Egypt Cancer Research Articles

501 Evaluation of specific biochemical indicators of Helicobacter pylori-associated gastric cancer in Egypt

The aim of the study was to assess the accuracy of some specific biochemical indicators in discriminating between Helicobacter pylori-associated gastritis and H. pylori-associated stomach cancer (serum gastrin level, serum soluble E-cadherin and tissue COX-2 activity, as well as serodiagnostic markers for H. pylori infection) in order to find a simple diagnostic test that can reasonably predict the development of gastric cancer. The study participants comprised 20 patients with gastric carcinoma, 20 patients with positive H. pylori-associated gastritis and 20 individuals as the control group. Standard procedures and quality control measures were followed. Using cut-off values and ROC analysis to assess the diagnostic abilities of the biochemical indicators, E-cadherin showed the highest sensitivity (100%). We suggest that close follow-up together with periodic endoscopic examination for all patients with persistent H. pylori infection and serum soluble E-cadherin level above 5 microg/mL is essential.

Gelatinases A and B Expression in Human Colorectal Cancer in Upper Egypt: A Clinicopathological Study

Aim: Prognosis of colorectal carcinoma depends on many factors, such as age and sex of patient; location; multiplicity; local extent and size of tumor, bowel obstruction, or perforation; as well as tumor microscopic type and grade; vascular and perineural invasion; and nodal and distant metastasis. The matrix metalloproteinases (MMPs) are a family of proteolytic enzymes strongly implicated in tumor invasion and metastasis, hence in tumor prognosis. The purpose of this study was to assess the role of MMP-2 and MMP-9 expression in colorectal tumorigenesis, invasion, and metastasis, hence their prognostic values.Method: Immunohistochemical analysis of MMP-2 and MMP-9 in colorectal cancer cells, an immunohistochemical score based on the intensity of immunoreactivity and proportion of immunoreactive cells that established for each MMP, and correlation of this expression with the established prognostic factors.Results: MMP-2 was expressed in 81.8% (strong expression in 40%) of cases, and MMP-9 was expressed in 72% (strong expression in 35%) of cases.Conclusions: MMP-2 and MMP-9 are widely expressed in colorectal carcinoma, suggesting significant diagnostic and prognostic values in these tumors. Increased levels of MMP-2 and MMP-9 protein expression in colorectal carcinoma tissues as compared to normal tissues suggest their association with colorectal tumor invasion and metastasis and that they could be targets for intervention and therapy in colorectal carcinoma.

Erratum to: Public and Professional Educational Needs for Downstaging Breast Cancer in Egypt

In the original publication, a sentence was omitted from the end of the Acknowledgments section. The full Acknowledgements should read: “Nazneen Uddin was supported by the Student Biomedical Research Program and the GlobalReach Program of the University of Michigan Medical School, and the Global Health Research Initiative of the University of Michigan. Nazneen Uddin and Elissa Brown were supported by the Cancer Epidemiology Education in Special Populations Program of the University of Michigan (R25-CA112383). The authors also acknowledge support from the Avon Foundation (SDM,AS), the Breast Cancer Research Foundation (SDM), and the University of Michigan Center for Global Health. The authors also acknowledge support from the Avon Foundation (SDM,AS), the Breast Cancer Research Foundation (SDM), and the University of Michigan Center for Global Health.”

Organ Preservation in Bilharzial Bladder Cancer in Egypt: Single Institutional Experience

Background: Phase II study was conducted to evaluate bladder preservation protocol in Bilharzial and non Bilharzial invasive transitional cell carcinoma (TCC) bladder cancer using gemcitabine and conformal radiotherapy (RT). Methods: 30 TCC patients with good performance status and renal function subjected to maximum trans-urethral resection of bladder tumor (TURBT). Patients received 66 Gy/33 fractions/6.5 weeks with weekly gemcitabine 125 mg/m2. Evaluation was done after one month with cystoscopy and CT/MRI pelvis. Patients who had complete remission (CR) subjected for follow up and patients who had invasive bladder tumor subjected to radical cystectomy. Results: 24 patients had CR after one month evaluation. Stage 2 tumor, low grade, non Bilharzial and maximum TUR were the only prognostic factors. The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of RT. Cystectomy free survival was 88% at a median follow up for 2 years. Conclusions: Gemcitabine and conformal RT after TURBT treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance. Organ preservation in Bilharzial bladder is still possible.

