Incidence analyses of bladder cancer in the Nile delta region of Egypt

Association between pioglitazone use and bladder cancer: A systematic review

BACKGROUND

Bladder cancer (BC) remains a significant global health concern, and its incidence is influenced by a wide array of factors, including geography, sex, and socioeconomic status.

OBJECTIVE

This systematic review evaluated the potential association between pioglitazone use and the risk of BC. We sought to determine whether pioglitazone, used in diabetes management, is associated with an increased risk of BC by reviewing recent studies.

METHODS

A comprehensive search was conducted in the PubMed, Scopus, and Web of Science databases for relevant studies published between January 31, 2018 and July 31, 2024. From an initial pool of 212 articles, 176 were excluded due to failure to meet the inclusion criteria, 24 were removed for inadequate data or unclear conclusions, and six were eliminated due to inaccessibility. Ultimately, six eligible studies were included in the final review.

RESULTS

Of the included studies, two suggested a potential association between pioglitazone use and an increased risk of BC, whereas four reported no statistically significant correlation.

CONCLUSION

These mixed findings highlight the need for further research that accounts for confounding factors, such as treatment duration and patient demographics. This systematic review emphasizes the importance of cautious interpretation regarding the safety profile of pioglitazone in relation to BC risk.

Uncovering the epidemiology of bladder cancer in the Arab world: A review of risk factors, molecular mechanisms, and clinical features

Objective

Bladder cancer (BC) is a significant public health concern in the Middle East and North Africa, but the epidemiology and clinicopathology of the disease and contributors to high mortality in this region remain poorly understood. The aim of this systematic review was to investigate the epidemiological features of BC in the Arab world and compare them to those in Western countries in order to improve the management of this disease.

Methods

An extensive electronic search of the PubMed/PMC and Cochrane Library databases was conducted to identify all articles published until May 2022, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A total of 95 articles were included in the final analysis after title, abstract, and full-text screening, with additional data obtained from the GLOBOCAN and WHO 2020 databases.

Results

Most of the included articles were case-control studies examining the risk factors and molecular mechanisms of BC. These studies originated from 10 different countries, with Egypt being the most active contributor. While BC in the Arab world shares some common risk factors with Western countries, such as smoking and occupational exposure, it also exhibits unique features related to schistosomiasis. The high mortality rates in this region are alarming and can be attributed to various factors, including the prevalence of smoking, the impact of schistosomiasis, a combination of genetic and socioeconomic factors, treatment shortages, and limited access to care or inadequate assessment of the quality of care.

Conclusion

Despite the relatively low incidence of BC in Arab countries, the mortality rates are among the highest worldwide. BC tends to be more aggressive in the Arab world, making it essential to implement strategies to address this burden.

Cadmium exposure and the risk of prostate cancer among Nigerian men: effect modification by zinc status

BACKGROUND

Prostate cancer (PCa) may result from an interplay between many factors including exposure to trace elements. This study examined the association between cadmium exposure and PCa among Nigerian men and evaluated possible modification of this effect by zinc status.

METHODS

This case-control study involved men with histologically confirmed PCa (n = 82), benign prostatic hyperplasia (BPH; n = 93) and controls (n = 98), aged between 40 and 80 years. Study participants were recruited from the main teaching hospital that draws clients from the entire Anambra State in South-Eastern Nigeria. Blood and urine samples were collected from these participants and were analyzed for trace elements using ICP-MS. Statistical models were used to assess the exposure risk for cadmium exposure as well as the mediating effect of zinc status.

RESULTS

Among men with prostatic disorders (case-case analysis), every 10-fold increase in urinary cadmium was associated with increased risk of PCa (adjusted odds ratios: 2.526; 95% CI: 1.096-5.821). Men in the highest blood zinc quartile had lower odds of PCa compared to the lowest quartile (AOR: 0.19; 95% CI, 0.06-0.54; p-for trend = 0.001). Zinc-specific effect was observed in this group: every 10-fold increase in urinary cadmium was associated with increased risk of PCa among men with creatinine-adjusted urinary zinc levels below the median value (AOR: 8.46; 95% CI: 1.97 -36.39) but not in those above the median value (AOR: 1.55; 95% CI: 0.45 - 5.39).

CONCLUSION

Higher exposure to cadmium may be associated with increased risk of PCa in Nigeria and probably other countries with high prevalence of Zn deficiency. These results point to the need to consider co-occurring trace metals in any effort to mitigate the toxicity of Cd in the environment.

Epidemiology of Bladder Cancer in the Arab World: 2019 Global Burden of Disease Data

BACKGROUND

Urinary bladder cancer (UBC) has unique epidemiology. It is well known that some Arab countries have higher incidence of UBC due to certain risk factors, including schistosomiasis and smoking.

METHODS

We systematically reviewed the Global Burden of Disease study (GBD) database for the year 2019. We queried GBD study database using results tool for UBC in the 22 Arab countries and compared the age-standardized incidence rate (ASIR), death rate (ASDR), mortality-to-incidence ratio (MIR) and Disability-Adjusted Life Years (ASDALYs) in Arab countries with global values.

RESULTS

The Arab population represents 5.6% of the global population. There was an estimated number of 27,503 patients diagnosed with UBC in 2019 in the Arab world. The ASIR for developing UBC in the Arab countries was 9.9/100,000; which is higher than the average global ASIR (6.5/100,000). Specifically, the ASIR was higher than the global average in 11 out of the 22 Arab countries. Notably, the age-specific incidence in Egypt showed that younger individuals had higher incidence of UBC than other countries, reflecting unique epidemiology. It is estimated that 10,532 patients died of UBC in the Arab world in 2019. The average mortality-to-incidence ratio (MIR) was estimated to be 0.448. The burden of UBC as estimated by the number of DALYs in the Arab world was 272,976 years representing 4% of cancer burden in Arab countries and 6.2% of the global DALYs related to UBC.

CONCLUSION

UBC has high incidence in many Arab countries, particularly in North Africa.  Risk factors are known and are modifiable, making prevention the most optimal way to reduce disease burden. High MIR in many Arab countries reflects suboptimal management and a window for improvement.

Detection of Epithelial-Mesenchymal Transition Markers in High Grade Bladder Cancer and Special Variants of Urothelial Carcinoma

Transitional cell carcinoma is considered the most predominant type of bladder cancer. Bladder can cer can also be found as squamous cell carcinoma that accounts for 5% of the total bladder cancer due to its etiology. The biomarkers associated with grade, prognosis, and stage of the disease are not well proved and known however, many studies have pointed to the association between SNAL/SLUG and Twist2 to the overall survival in patients with bladder cancer. These biomarkers were found to have a crucial role in inhibiting cadherin mediators specifically E-cadherin which are found normally in high level to integrate cell adhesion and normal function of the bladder. This research aims to detect SNAL/SLUG and Twist2 biomarkers in specimens of patients with bladder cancer and to detect their impact on E-cadherin, a tumor suppressor mediator responsible for improving survival and prevent metastasis.

