Bladder cancer in Africa.
Accurate epidemiological data about the incidence and mortality of bladder cancer are unavailable for most African countries. Transitional cell carcinoma (TCC) of the bladder is probably less common in rural African regions than in industrialized countries, due to lower levels of exposure to carcinogenic chemicals. In areas with endemic schistosomiasis (bilharzia) caused by parasitic schistosomes (blood flukes), most bladder cancer cases are comprised of squamous cell carcinoma (SCC). However, with increased urbanization, industrialization, and cigarette smoking in many African countries, there is an increasing incidence of TCC relative to SCC of the bladder. SCC of the bladder presents in patients who are on average 10 to 20 years younger than those with TCC. In Egypt and other North African countries, SCC is more common in men (the male to female ratio ranges from 3:1 to 5:1), probably because boys and men performing agricultural work are more exposed to schistosomiasis-infested water. In some sub-Saharan countries, SCC of the bladder is equally common in men and women, probably due to equal schistosomiasis exposure of girls and boys, and because women obtain household water and perform most agricultural tasks. Although SCC of the bladder often presents at a locally advanced stage, the tumors are usually well differentiated, with a relatively low incidence of lymphatic and hematogenous metastases. Patients with localized SCC are ideal candidates for cystectomy and orthotopic neobladder construction, because they are relatively young and healthy, and there is no risk of urethral recurrence, unlike with TCC. Unfortunately, many patients in Africa still present with advanced and inoperable bladder cancer, and many do not have access to healthcare facilities that can provide a cure and a good quality of life by means of radical cystectomy and neobladder construction.