Age distribution, polyps and rectal cancer in the Egyptian population-based cancer registry

To describe the clinical and epidemiologic profiles of the disease and to compare the findings with those generated from the previous hospital-based studies. The Gharbiah cancer registry is the only population-based cancer registry in Egypt since 1998. We analyzed the data of all colorectal cancer patients included in the registry for the period of 1999-2007. All medical records of the 1364 patients diagnosed in Gharbiah during the study period were retrieved and the following information abstracted: age, residence, diagnosis date, grade, stage, topology, clinical characteristics, and histology variables. Egyptian census data for 1996 and 2006 were used to provide the general population's statistics on age, sex, residence and other related demographic factors. In addition to age- and sex-specific incidence rate analyses, we analyze the data to explore the incidence distribution by rural-urban differences among the 8 districts of the province. We also compared the incidence rates of Gharbiah to the rates of the Surveillance Epidemiology and End Results (SEER) data of the United States. Over the 9 year-period, 1364 colorectal cancer cases were included. The disease incidence under age 40 years was relatively high (1.3/10(5)) while the incidence in the age groups 40 and over was very low (12.0/10(5), 19.4/10(5) and 21.2/10(5) in the age groups 40-59 years, 60-69 years and > 70 years, respectively). The vast majority of tumors (97.2%) had no polyps and 37.2% of the patients presented with primary lesions in the rectum. Colorectal cancer was more common in patients from urban (55%) than rural (45%) areas. Regional differences in colon and rectal cancer incidence in the 8 districts of the study province may reflect different etiologic patterns in this population. The registry data of Egypt shows a slightly higher incidence of colorectal cancer than the United States in subjects under age 40 years. The results also shows significantly lower incidence of colorectal cancer in subjects over age 40 years compared to the same age group in the United States SEER. Low rate of polyps, low incidence in older subjects, and high rate of rectal cancer in Egypt. Future studies should explore clinical and molecular disease patterns.

Changing Patterns (Age, Incidence, and Pathologic Types) of Schistosoma-associated Bladder Cancer in Egypt in the Past Decade

To assess the patterns of schistosomiasis-associated bladder cancer in Egypt from 2001 to 2010 in a retrospective study. Bilharzial bladder carcinoma is the most common cancer, particularly in Egyptian men. Classically, carcinoma in a bilharzial bladder is most commonly of the squamous cell type. During the past decade, certain changes have occurred in the features in Schistosomiasis-associated carcinoma in Egypt with a decline in the frequency of squamous cell carcinoma and increase in the frequency of transitional cell carcinoma. This was a retrospective study of 1932 patients treated at Kasr Al Aini Hospital, Cairo University, from 2001 to 2010. Two groups were selected: group 1 included 1002 patients from 2001 to 2005 and group 2 included 930 patients from 2006 to 2010. The mean patient age increased from 41±11.2 years to 52±8.6 years, and the male/female ratio changed from 5.6:1 to 4.2:1. The incidence of associated bilharziasis decreased from 80% to 50%. A significant increased occurred in transitional cell carcinoma from 20% to 66%, with a significant decrease in squamous cell carcinoma from 73% to 25%. No difference was observed in the tumor stage or grade or incidence of lymph node metastases between the 2 groups. The pattern of incidence of the various histologic types of bladder cancer have changed, with most cases now transitional cell carcinoma, in contrast to the findings in the earlier Egyptian series. Additional studies are encouraged to explain the factors explaining these changes.

Public and professional educational needs for downstaging breast cancer in Egypt.