MATERIALS AND METHODS

Using 150 archival tissue blocks from human bladder cancer cases to detect expression of SNAIL/SLUG and Twist2 in relation to loss of E-cadherin by immunohistochemical method.

RESULTS

Our results have revealed that in squamous cell carcinoma 40 specimens showed marked Twist 2 expression, and 30 specimens showed marked snail/slug biomarkers expression while poorly differentiated cancer cases showed marked expression of Twist 2 in 60 specimens and marked expression of Snail/slug marked expression in 50 specimens. Both were associated with E-cadherin loss. Among the 100 specimens with transitional cell carcinoma, 70 specimens showed divergent differentiation with 7 subtypes each showed different medium to high expression of Snail/Slug and Twist 2 biomarkers with the loss of E-cadherin. E-cadherin was strongly associated with the inverse increase in SNAL/SLUG and Twist2 biomarkers in urothelial carcinoma.

CONCLUSION

Detection of SNAIL/SLUG and Twist 2 biomarkers in urothelial cancer is an important predictor for the loss of E-cadherin, a cornerstone in urinary bladder cell adhesion and its loss in urothelial carcinoma may contribute to cancer invasion and poor prognosis. <br />.

Experiential Learning in Career Development

This manuscript demonstrates the learning experiences of graduate public health students through mentored field research in cancer epidemiology and cancer prevention over the past 13 years. The program has been funded through an R25 grant from the National Cancer Institute (NCI) since 2006 and has supported nearly 200 students from different universities in the USA. Included are data on student recruitment, selection, mentorship, and evaluation of research training in US minority settings as well as foreign countries. Examples of students' learning experiences and life-long skills that shaped students' careers are presented. The insights that fostered the experiential learning idea among key leaders at the NCI Cancer training branch have proven to be sound.

Developing and Maintaining a Global Research Training Infrastructure for Cancer Education

This manuscript illustrates the 20-year process of establishing research sites that have been developed and maintained by the authors in collaboration with oncology colleagues at institutions in low- and middle-income countries. This infrastructure has been created for research training of US public health graduate students over the past 20 years for the Cancer Epidemiology Education in Special Populations (CEESP) Program funded by the US National Cancer Institute (R25 CA112383). We describe the history and resources that were utilized for developing and maintaining the research training infrastructure. We then define the elements needed for selecting and nurturing these global sites for education and research training of students. The elements include data and field resources, patient population, facilities for cancer management, laboratory resources, academic collaborators, and population parameters and cultural characteristics. These elements have also been essential in our US domestic training sites. We then emphasize the strengths and limitations of our global sites. Finally, we elaborate on our learning experience over the past 20 years. We believe that the material provided in this manuscript will serve as a useful toolkit for faculty, mentors, students, and trainees interested developing and/or utilizing research sites for cancer epidemiology and cancer prevention and control research training programs in global settings.

Exploring natural products-based cancer therapeutics derived from egyptian flora

ETHNOPHARMACOLOGICAL RELEVANCE

Egyptian plants are a rich source of natural molecules, representing considerable biodiversity due to climate variations between the Northern, Southern, Eastern and Western regions of the country. Sinai is considered a precious nature reserves preserving flora, fauna, marine organisms, and historical habitats with ancient origins. Here, traditional medicinal approaches have been used for hundreds of years. Healthy lifestyles, low levels of stress and microbial infections, and a dependence on flora and herbal medicine might in combination explain why the burden of cancer is lower in some regions than in others.

AIM OF THE STUDY

The primary aim of this review is to document the plants and natural products that are used as foods and medicines in Egypt, in general, and in Sinai, in particular, with a focus on those with demonstrated anticancer activities. The documented traditional uses of these plants are described, together with their chemical and pharmacological activities and the reported outcomes of clinical trials against cancer.

MATERIALS AND METHODS

A literature search was performed to identify texts describing the medicinal plants that are cultivated and grown in Egypt, including information found in textbooks, published articles, the plant list website (http://www.theplantlist.org/), the medicinal plant names services website (http://mpns.kew.org/mpns-portal/), and web databases (PubMed, Science Direct, and Google Scholar).

RESULTS AND DISCUSSION

We collected data for most of the plants cultivated or grown in Egypt that have been previously investigated for anticancer effects and reported their identified bioactive elements. Several plant species, belonging to different families and associated with 67 bioactive compounds, were investigated as potential anticancer agents (in vitro studies). The most potent cytotoxic activities were identified for the families Asteraceae, Lamiaceae, Chenopodiaceae, Apocynaceae, Asclepiadaceae, Euphorbiaceae, Gramineae, and Liliaceae. The anticancer activities of some species, such as Punica granatum L., Nerium oleander L., Olea europea L., Matricaria chamomilla L., Cassia acutifolia L., Nigella sativa L., Capsicum frutescens L., Withania somnifera L., and Zingiber officinale Roscoe, have been examined in clinical trials. Among the various Egyptian plant habitats, we found that most of these plants are grown in the North Sinai, New-Delta, and Giza Governorates.

CONCLUSION

In this review, we highlight the role played by Egyptian flora in current medicinal therapies and the possibility that these plants may be examined in further studies for the development of anticancer drugs. These bioactive plant extracts form the basis for the isolation of phytochemicals with demonstrated anticancer activities. Some active components derived from these plants have been applied to preclinical and clinical settings, including resveratrol, quercetin, isoquercetin, and rutin.

Role of a schistosoma haematobium specific microRNA as a predictive and prognostic tool for bilharzial bladder cancer in Egypt

Urinary bladder cancer is a common malignancy in Egypt, thus reliable methodologies are required for screening and early detection. In this study, we analyzed the gene expression of a Schistosoma hematobium specific microRNA "Sha-miR-71a" and mitogen-associated protein kinase-3 (MAPK-3) in the urine samples of 50 bladder cancer patients and 50 patients with benign bilharzial cystitis. Fifty control subjects were also tested. Indirect hemagglutination test (IHA) diagnosed 70% of studied cancer cases as bilharzial associated bladder cancer (BBC), while histopathological examination detected only 18%. Urinary Sha-miR-71a & MAPK-3 revealed enhanced expression in BBC (p-value = 0.001) compared to non-bilharzial bladder cancer (NBBC) cases. Patients with chronic bilharzial cystitis exhibited a significant increase in gene expression compared to those with acute infection (p-value = 0.001). Sha-miR-71a and MAPK-3 showed good sensitivity and specificity in the diagnosis of BBC when analyzed by the receiver operating characteristic (ROC) curve. They were also prognostic regarding malignancy grade. Both biomarkers showed a positive correlation. Our results revealed that IHA is a reliable test in the diagnosis of bilharziasis associated with bladder cancer, and that Sha-miR-71a and MAPK-3 provide non-invasive specific biomarkers to diagnose BBC, as well as a potential role in testing bilharzial patients for risk to develop cancer.

