%) were SCCs and 2 (20%) ADCs, but none were TCC. All of the prostatic cancers were ADC. Out of 16 renal cancers, 11 (69%) were renal cell carcinomas, three (19%) were TCCs of the renal pelvis, and two (12%) were nephroblastomas, which is comparable to figures from other areas in Saudi Arabia. Out of seven testicular tumors, only three (43%) were seminomas. The only adrenal tumor was a pheochromocytoma. All penopubic cancers were SCCs.Among 20 prostatic cancers, 19 were found in Saudis and ranked as the tenth main cancer in this region.There was a general trend for late presentation of neoplasms at different sites. Advanced disease was seen in 80%, 85%, 57%, and 71% of bladder, prostate, kidney, and testis, respectively, which compares with the findings of Hanash et al [4].Among several reports regarding cancer in Saudi Arabia [2], only a few dealt with cases originating in a single region such as Al-Baha, ARAMCO, and Asir [3]. Larger series from the main referral centers in Riyadh do not reflect the true frequency of various cancers at the regional levels [2,5,6]. Taylor reported on 264 cancer patients seen over a ten year period from ARAMCO and 5.6% were urological, four of whom were vesical. A similar review of 11,204 cases from King Faisal Specialist Hospital and Research Centre (KFSH&RC), in Riyadh [6] reported that 6% of all cancers were urological. However, the frequency was different i.e., bladder cancer 41%, kidney 28%, prostate 18%, and testis 13%, which is comparable to our findings. In the Asir region, 7% of all cancers seen in Saudi citizens were urological [2].We wish to draw attention to the fact that bladder cancer is the most common urological cancer in the Asir region. In spite of being an endemic bilharzial zone, most of these cancers were non-bilharzial cancers. The majority of patients with bladder, prostate, renal, and testicular cancers present at an advanced stage and hence, the available treatment options are few. Public health education may lead to early disease detection and better treatment management. The need for a well documented regional cancer registry cannot be overemphasized.ARTICLE REFERENCES:1. Amer MH. "The need for a national cancer registry in Saudi Arabia" . Ann Saudi Med. 1987; 7 (4): 263–4. Google Scholar2. Amer MH. 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