We conducted focus groups with women from urban and rural areas in the Nile Delta region to investigate their attitudes regarding breast cancer diagnosis, treatment, and screening. Six 60-min focus groups, each group comprised of 6-10 women with ages between 20-69 years, were conducted. Discussions included breast health, breast cancer diagnosis, treatment, early detection and screening, and communication for breast health. Almost all urban and rural women reported that women do not see physicians until they are seriously ill or have advanced cancer. They reported that oncologists or gynecologists were important to be seen first if a woman suspected breast cancer and primary care physician are not the primary line of cancer diagnosis. Other deterring factors besides distrust in primary care physicians included attitude that breast cancer equals death and lack of knowledge of early detection and screening techniques. Women felt that public education campaigns must be implemented to improve early detection and screening methods for breast cancer. The majority of beliefs regarding breast cancer and screening were common among urban and rural women. Culture-specific and tailored professional and public education programs in developing countries are essential for achieving downstaging cancer.

Molecular subtype analysis determines the association of advanced breast cancer in Egypt with favorable biology

BackgroundPrognostic markers and molecular breast cancer subtypes reflect underlying biological tumor behavior and are important for patient management. Compared to Western countries, women in North Africa are less likely to be prognosticated and treated based on well-characterized markers such as the estrogen receptor (ER), progesterone receptor (PR) and Her2. We conducted this study to determine the prevalence of breast cancer molecular subtypes in the North African country of Egypt as a measure of underlying biological characteristics driving tumor manifestations.MethodsTo determine molecular subtypes we characterized over 200 tumor specimens obtained from Egypt by performing ER, PR, Her2, CK5/6, EGFR and Ki67 immunohistochemistry.ResultsOur study demonstrated that the Luminal A subtype, associated with favorable prognosis, was found in nearly 45% of cases examined. However, the basal-like subtype, associated with poor prognosis, was found in 11% of cases. These findings are in sharp contrast to other parts of Africa in which the basal-like subtype is over-represented.ConclusionsEgyptians appear to have favorable underlying biology, albeit having advanced disease at diagnosis. These data suggest that Egyptians would largely profit from early detection of their disease. Intervention at the public health level, including education on the benefits of early detection is necessary and would likely have tremendous impact on breast cancer outcome in Egypt.

A clinicopathologic study of gynecologic organ involvement at radical cystectomy for bladder cancer

Objective To report the clinicopathologic analysis of women who underwent radical cystectomy for bladder cancer in Egypt from 1997 to 2005. Methods Clinicopathologic data for 250 women who underwent radical cystectomy for bladder cancer at 3 centers in Cairo were retrospectively reviewed from hospital charts and pathology sheet records. Cystectomy specimens were evaluated pathologically for involvement of internal genitalia. Results The uterus was not available for histopathologic examination in 11 specimens; 1 ovary was absent from 18 specimens; and both ovaries were absent from 2 specimens. Uterine involvement was observed in 1 case of transitional cell carcinoma. Benign uterine pathology was detected in 25 cases. All patients had normal ovaries, and the vagina was involved in 11 cases. There was urethral involvement in 10% of patients. Of the 50 patients available for follow-up, 11 had 1 ovary preserved and 2 had the uterus plus both ovaries preserved. None of them experienced late ovarian or uterine recurrence. Conclusion Involvement of female internal genitalia in bladder cancer is uncommon. Thus, preservation of these organs in young women undergoing radical cystectomy should be considered in selected cases after careful preoperative assessment.

Patient-mediated factors predicting early- and late-stage presentation of breast cancer in Egypt.