Is Schistosomiasis a Risk Factor for Bladder Cancer? Evidence-Based Facts

Background . Globally, approximately 20% of malignancy are caused by infection. Schistosoma infection is a major cause of bladder in most part of Africa. In 2018 alone, there were approximately 549,393 new cases and 199,922 deaths from bladder cancer. The presence of Schistosoma ova in the venous plexus of the bladder induces a cascade of inflammation causing significant tissue damage and granulomatous changes. Methodology. A literature review was conducted from 1995 to 2019 using PubMed, Google Scholar, African Journal Online, and Google databases. Relevant data on the association of "Schistosomiasis and Bladder cancer" in sub-Saharan Africa (SSA) were retrieved. Evidence Synthesis. Results from research using animal models to establish the carcinogenesis of Schistosoma and bladder cancer have been helpful but inconclusive. Immunoregulatory cytokines and genetic marker have been identified to play a role in the pathogenesis. In some parts of sub-Saharan Africa, there has been close association of squamous cell carcinoma and histological evidence of Schistosoma ova. Conclusion. There are some data to support the association between schistosomiasis and bladder cancer in sub-Saharan Africa. However, these have been limited by their design and may not sufficiently establish carcinogenesis. There is a need for more genomic and molecular research to better characterize S. haematobium and its effects on the bladder. Such goal will contribute immensely to Schistosoma bladder cancer prevention and control.

Assessing CD 10 Expression Level and Its Prognostic Impact in Egyptian Patients with Urothelial Carcinoma

Background and aim:

CD10 is expressed in urothelial carcinoma cells and cancer associated fibroblasts (CAF). In the current study, CD10 immunohistochemical staining (IHC) and CD10 mRNA expression in urothelial carcinoma of bladder (UCB) were assessed, and its relationship with tumor progression and prognosis was investigated.

Patients and Methods:

In this study, 106 formalin fixed paraffin-embedded (FFPE) tissue of UCB, obtained through radical cystectomy specimen, and 10 matched normal tissue samples were included.CD10 expression was evaluated by immunohistochemistry and real time PCR techniques.

Results:

CD10 expression in tumor cells and associated stromal fibroblasts was significantly associated with high tumor grade and advanced stage. Significant correlation was found between CD10 tumor expression and lymphovascular invasion (LVI) (P<0.001) as well as perineural invasion (PNI). CD10 expression in stromal fibroblasts was significantly associated with squamous differentiation of tumor cells, lymph node metastasis (LNM), and tumor necrosis. Positive CD10 expression in both tumor cells and associated stromal fibroblasts was associated with shorter OS . CD10 mRNA was overexpressed in tumors in comparison with the matched normal tissues. CD10 mRNA was significantly higher in invasive tumor, advanced stage tumor, and high grade tumor. There was significant correlation between CD10 mRNA tumor expression and LVI, PNI, and tumor recurrence.

Conclusion:

Increased expression of CD10 in the tumor and CAF was strongly correlated with tumor progression, invasion, metastasis, shorter OS, and RFS in urothelial carcinoma patients. CD10 mRNA showed significantly higher expression in tumor tissue than in matched normal tissue. CD10 mRNA was associated with depth of invasion, TNM stage, tumor grade, vascular tumor invasion, and tumor recurrence.

Copper and zinc levels in plasma and cancerous tissues and their relation with expression of VEGF and HIF-1 in the pathogenesis of muscle invasive urothelial bladder cancer: a case-controlled clinical study

To evaluate Cu and Zn levels in bladder cancer (BC) patients and their relationship with expression of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1 (HIF-1). Plasma levels of Cu and Zn were determined in 66 transitional bladder cell carcinoma patients (BC group) and 60 matched controls. The concentration of Cu and Zn as well as the expressions of both VEGF and HIF-1 were also estimated in cancerous and non-cancerous bladder tissues in the BC group. The results showed that plasma Cu and Cu/Zn ratio were significantly higher in BC group when compared with the control group. In contrast, the plasma Zn in BC group was significantly lower than in the controls. Comparing levels of Cu and Zn in cancerous and non-cancerous bladder tissues among the BC group indicated a significantly higher Cu levels in the cancerous tissues, while Zn levels was significantly lower. There were higher expressions of both VEGF and HIF-1 in the cancerous samples. Moreover, the Cu concentration in cancerous tissues was significantly correlated with expressions of VEGF and HIF-1. Logistic regression analysis revealed that the increase in plasma Cu/Zn ratio and plasma Cu and the decrease in plasma Zn may be risk factors for development of bladder cancer. We concluded that alteration of plasma and bladder tissue levels of both Cu and Zn is correlated with pathogenesis of bladder cancer. The increase in Cu level in cancerous tissues of BC group has an important role in angiogenesis in bladder cancer cells.

Long-term evaluation of modified orthotopic Y-shaped ileal neobladder (Tanta pouch) with left retro-colic chimney

PURPOSE

In the present study, we evaluated the long-term results of modified Y-shaped orthotopic ileal neobladder (Tanta pouch) with trans-mesenteric left retro-colic chimney.

PATIENTS AND METHODS

A total of 70 patients with invasive bladder cancer underwent radical cystectomy and modified Y-shaped orthotopic ileal neobladder. (The left chimney elongated to pass to the left side through a window in the mesentery of the pelvic colon and the ureters were implanted directly end to side, in both chimneys after doing good spatulation.

RESULTS

The mean follow-up period ranged between 7 and 10 years (mean 7.8 years). 18 patients died during the period of follow-up. 6 months postoperatively, there was a spherical orientation of the pouch (The mean capacity was 542 ± 47 cm³) and the maximum intra-pouch pressure was 24 ± 3.2 cm H₂O. Daytime continence was achieved in 93% of the patients and nighttime continence was achieved in 87%. Stress incontinence occurred in 15% and total incontinence in 2%. Renal function was stable in 93% of renal units. Stricture ureter was not recorded of any case. Of 14 renal units with preoperative dilated ureters, 5 units had improved postoperatively and the others had persistent reflux. 13 renal units (3 unilateral and 5 bilateral) with normal preoperative ureters had persistent postoperative reflux. Persistent reflux showed no influence on renal function.

CONCLUSION

Modified Y-shaper pouch is suitable for short, dilated ureters. Longitudinal orientation of the pouch facilitates ileo-urethral anastomosis, especially with short mesentery. Long-term follow-up for direct uretero-ileal anastomosis did not show deterioration of the renal function.

The diagnostic and prognostic roles of serum irisin in bladder cancer

BACKGROUND

Egypt is among the countries with the highest incidence of bladder cancer (BC). Adipokines involved in BC development. This study aimed to examine the diagnostic and prognostic roles of irisin in BC through its function as an adipokine.

PATIENTS AND METHODS

This study included 150 subjects; 75 patients newly diagnosed as BC and 75 apparently healthy subjects. Serum irisin levels were quantified by enzyme-linked immunosorbent assay.

RESULTS

Serum irisin levels exhibited significantly lower levels in BC patients compared to controls (1.07 [0.51-1.96] and 1.8 [0.5-2.44] µg/mL), respectively (P < 0.001). Serum irisin was positively correlated with BMI (r = 0.386, P = 0.001) and negatively correlated with serum cholesterol (r = -0.58, P < 0.0001). Irisin had 74.7% sensitivity and 90.7% specificity at a cutoff point of ≤1.2 µg/mL. Serum irisin levels reduction can predict the BC stages, when adjusted for BMI and serum cholesterol level, serum irisin had an adjusted odds ratio of 14 (P = 0.001). Low serum irisin patients had a higher mortality rate when compared to those with high levels (38.2% vs 5%).