Breast cancer fatality rates are high in low- and middle-income countries because of the late stage at diagnosis. We investigated patient-mediated determinants for late-stage presentation of breast cancer in Egypt. A case-case comparison was performed for 343 women with breast cancer, comparing those who had been initially diagnosed at Stage I or II with those diagnosed at Stage III or IV. Patients were recruited from the National Cancer Institute of Cairo University and Tanta Cancer Center in the Nile delta. Patients were either newly diagnosed or diagnosed within the year preceding the study. Interviews elicited information on disease history and diagnosis, beliefs and attitudes toward screening practices, distance to treatment facility, education, income, and reproductive history. Forty-six per cent of the patients had presented at late stage. Women seen in Cairo were more likely to present at late stages than patients in Tanta (OR=5.05; 95% CI=1.30, 19.70). Women without any pain were more likely to present at later stage (OR=2.68; 95% CI=1.18, 6.08). Knowledge of breast self-examination increased the likelihood of women to present in early stages significantly (OR=0.24; 95% CI=0.06, 0.94). Despite increasing numbers of cancer centers in Egypt during the past 20 years, additional regional facilities are needed for cancer management. In addition, increasing awareness about breast cancer will have significant long-term impact on breast cancer prevention.

Laryngeal cancer in Egypt: Quality of life measurement with different treatment modalities

Quality of life (QOL) reflects the need to assess the patient's overall sense of well-being. A nonrandomized, prospective longitudinal study was conducted to evaluate QOL in Egyptian patients treated for laryngeal cancer. In all, 60 newly diagnosed patients with laryngeal cancer were divided into 3 groups: surgical resection, radiotherapy, and combined therapy. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC-QLQ) were administered to the patients at 4 points: prior to treatment, during active treatment, and at 3 and 6 months after completion of treatment. All pretreatment scales were worse in the combined therapy group. The functional scales reached their lowest levels in all groups during active treatment. Radiotherapy group scales showed persistent slow recovery. There was striking prevalence of the financial difficulties score in all groups. QOL measurement provides information to guide clinical decision making in patients treated for laryngeal carcinoma.

Successful control of schistosomiasis and the changing epidemiology of bladder cancer in Egypt

Schistosomiasis is a parasitic disease caused by flatworms that live in snail-infested fresh water. It is endemic to 74 countries and affects some 200 million people worldwide, causing an estimated 200,000 deaths annually [1]. Schistosomiasis can affect the gastrointestinal tract and liver (S. mansoni and S. japonicum species), resulting in diarrhoeal disease and hepatic fibrosis, or the urinary tract (S. haematobium) where it causes haematuria, strictures, obstruction, super-infection and, ultimately, cancer. In children and vulnerable adults, systemic effects such as anaemia, malnutrition, stunted growth and impaired cognition can be profound. The association between this parasitic infestation and the development of bladder cancer literally took millennia to uncover. It is unusual for a parasitic disease to result in a fatal neoplastic process, and rarer still to have public health efforts, aimed at eradication of the parasitic menace, to result in a dramatic shift in the epidemiology of the most common cancer in a nation.

Presymptomatic breast cancer in Egypt: role of BRCA1 and BRCA2 tumor suppressor genes mutations detection

BackgroundBreast cancer is one of the most common diseases affecting women. Inherited susceptibility genes, BRCA1 and BRCA2, are considered in breast, ovarian and other common cancers etiology. BRCA1 and BRCA2 genes have been identified that confer a high degree of breast cancer risk.ObjectiveOur study was performed to identify germline mutations in some exons of BRCA1 and BRCA2 genes for the early detection of presymptomatic breast cancer in females.MethodsThis study was applied on Egyptian healthy females who first degree relatives to those, with or without a family history, infected with breast cancer. Sixty breast cancer patients, derived from 60 families, were selected for molecular genetic testing of BRCA1 and BRCA2 genes. The study also included 120 healthy first degree female relatives of the patients, either sisters and/or daughters, for early detection of presymptomatic breast cancer mutation carriers. Genomic DNA was extracted from peripheral blood lymphocytes of all the studied subjects. Universal primers were used to amplify four regions of the BRCA1 gene (exons 2,8,13 and 22) and one region (exon 9) of BRCA2 gene using specific PCR. The polymerase chain reaction was carried out. Single strand conformation polymorphism assay and heteroduplex analysis were used to screen for mutations in the studied exons. In addition, DNA sequencing of the normal and mutated exons were performed.ResultsMutations in both BRCA1 and BRCA2 genes were detected in 86.7% of the families. Current study indicates that 60% of these families were attributable to BRCA1 mutations, while 26.7% of them were attributable to BRCA2 mutations. Results showed that four mutations were detected in the BRCA1 gene, while one mutation was detected in the BRCA2 gene. Asymptomatic relatives, 80(67%) out of total 120, were mutation carriers.ConclusionsBRCA1 and BRCA2 genes mutations are responsible for a significant proportion of breast cancer. BRCA mutations were found in individuals with and without family history.

Abstract 1820: Patterns of hematopoietic cancers in Egypt from a population-based registry

Abstract Objectives: Rates of lymphoma are rising by 4% annually in the United States. Globally, lymphoma incidence rates are also on the rise with about 342,000 new cases per year. Egypt, where hematopoietic (blood and lymphatic) cancer is considered common, has one of the highest age-standardized incidence rates of lymphoma in the world (16.3/100,000), greater than that of the United States (15.3/100,000). Risk factors for hematopoietic cancers include radiation, viral and bacterial infections, occupational and environmental exposures, family history, and genetic mutations. We evaluated the incidence of these cancers in Egypt and analyzed them in relation to select risk factors to better understand their etiology. Methods: Hematopoietic cancer case data for 1999-2005 from the Gharbiah Population-Based Cancer Registry in Tanta, Egypt, the only population-based registry in Egypt, were analyzed. Crude and age- and gender-specific rates were calculated for 4,260 cases, and evaluated by REAL Malignancy type, morphology, topology, and stage. Potential risk factor variables included age, gender, date of diagnosis, and district of residence, and urban/rural setting. Descriptive and multivariable statistics were calculated and space-time patterns were investigated. Results: Overall, incidence was greater among males and among residents of urban areas. More than half of cases were diagnosed at Stage III or IV. Leukemia and Hodgkin lymphoma predominated in cases under 18 years of age whereas mature B-cell neoplasms were the most common in those older than 18. Average annual crude incidence varied by district, ranging from 10.21 to 20.34 per 100,000, and generally rose during the seven year period. This rise was most prominent in the crude incidence of mature B cell neoplasms, mostly due to diffuse B cell lymphoma. Conclusions: This study provides numerical evidence of the impact of hematopoietic cancer, especially Non-Hodgkin lymphoma, on the Egyptian population. It also appears to follow the rising trend in Non-Hodgkin lymphoma cases seen worldwide. Further comparison of the distribution of incidence and alternative risk factors may lead to a novel understanding of the etiology of hematopoietic cancers and improvements in current treatment. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1820.

Abstract 3767: Detection biomarkers for squamous cell bladder carcinoma in a global setting

Abstract Bladder cancer is the fifth common malignancy in the US, and internationally it is the second most common cause of mortality from genitourinary malignancies after prostate cancer. Current clinical practice and recommendations do not include early screening for prevention. The use of cystoscopy cannot become a routine screening method of early detection due to limitations, including cost, while cytology is specific but not sensitive. Biomarkers that screen for bladder cancer before it becomes invasive are an alternative viable solution if validated and made cost-effective. Studies have mostly looked at translational cell bladder cancer and not squamous cell bladder cancer that is much more common in many parts of Africa, including Egypt and related to Schistomiasis parasitic infection. The aim in this study was to validate the use of three FDA approved biomarkers of early detection of translational baldder cancer on squamous bladder cancer in Egypt. The NMP22, Telomerase, and CD44 test kits were used for urine sample from 60 squamous bladder cancer patients and 60 non-cancer population controls. The cases and the controls were recruited from the Urology and Nephrology Center at Mansora University in Mansora, Egypt. Patients were diagnosed by cytoscopy and cytology. There was a significant difference in mean NMP22, CD44 and Telomerase levels among cases compared to controls. However, when adjusting for age and sex, only NMP22 and Telomerase remained significant. There was no significant difference among bladder cancer patients for presence or absence of a mass or schistomiases infection. CD44 and NMP22 mean levels were higher among patients if they were with stages 3 or 4 of bladder cancer compared to stages 1or 2 but this did not reach statistical significance. NMP22 and Telomerase biomarkers had better specificity and sensitivity than CD44 in predicting bladder cancer as shown by the Receiver Operating Characteristics (ROC) curves. In Conclusion, these biomarkers are satisfactory for detection of squamous cell bladder cancer, especially NMP22 and telomerase, and can become routinely used in the clinical setting in developing countries with high percentage of squamous cell bladder cancer. The next phase of biomarker validation for these assays among high-risk populations is warranted. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3767.