CONCLUSION

BC patients had significantly lower levels of serum irisin. Serum irisin showed acceptable performance criteria in BC diagnosis. It had a limited role in BC grading but showed a decreasing trend in different BC stages. Serum irisin seems to be an excellent diagnostic and prognostic marker for BC.

The global burden of urinary bladder cancer: an update

Bladder cancer is among the top ten most common cancer types in the world, with approximately 550,000 new cases annually. The highest burden of bladder cancer is currently falling on most developed communities across the globe. But with an anticipated shift in world demographics with growing and aging populations mainly on the African continent, and important shifts in exposure to different risk factors across the world, this is likely to change over the next decades. In this review, we provide an overview of the current incidence, mortality, prevalence, survival, risk factors and costs of bladder cancer worldwide.

Estimate of the incidence of bladder cancer in Africa: A systematic review and Bayesian meta-analysis

OBJECTIVES

To quantify the epidemiology of bladder cancer in Africa to guide a targeted public health response and support research initiatives.

METHODS

We systematically searched publicly available sources for population-based registry studies reporting the incidence of bladder cancer in Africa between January 1980 and June 2017. Crude incidence rates of bladder cancer were extracted. A Bayesian network meta-analysis model was used to estimate incidence rates.

RESULTS

The search returned 1328 studies. A total of 22 studies carried out across 15 African countries met our pre-defined selection criteria. Heterogeneity across studies was high (I2  = 98.9%, P < 0.001). The pooled incidence of bladder cancer in Africa was 7.0 (95% credible interval 5.8-8.3) per 100 000 population in men and 1.8 (95% credible interval 1.2-2.6) per 100 000 in women. The incidence of bladder cancer was consistently higher in North Africa in both sexes. Among men, we estimated a pooled incidence of 10.1 (95% credible interval 7.9-11.9) per 100 000 in North Africa and 5.0 (95% credible interval 3.8-6.6) per 100 000 in sub-Saharan Africa. In women, the pooled incidence was 2.0 (95% credible interval 1.0-3.0) per 100 000 and 1.5 (95% credible interval 0.9-2.0) per 100 000 in North Africa and sub-Saharan Africa, respectively. Incidence rates increased significantly among men from 5.6 (95% credible interval 4.2-7.2) in the 1990s to 8.5 (95% credible interval 6.9-10.1) per 100 000 in 2010.

CONCLUSIONS

The present study suggests a growing incidence of bladder cancer in Africa in recent years, particularly among men and in North Africa. This study also highlights the lack of quality data sources and collection of essential clinical and epidemiological data in several African countries, and this hinders public health planning.

Breaking the ritual metabolic cycle in order to save acetyl CoA: A potential role for mitochondrial humanin in T2 bladder cancer aggressiveness

INTRODUCTION

Cancer cells may exhibit outsourcing of their high energy need in order to avoid the intrinsic mitochondrial apoptosis. Reduced mitochondrial respiration and accumulation of mitochondrial genome mutations are among metabolic transformations in this regard. Mitochondrial humanin (MT-RNR2) is a small peptide with anti-apoptotic activities attributed to binding some pro-apoptotic proteins.

AIM OF THE WORK

The current study aims at investigating the expression of mitochondrial humanin in bladder tumor cells and the possible casting of humanin anti-apoptotic action through orchestrating some of the mitochondrial metabolic enzymes.

MATERIAL AND METHODS

Here messenger RNA of humanin, succinate dehydrogenase, glutaminase, isocitrate dehydrogenase were compared in tissues from patients with T2 bladder carcinoma in comparison to tumor associated normal tissues from the same patients. Levels of lactate and mitochondrial pyruvate carrier (MPC1) mRNA were determined to scrutinize the prevalence of aerobic glycolysis.

RESULTS

The present study found that tumor cells had suppressed aerobic glycolysis, augmented mitochondrial respiration and interrupted tricarboxylic acid cycle, all of which were suggested to serve tumor aggressiveness. MT-RNR2 was found closely related to the alterations in mitochondrial activity.

CONCLUSION

MT-RNR2 plays its anti-apoptotic role partly by avoiding deploying energy from complete oxidation of organic compounds to inorganic wastes. Thus MT-RNR2 can potentially serve as a new biomarker in the diagnosis of bladder carcinoma especially that it is present in blood circulation.

Measuring the effect of improvement in methodological techniques on data collection in the Gharbiah population-based cancer registry in Egypt: Implications for other Low- and Middle-Income Countries

The purpose of this study was to describe and quantify procedures and methods that maximized the efficiency of the Gharbiah Cancer Registry (GPCR), the only population-based cancer registry in Egypt. The procedures and measures included a locally-developed software program to translate names from Arabic to English, a new national ID number for demographic and occupational information, and linkage of cancer cases to new electronic mortality records of the Ministry of Health. Data was compiled from the 34,058 cases from the registry for the years 1999-2007. Cases and registry variables about demographic and clinical information were reviewed by year to assess trends associated with each new method or procedure during the study period. The introduction of the name translation software in conjunction with other demographic variables increased the identification of detected duplicates from 23.4% to 78.1%. Use of the national ID increased the proportion of cases with occupation information from 27% to 89%. Records with complete mortality information increased from 18% to 43%. Proportion of cases that came from death certificate only, decreased from 9.8% to 4.7%. Overall, the study revealed that introducing and utilizing local and culture-specific methodological changes, software, and electronic non-cancer databases had a significant impact on data quality and completeness. This study may have translational implications for improving the quality of cancer registries in LMICs considering the emerging advances in electronic databases and utilization of health software and computerization of data.

Age distribution types of bladder cancers and their relationship with opium consumption and smoking

BACKGROUND

Recognition of the predisposing factors of bladder cancer is very important and provides possible prevention measures. The aim of this study was to investigate the types, distribution of bladder tumors and their relationship with opium consumption and smoking in patients who referred to Shahid Beheshti Hospital, Babol, Iran.

METHODS

In this case-control study, all patients diagnosed with bladder cancer who underwent surgery during 2001-2012 were enrolled. The subjects of the control group were selected among the patients who underwent ERCP (endoscopic retrograde cholangiopancreatography) for gallstone and had no tumors and genitourinary problems. Data regarding demographic, pathology reports and tumor type, smoking status, history of opium consumption and its duration were collected. Patients and controls were compared using t-test and chi-square test. SPSS software Version 20 was used for analysis.

RESULTS

In this study, 175 patients with an average age of 63.30±15.29 years and 175 age- matched controls were studied. A significant association was observed between smoking and opium consumption with bladder cancer (P=0.001 for both).

CONCLUSION

The results of this study showed that opium consumption and smoking are associated with bladder cancer.