Abstract 1813: Frequency and risk factors of male breast cancer in Egypt and Morocco

Abstract Background: Although male breast cancer (MBC) is a rare disease, important geographic differences may help elucidate its etiology. For example, MBC in Europe and the U.S. accounts for less than 1% of all breast cancers, whereas incidence in Africa is estimated to be both higher overall and more variable amongst regions. Research from Egypt during the 1970s and 1980s showed higher incidence of MBC than the current incidence of the disease in Egypt. Preliminary studies showed that the proportion of MBC in Morocco as 3% of all breast cancers, which would suggest the possibility of MBC being more common in certain regions of Africa. Little knowledge exists, however, about the actual proportion, risk factors, and clinical characteristics of MBC in Egypt and Morocco. The goals of the current study were to explore the demographic and clinical characteristics of MBC in Egypt and Morocco with a particular focus on place of residence, age at diagnosis, previous medical history including: family history of breast cancer, treatment seeking patterns, and BRCA2 germline and tumor status. Materials and Methods: We analyzed data from Egypt (National Cancer Institute of Cairo University and the Gharbiah population-based cancer registry) for years 1999-2008 and Morocco (Casablanca and Rabat hospital cancer registries) for years 2002-2008. Information was abstracted from medical records and pathology reports (Egypt: N=191; Morocco: N=131) and tissue samples were collected for analysis of BRCA2 expression, as described previously. Results: The 1999-2006 age-adjusted incidence rate for the Gharbiah province in Egypt is 1.79/105. Frequency of MBC, out of all breast cancer cases in Morocco is 2.6%. The median age is 58 years (+/− 15.2) and 66 years (+/− 14.4) for Egypt and Morocco, respectively. At both sites, a majority of patients presented with grade II cancer (Egypt: 78.4%, Morocco: 81.0%). The most common type of cancer was invasive ductal carcinoma (Egypt: 86.5%, Morocco: 68.5%), and both countries presented with a majority of ER positive (Egypt: 81.1%, Morocco: 85.5%) cases. In both countries, most cases came from urban areas (Egypt: 66.0%; Morocco: 67.9%) and were without a family history of any breast cancer (Egypt: 2.0%; Morocco: 3.9%). Immunohistochemical analysis showed BRCA2 protein truncation in 23.1% of Egyptian cases and 26.3% of Moroccan cases. Conclusion: Although the molecular pattern of MBC in North Africa resembles MBC in the US, the higher incidence suggests studies of the CAG repeat polymorphism of the androgen receptor gene, which are ongoing in cases and normal controls to help explain the potential higher risk of MBC in North Africa. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1813.

The changing patterns of bladder cancer in Egypt over the past 26 years.

To evaluate temporal changes in histopathological types of bladder cancer and to assess associated changes in demographic, epidemiologic, and lifestyle risk factors. We abstracted data from all available medical records from the National Cancer Institute of Cairo University (NCI-Cairo). Six calendar years representing 5-year periods between 1980 and 2005 were evaluated. Information on demographics, schistosomal infection, clinical symptoms of bladder cancer, and tumor pathology was abstracted. During this 26-year period, important changes in the frequency of histopathological types of bladder cancer occurred. We found a statistically significant association between time period of diagnosis and histopathological type. Patients diagnosed in 2005 had a sixfold higher odds associated with transitional cell carcinoma compared to those patients diagnosed in 1980 (odds ratio (OR) 6.00 (95% CI 4.00-8.97)). These data strongly suggest that the histopathological profile of bladder cancer in Egypt has changed significantly over the past 26 years. Historically, squamous cell carcinoma was the predominant form of bladder cancer in Egypt; however transitional cell carcinoma has become the most frequent type. These results corroborate findings from a few small-scale hospital-based studies which conclude that the etiology of bladder cancer in Egypt has changed significantly over the past 26 years.

Nitric oxide and nitric oxide synthase as early predictors of the clinical outcome of chronic bladder lesions including malignancy

Background Bladder cancer is the most prevalent cancer in Egypt and in most African countries. Two distinct types of bladder cancer exist in Egypt, namely the bilharzial and non-bilharzial types. Nitric oxide (NO) exerts several functions in benign and malignant human tissues. Many studies have proved significantly higher urinary NO levels, as well as presence of inducible nitric oxide synthase (iNOS) in bladder tumors. Because tissue iNOS is responsible for the production of urinary and serum NO, it is possible that urine from bladder cancer patients includes high levels of NO. Aim of the work To study serum and urinary levels of NO as well as iNOS expression in bladder tissue of patients with different chronic schistosomal and non-schistosomal bladder lesions including malignancy to determine the possibility of using them as biological markers for early diagnosis and prediction of the clinical out come of bladder tumors. Patients and methods Sixty five patients; 40 with malignancy and 25 with chronic cystitis, were included in the study. Seventeen individuals with apparently normal urothelium served as controls. NO was assayed in urine and serum using the modified Griss reaction technique. Expression of iNOS in bladder tissue was determined by indirect immunohistochemical techniques. Results All controls were negative for NO in both serum and urine. The rate of positivity of NO in sera of the malignant group was significantly higher than in the chronic cystitis group ( p p p Conclusion Urinary and serum NO levels as well as iNOS expression in bladder tissue could be used as tumor markers for diagnosis of bladder cancer. Urinary NO could be also used as an early non-invasive predictive marker for the tumor behavior and prognosis.

Human papilloma virus and p53 expression in bladder cancer in Egypt: Relationship to schistosomiasis and clinicopathological factors

Human papilloma virus and p53 expression in bladder cancer in Egypt: Relationship to schistosomiasis and clinicopathological factors

Human papilloma virus and p53 expression in bladder cancer in Egypt: Relationship to schistosomiasis and clinicopathologic factors

The aim of the current study was to compare the role of p53 and human papillomavirus (HPV) in schistosomiasis-related and schistosomiasis-unrelated carcinoma of the urinary bladder. To achieve this aim, we investigated 114 bladder carcinomas for p53 oncoprotein expression by immunohistochemistry and for human papillomavirus by in situ hybridization technique. The results revealed that 64 tumors (56.1%) were schistosomiasis-associated. Sixty seven (58.8%) were transitional cell carcinomas and 32 (28%) were squamous cell carcinomas. The remaining 15 tumors (13.2%) included adenocarcinomas and sarcomatoid carcinomas. In both schistosomiasis-associated and non-associated carcinomas, p53 oncoprotein expression was significantly higher in poorly differentiated tumors. However, it was significantly higher in locally more invasive tumors in the schistosomal carcinomas only. HPV types 16/18 could be detected in 1 of the 114 bladder carcinomas (0.95%), which was schistosomiasis-related squamous cell carcinoma in situ. These results suggest that p53 immunohistochemistry can be a prognostic factor in both schistosomal and nonschistosomal bladder cancer. More importantly, HPV does not seem to play a role in the pathogenesis of either type of bladder cancer in our country.