Urinary schistosomiasis

Schistosomiasis is the second most common socio-economically devastating parasitic disease after malaria, affecting about 240 million residents of developing countries. In Africa, it predominantly manifests as urogenital disease, and the main infective agent is Schistosoma hematobium. Endemicity is propagated by poor socio-economic status and environmental degradation due to rapid urbanization. Recreational swimming is a potent medium for the spread of disease in children and adolescents. Most affected individuals are asymptomatic. The male and female worms are equipped with an extraordinary capacity for immune evasion and are able to co-habit for several decades within the pelvic venous plexus. Eggs deposited in the bladder wall resist elimination by type 1 T lymphocytes. Instead, they are sustained by pro-fibrogenic encapsulation (as modulated by type 2 helper cells). Progressive bladder disease results in obstructive uropathy and predisposes to (mostly) squamous cell carcinoma. Schistosomal glomerulopathy manifests as a clinical spectrum of asymptomatic proteinuria, nephrosis and/or nephritic syndrome. Findings on renal biopsy may be influenced by co-morbidity with Salmonella bacteria, amyloidosis and hepatitis C infection. Potentially fatal Katayama fever and spinal radiculopathy may ensue in tourists visiting an endemic zone. Early detection by urine microscopy is hampered by low urinary excretion rates of the parasite eggs. Although useful in travelers with newly acquired disease, the results of the serological antibody assay may be false positive in residents of an endemic zone. Cystoscopy, however, may be invaluable. Due to its safety, effectiveness and once-daily dosing, praziquantel is the drug of choice. An integrated approach that includes mass chemotherapy, environmental health programs and public health education is the most cost-effective preventive strategy.

Cancer incidence in egypt: results of the national population-based cancer registry program

Background. This paper aims to present cancer incidence rates at national and regional level of Egypt, based upon results of National Cancer Registry Program (NCRP). Methods. NCRP stratified Egypt into 3 geographical strata: lower, middle, and upper. One governorate represented each region. Abstractors collected data from medical records of cancer centers, national tertiary care institutions, Health Insurance Organization, Government-Subsidized Treatment Program, and death records. Data entry was online. Incidence rates were calculated at a regional and a national level. Future projection up to 2050 was also calculated. Results. Age-standardized incidence rates per 100,000 were 166.6 (both sexes), 175.9 (males), and 157.0 (females). Commonest sites were liver (23.8%), breast (15.4%), and bladder (6.9%) (both sexes): liver (33.6%) and bladder (10.7%) among men, and breast (32.0%) and liver (13.5%) among women. By 2050, a 3-fold increase in incident cancer relative to 2013 was estimated. Conclusion. These data are the only available cancer rates at national and regional levels of Egypt. The pattern of cancer indicated the increased burden of liver cancer. Breast cancer occupied the second rank. Study of rates of individual sites of cancer might help in giving clues for preventive programs.

Urothelial cancer of bladder in young versus older adults: clinical and pathological characteristics and outcomes

Bladder urothelial carcinoma is rare in young adults and occurs more commonly in older individuals. The aim of this study was to compare the clinical behavior, pathologic characteristics, and prognosis of urothelial carcinoma of urinary bladder in young versus older adults. A retrospective review of our records between 2007 and 2013 identified 56 patients (42 males and 14 females) with transitional cell carcinoma of the bladder who were less than 40 years old. Clinical and pathological parameters of patients who were less than 40 years of age were compared with those of a series of patients older than 40 years of age (the control group) during the same period. A survival analysis was performed using the Kaplan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinical outcomes. The mean age was 29.21 years (range, 5-40 years) for patients less than 40 years old and 61.66 years (range, 41-75) for those older than 40 years. The mean follow-up was 40.26 months (range, 12-65 months) for young patients and 42.57 months (range, 12-72 months) for the older patients. Young bladder cancer patients had smaller-sized tumors (less than 3 cm), less high-grade cancers, higher papillary urothelial neoplasms of low malignant potential, and low-grade tumors than patients older than 40 years. Multivariate logistic regression analysis predicted tumor recurrence in young patients with high-grade tumors [odds ratio (OR), 1.959; 95% confidence interval (CI), 1.235-2.965; p = 0.046] and tumors larger than 3 cm (OR, 1.772; 95% CI, 1.416-1.942; p = 0.032). The 5-year overall survival rate was 100% for young patients and 88.1% for older patients. No difference was observed in the recurrence-free (p = 0.321) and progression-free (p = 0.422) survival rates between the two groups. We concluded that although the clinical stage distribution, natural history, and outcomes of bladder urothelial cancer in young adults are similar to those in their older counterparts, clinicians must be aware that patients under 40 years of age presented with higher-grade and larger (>3 cm) tumors and are more likely to experience tumor recurrence.

Cancer incidence in Rabat, Morocco: 2006-2008

INTRODUCTION

No population-based data of cancer incidence from Morocco have been published before. This is the first report of cancer incidence in Rabat from a population-based cancer registry for the period 2006-2008.

MATERIALS AND METHODS

The cancer registry collects data on all new cases of cancer diagnosed in the resident population of the Rabat area. Data collection is an active process involving visits by registry staff to all data sources, essentially hospitals, pathological laboratories, and private clinics in Rabat.

RESULTS

A total of 2,473 new cases of cancer were registered among residents in Rabat during the period 2006-2008. The overall world age-standardised rate (ASR) for all sites combined was 136.6/100,000 for men and 114.5/100,000 for women. The most frequently diagnosed malignancies in males were lung cancer (19.0%, ASR 24.8/10(5)), followed by prostate cancer (15.5%, ASR 22.9/10(5)), colorectal cancer (8.8%, ASR 12.0/10(5)), bladder cancer (6.9%, ASR 9.7/10(5)), and non-Hodgkin's lymphoma (NHL) (6.0%, ASR 8.2/10(5)). In females, the most frequently reported malignancies were breast cancer (39.9%, ASR 43.4/10(5)), followed by cervix uteri cancer (11.4%, ASR 13.0/10(5)), colorectal cancer (7.5%, ASR 9.0/10(5)), NHL (3.4, ASR 4.2/10(5)), and thyroid cancer (3.4%, ASR 3.9/10(5)). Of all cancers, 2% are observed in childhood (0-14 years), and ~43% of them are malignant haemopathies.

CONCLUSION

The data reported by Rabat Cancer Registry indicate that cancers of the breast, cervix, uteri, and colon and rectum in females and the lung, prostate, and colon and rectum in men are major cancers in the population of Rabat. The Incidences observed are sometimes different from those observed in the neighbouring North African countries.

Chemical neurolysis of the inferior hypogastric plexus for the treatment of cancer-related pelvic and perineal pain

BACKGROUND

Various interventions, including the superior hypogastric plexus block and ganglion impar block, are commonly used for the treatment of pelvic or perineal pain caused by cancer. The inferior hypogastric plexus block (performed using a trans-sacral approach under fluoroscopy and using a local anesthetics⁄steroid combination) for the diagnosis and treatment of chronic pain conditions involving the lower pelvic viscera was first described in 2007. Neurolysis of the inferior hypogastric plexus may be useful for the treatment of pelvic and perineal pain caused by cancer.

OBJECTIVES

To assess the feasibility, safety and efficacy of the newly introduced inferior hypogastric plexus block, performed using a trans-sacral approach, for the relief of cancer-related pelvic and perineal pain.

METHODS

A total of 20 patients with cancer pain in the pelvis and⁄or perineum were injected with 6 mL to 8 mL of 10% phenol bilaterally by passing a spinal needle through the sacral foramen to perform the inferior hypogastric block. Pain intensity (measured using a visual analogue scale), sleep score, activity score, psychological score and oral morphine consumption pre- and postprocedure were measured.

RESULTS

Two of the 20 patients died during the follow-up period and were, therefore, excluded from the study. All patients presented with cancer-related pelvic, perineal or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.22±1.31 preprocedurally to 4.06±1.73 one week postprocedurally (P<0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 106.67±32.90 mg to 61.67±40.48 mg after one week (P<0.05). No complications or serious side effects were encountered during or after the block.

DISCUSSION AND CONCLUSION

The approach provides a good alternative technique for the treatment of low pelvic and perineal cancer-related pain. Additional studies are required for evaluation and refinement of the technique using other radiological techniques.

Schistosomiasis and urinary bladder cancer in North Western Tanzania: a retrospective review of 185 patients

Introduction

Worldwide, cancers of the urinary bladder are well known to be associated with environmental chemical carcinogens such as smoking and occupational exposure to polycyclic aromatic hydrocarbons. These cancers are typically transitional cell carcinoma (urothelial carcinoma). In areas where schistosomiasis is endemic there is a high incidence of squamous cell carcinoma of the urinary bladder. Schistosomiasis causes chronic granulomatous cystitis leading to squamous metaplasia of transitional epithelium, and subsequently development of squamous cell carcinoma. The western part of Tanzania on the shores of Lake Victoria is such an endemic area. This study was done to document the burden of urinary bladder cancer associated with schistosomiasis in this region.

Methods

This was a descriptive retrospective study of histologically confirmed cases of urinary bladder cancer seen at the Department of Pathology Bugando Medical Centre (BMC) over a period of 10 years. Data were retrieved from the records of the Departments of Pathology, Medical Records and Surgery. Data were analyzed by the use of contingency tables.

Results

A total of 185 patients were diagnosed with cancer of the urinary bladder during the study period, where as 90 (48.6%) were males and 95 (51.4) were females. The mean age at diagnosis was 54.3 years. Squamous cell carcinoma was the most frequent histological type (55.1%), followed by conventional transitional cell carcinoma (40.5%). Eighty three of all cancer cases (44.9%) were found to have schistosomal eggs. Schistosomiasis was commonly associated with squamous cancers compared to non squamous cancers. Most of the cancers associated with schistosomiasis had invaded the muscularis propria of the urinary bladder at the time of diagnosis (p<0.001) and such cancers were frequent below 50 years of age with a significant statistical difference (p<0.001). Poorly differentiated tumors were more frequent in females than males with a significant statistical difference (p=0.006).

Conclusion

The majority of urinary bladder cancers seen in the Lake Region were squamous cell carcinoma associated with schistosomiasis. These cancers showed an aggressive behavior and were commonly seen in the younger age groups. Effective control of schistosomiasis in this region should significantly reduce the burden of urinary bladder cancer.

Geographic distribution of hematopoietic cancers in the Nile delta of Egypt

BACKGROUND

Previous evidence indicated that incidence rates of non-Hodgkin's lymphoma (NHL) are high in Egypt although little is known about risk factors.

MATERIALS AND METHODS

Using data from the population-based cancer registry of Gharbiah governorate in Egypt, we assessed the 1999-2005 incidence of hematopoietic cancers (HCs) based on the ICD-O3 by age- and sex-specific urban-rural distribution.

RESULTS

NHL showed the highest incidence among all HCs (11.7 per 100 000). Urban incidence of HCs was higher than rural incidence. Incidence rates of Hodgkin's lymphoma (HL) and NHL were high especially among urban males up to the 64-year age category. Rural incidence of HL and NHL was high below age 20. Among the districts of the governorate, we observed NHL incidence pattern similar to that observed for hepatocellular carcinoma because of the possible link to hepatitis C virus for both cancers. Comparison to the published HCs data from Algeria, Cyprus, and Jordan showed the highest NHL rate in Egypt than the other countries in the region.

CONCLUSIONS

Future studies should define the role of environmental exposures in hematopoietic carcinogenesis in this population. In-depth studies should also investigate the role of access to health care in the urban-rural variation of HC distribution in this population.

CD44s and CD44v6 in diagnosis and prognosis of human bladder cancer

The cell adhesion molecules (CAMs) CD44 standard (CD44s) and its variant 6 (CD44v6) are involved in the progression and invasion of human malignancies. However, discrepancies in the prognostic value of CD44s and CD44v6 expression need to be addressed.

AIMS

To investigate the expression of CD44s and CD44v6 in bladder carcinomas and relate the results to the established prognostic factors.

MATERIALS AND METHODS

50 bladder carcinoma specimens, 30 cases with transitional cell carcinoma (TCC: 6 bilharzial and 24 nonbilharzial) and 20 cases with squamous cell carcinoma (SCC: 8 bilharzial and 12 nonbilharzial), were included. Immunohistochemical analysis for CD44s and CD44v6 was carried out using avidin-biotin peroxidase method.

RESULTS

The level of both CD44s and CD44v6 in TCC was significantly higher in invasive than in preinvasive tumors and normal urothelium (p < .05). A direct association between the percentage of expression of both markers and the grade of TCC (p < .05) was observed. An inverse correlation between CD44s and SCC was seen, where metaplastic urothelium showed higher expression than invasive carcinomas. No association was observed between the expressions of both CD44s and CD44v6 and bilharzial ova, sex and age of the patient, or size of the tumor.

CONCLUSIONS

The authors report statistically significant correlation between CD44s and CD44v6 expression and increasing grade and stage of TCC. No such correlation with SCC and with bilharzial cystitis, sex and age of the patient, or size of the tumor was documented.

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

AIM: To describe the clinical and epidemiologic profiles of the disease and to compare the findings with those generated from the previous hospital-based studies.

METHODS: 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.

RESULTS: Over the 9 year-period, 1364 colorectal cancer cases were included. The disease incidence under age 40 years was relatively high (1.3/10⁵) while the incidence in the age groups 40 and over was very low (12.0/10⁵, 19.4/10⁵ and 21.2/10⁵ 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.

CONCLUSION: 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.

Urinary retinoic acid receptor-β2 gene promoter methylation and hyaluronidase activity as noninvasive tests for diagnosis of bladder cancer

OBJECTIVES

We evaluated the significance of urinary retinoic acid receptor-β2 (RAR-β2) gene promoter methylation and hyaluronidase activity in comparison with voided urine cytology (VUC) in diagnosis of bladder cancer.

DESIGN AND METHODS

This study included 100 patients diagnosed with bladder cancer, 65 patients with benign urological disorders and 51 healthy volunteers. Urine supernatant was used for determining hyaluronidase activity by zymography while urine sediment was used for cytology and detection of methylated RAR-β2 gene promoter by methylation specific nested PCR.

RESULTS

The sensitivity and specificity were 53% and 90.5% for VUC, 65% and 89.7% for percent methylation fraction of RAR-β2 gene promoter, and 89% and 90.5% for hyaluronidase activity; combination of the three parameters increased sensitivity to 95%. A significant association was observed between investigated markers and advanced grade tumor.

CONCLUSIONS

Combined use of RAR-β2 gene promoter methylation, hyaluronidase activity and VUC is promising non-invasive tool for bladder cancer detection.

Epidermal growth factor receptor expression in urinary bladder cancer

Objective:

To evaluate the expression pattern of epidermal growth factor receptor (EGFR) in urinary bladder cancer and its association with human epidermal growth factor receptor 2 (HER2), epidermal growth factor (EGF), interleukin-6 (IL-6), and high risk human papilloma virus (HPV) types 16 and 18.

Materials and Methods:

Thirty cases of urothelial carcinoma were analyzed. EGFR, HER2, EGF, and IL-6 expressions in the tissue were evaluated by immunohistochemical staining. For HPV, DNA from tissue samples was extracted and detection of HPV was done by PCR technique. Furthermore, evaluation of different intracellular molecules associated with EGFR signaling pathways was performed by the western blot method using lysates from various cells and tissues.

Results:

In this study, the frequencies of immunopositivity for EGFR, HER2, EGF, and IL-6 were 23%, 60%, 47%, and 80%, respectively. No cases were positive for HPV-18, whereas HPV-16 was detected in 10% cases. Overall, expression of EGFR did not show any statistically significant association with the studied parameters. However, among male patients, a significant association was found only between EGFR and HER2.

Conclusions:

Overexpression of EGFR and/or HER2, two important members of the same family of growth factor receptors, was observed in a considerable proportion of cases. Precise knowledge in this subject would be helpful to formulate a rational treatment strategy in patients with urinary bladder cancer.

Efficiency of diagnostic biomarkers among colonic schistosomiasis Egyptian patients

The schistosomal parasite plays a critical role in the development of malignant lesions in different organs. The pathogenesis of cancer is currently under intense investigation to identify reliable prognostic indices for disease detection. The objective of this paper is to evaluate certain biochemical parameters as diagnostic tools to efficiently differentiate between colonic carcinoma and colonic carcinoma associated with schistosomal infection among Egyptian patients. The parameters under investigation are interleukin 2 (IL-2), tumour necrosis factor alpha (TNF-α), carcinoembryonic antigen (CEA) levels, tissue telomerase, pyruvate kinase (PK), glucose-6-phosphate dehydrogenase (G-6-PD) and lactate dehydrogenase (LDH) enzyme activities. The results revealed a significant elevation in the level of the tumour markers IL-2, TNF-α and CEA as well as the activities of LDH, telomerase and G-6-PD among non-bilharzial and bilharzial colonic cancer groups, with a more potent effect in bilharzial infection-associated colonic cancer. A significant inhibition in PK activity was recorded in the same manner as compared to normal tissues. The efficacy of this biomarker was also evaluated through detecting sensitivity, specificity, negative and positive predictive values. In conclusion, schistosomal colonic carcinoma patients displayed more drastic changes in all parameters under investigation. The combination of the selected parameters succeeded in serving as biomarkers to differentiate between the two malignant types.

Lymphosarcoma associated with Heterobilharzia americana infection in a dog

Hepatic T-cell lymphosarcoma with involvement of regional lymph nodes and concurrent schistosomiasis were diagnosed in an 11-year-old male neutered mixed-breed dog with a history of chronic weight loss, inappetence, vomiting, and diarrhea. Trematode ova present in the hepatic parenchyma and mesenteric node were surrounded by sheets of neoplastic lymphocytes while those in the intestinal wall were surrounded by large numbers of non-neoplastic lymphocytes. Immunohistochemistry revealed that both the neoplastic and hyperplastic populations were T lymphocytes. The ova were identified by fecal saline sedimentation as Heterobilharzia spp., and fecal ova shedding resolved after praziquantel anthelmintic treatment. The lymphoma progressed despite chemotherapy, and the dog was euthanized after developing neurologic signs and a necropsy was performed. A monomorphic population of neoplastic T cells expanded and replaced normal architecture in the liver and spleen, surrounded nerve roots within the cauda equina, and infiltrated the meninges of the brain. The presence of schistosome ova embedded within neoplastic T-cell infiltrates suggests that, as previously reported in human schistosomiasis, heterobilharziasis may be associated with neoplasia.

Prognostic value of cyclooxygenase-2 expression in squamous cell carcinoma of the bladder

PURPOSE

Inflammation is associated with the pathogenesis of carcinoma, including squamous cell carcinoma of the bladder. Cyclooxygenase-2 is an enzyme that is induced at inflammation sites. We assessed the expression pattern of cyclooxygenase-2 in patients with squamous cell carcinoma of the bladder and determined whether cyclooxygenase-2 expression is associated with clinical outcomes after radical cystectomy.

MATERIALS AND METHODS

Immunohistochemical staining for cyclooxygenase-2 was done on archival bladder specimens from 152 patients treated with radical cystectomy for squamous cell carcinoma on the Autostainer (DakoCytomation, Carpinteria, California). Bright field microscopy imaging coupled with advanced color detection software was used. Cyclooxygenase-2 was defined as over expressed when greater than 20% cells were positive. We assessed the relationship of cyclooxygenase-2 expression with pathological parameters and clinical outcome.

RESULTS

The study included 99 male and 53 female patients with a mean age of 52 years who had squamous cell carcinoma, including 80.9% with bilharziasis. Presenting stage was T2 or greater and presenting grade was GII or less in 93.4% of patients. Median followup was 63.2 months. Cyclooxygenase-2 was over expressed in 74 cystectomy specimens (48.7%) and associated with higher pathological stage (p=0.003) and grade (p=0.049). On multivariate Cox proportional hazards regression analysis cyclooxygenase-2 over expression was associated with disease recurrence (p=0.031) and bladder cancer specific mortality (p=0.046).

CONCLUSIONS

Cyclooxygenase-2 over expression is associated with pathological stage, grade and worse outcomes after radical cystectomy, suggesting a role in bladder squamous cell carcinoma progression. Our findings support the need for further evaluation of cyclooxygenase-2 and inflammatory signaling pathways, and cyclooxygenase-2 targeted prevention or therapy in patients with bladder squamous cell carcinoma.

Bilharzial vs non-bilharzial related bladder cancer: pathological characteristics and value of cyclooxygenase-2 expression

OBJECTIVE

• To assess the expression pattern of cyclooxygenase-2 (COX-2) in bilharzial and non-bilharzial related bladder cancer (BBC and NBBC) and its association with clinical outcome after radical cystectomy (RC). We also determined the clinico-pathological differences between BBC and NBBC.

PATIENTS AND METHODS

• Immunohistochemical (IHC) staining for COX-2 was performed on archival bladder specimens from 315 patients treated with RC between 1997 and 2003. • Patients were divided into 2 groups: Group 1 comprised 205 patients (65%) with BBC and group 2 comprised 110 patients (35%) with NBBC. • Clinico-pathological differences were compared and altered IHC expression of COX-2 was correlated with clinical outcome in both groups.

RESULTS

• The study included 315 patients (239 males and 76 females) with median age 54 y (range 31-79) and median follow up of 63.2 months after RC. • There was significant difference in histological types, tumor stage, grade, and architecture and COX-2 alterations between both groups (P < 0.05). • BBC presented with lower grade, higher stage, and non-papillary non-urothelial carcinoma. COX-2 overexpression was associated with pathological T stage (P= 0.01), grade (P < 0.001) and lymphovascular invasion (LVI) (P= 0.041). • COX-2 expression was an independent predictor of disease recurrence (HR 1.9, CI 0.99-3.626 and P= 0.05) and cancer specific mortality (HR 2.8, CI 1.155-6.73 and P= 0.023) only in BBC but not in NBBC (HR 1.6, CI 0.598-4.364, P= 0.344 and HR 0.349, CI 0.076-1.595, P= 0.175, respectively).

CONCLUSIONS

• BBC differs pathologically and biologically from NBBC. BBCs present more frequently as low-grade, high stage non-papillary and non-urothelial cancers. BBCs with COX-2 alterations are associated with worse outcome after RC. • Our findings support the need for further evaluation of COX-2 and inflammatory signaling pathways as well as COX-2-targeted prevention and therapies in BC.

Geographic patterns of cancer in the population-based registry of Egypt: Possible links to environmental exposures

BACKGROUND

We investigated the variation in cancer incidence in Gharbiah, Egypt to explore geographic differences in relation to demographic and environmental exposures.

METHODS

Using data from the only population-based cancer registry of Gharbiah, we studied the 10 most common cancers in men and women over 4 years (1999-2002). Census data provided denominators and urban-rural definitions. Crude and adjusted incidence rates (IRs), incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression.

RESULTS

Incidence of all common cancers was higher among men than women and urban incidence was higher than rural incidence for all cancer sites. Among men and women urban-rural incidence difference was highest for prostate cancer (IRR=4.85, 95% CI=3.76, 6.26) and uterus (IRR=6.05, 95% CI=4.17, 8.78), respectively. Among men and women, El-Santa district had the highest urban-rural difference within districts for laryngeal cancer (IRR=29.45, 95% CI=10.63, 81.61) and uterine cancer (IRR=15.98, 95% CI=2.69, 95.10), respectively. El-Santa also showed the highest urban incidence among all eight districts for most cancer sites.

CONCLUSIONS

Geographic differences of cancers in Gharbiah need in-depth investigation with respect to specific environmental factors that explain the geographic cancer in this region.

Expression of O-Alkylguanine-DNA Alkyltransferase in Normal and Malignant Bladder Tissue of Egyptian Patients

Bladder tumour tissues and corresponding uninvolved mucosa (normal tissue) of Egyptian bladder cancer patients were assessed for O⁶-alkylguanine-DNA-alkyltransferase (MGMT) activity by functional assay of tissue extracts (36 paired samples), and distribution by immunofluorescence (IF) microscopy of fixed material (24 paired samples). MGMT varied widely from 42–253 fmoles/mg protein and from 3.2–40 fmoles/μg DNA in normal and 58–468 fmoles/mg protein and 2.5–49.5 fmoles/mg protein, in the tumour tissues; only one tumour had undetectable activity. Pairwise comparison of MGMT activity in tumour and adjacent normal tissue showed no significant difference based on DNA content but was 1.75-fold higher in tumour (P < .01) based on protein. There was no effect of gender or bilharzia infection status. IF showed that in tumours, both the mean percentage of positive nuclei (57.3 ± 20.3%) and mean integrated IF (5.47 ± 3.66) were significantly higher than those in uninvolved tissues (42.8 ± 13.5% P = .04) and (1.89 ± 1.42; P < .01), respectively. These observations suggest that, overall, MGMT levels are increased during human bladder carcinogenesis and that MGMT downregulation is not a common feature of bladder cancers. Based on this, bladder cancers would be expected to be relatively resistant to chemotherapy which involved O⁶-guanine alkylating antitumour agents.

Head and neck cancer in a developing country: a population-based perspective across 8 years

Head and neck cancer (HNC) has been studied in different regions of the world but little is known about its incidence patterns in the Middle East and Egypt. In this study from Egypt's only population-based registry, we analyzed data from 1999 to 2006, to estimate incidence, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) categorized by age, district and subsites. Overall urban incidence of HNC was twice or more that of rural incidence for both males (IRR=2.59; 95% CI=2.26, 2.97) and females (IRR=2.00; 95% CI=1.64, 2.43). Highest urban-rural difference for males was seen in 40-49years (IRR=2.79; 95% CI=1.92, 4.05) and for females in 30-39years (IRR=2.94; 95% CI=1.60, 5.40). Among subsites, highest incidence among males was for larynx (1.53/10(5)) and among females for gum and mouth (0.48/10(5)). Maximum urban-rural difference in males was for paranasal sinus (IRR=4.66; 95% CI=1.88, 11.54) and in females for lip (IRR=8.91; 95% CI=1.89, 41.98). The study underscores the patterns of HNC incidence in Egypt while indicating the need for future analytical studies investigating specific risk factors of HNC in this population.

Research training of students in minority and international settings: lessons learned from cancer epidemiology education in special populations

This article describes the development and evaluation of an NCI-sponsored short-term summer cancer research education program. The study questions examined: the feasibility of conducting a cancer education program in special populations at multiple US and international field sites for masters students; the merit and worth that students and faculty attribute to the program; and students' scholarly and cancer-related career outcomes. Developing a new curriculum, increasing the pool of mentors, utilizing and increasing the number of field sites, and program dissemination were also evaluated. Evidence of the program's success included students' completion of field experiences at multiple sites and their subsequent 70% project-related publication rate, with 79% of trainees reporting themselves as likely to pursue future cancer-related careers. Evaluation-guided future plans for the program include implementing faculty development to further enhance the program outcomes.

Environmental factors and genetic susceptibility promote urinary bladder cancer

Cancer of the urinary bladder is the second most common malignancy of the genitourinary tract, currently accounting for up to 5% of all newly diagnosed tumours in the western world. Urinary bladder carcinogenesis seems to develop from the interaction of environmental exposure and genetic susceptibility. Smoking, specific industrial chemicals, dietary nitrates and arsenic represent the most important exogenous risk factors. Chromosomal abnormalities, silencing of certain genes by abnormal methylation of their promoter region, alterations in tumour suppressor genes and proto-oncogenes that induce uncontrolled cell proliferation and reduced apoptosis, are molecular mechanisms that have been reported in bladder carcinogenesis. In this article, we discuss the environmental risk factors of bladder cancer and we review the genetic and epigenetic alterations, including aberrant DNA methylation and deregulation of microRNAs expression. We also discuss the role of p53 and retinoblastoma suppressor genes in disease progression. Finally, we present recent reports on the use of molecular profiling to predict disease stage and grade and direct targeted therapy.