TMSS Medical College Journal

Background: Cigarette smoking is the most well-established risk factor for developing bladder cancer. Objective: To investigate the role of smoking as a risk factor for recurrence of non-muscle invasive transitional cell carcinoma (TCC) of the urinary bladder after transurethral resection. Materials & Methods: In this prospective comparative study from January, 2010 to December, 2013 with newly diagnosed non-muscle invasive transitional cell carcinoma of the urinary bladder recruited from Rajshahi Medical College Hospital were selected and divided into smokers (60 patients) and non-smokers (60 patients) group. Data were obtained from 120 patients during a prospective phase of 4 schedules of three monthly cystoscopic follow-up on the 3rd, 6th, 9th and 12th month after transurethral resection (TUR) to compare the recurrence rate between the smokers and non-smokers. Smoking status (obtained when entering the study) was matched with other known risk factors and the effect of smoking on size, number, presenting grade and stage of TCC in each group was evaluated. Results: Recurrence rate in smokers group was 36.67% and in non-smokers group was 23.33 %. Conclusion: Smoking not only induces bladder cancer, but also, once it develops, it can increase the post resection recurrence rate, resulting in worse prognosis. Another significant factor, that predicts a shorter recurrence free survival among the smokers compared with non-smokers. Painless haematuria is the most common presentation and greater awareness is needed not to overlook the bladder cancer.

Urinary bladder is the most common site of involvement with cancer in the urinary tract system. Among the best established risk factors for the development of the urinary bladder cancer, there is a strong association between it and cigarette smoking. While specific industrial chemicals have been linked to the development of this disease, 60% of bladder cancers are estimated to result from smoking. Therefore; cigarette smoking is the most important risk factor for the development of TCC of the urinary bladder’. Experimental evidence suggests that, nitrosamines, 2-naphthylamine and 4-aminobiphenyl might be the bladder carcinogens in cigarette smoke’. These amines cause oxidative DNA damage in the normal urothelium and induce bladder cancer”. The association between bladder cancer and smoking has been studied and evaluated from different aspects, especially in relation to gender’, intensity and duration of smoking *°, ceasing smoking’, environmental tobacco smoking®’, and cigarettes vs. other types of smoking®'’. It is not clear whether smoking contributes to the development of higher grades and stages of bladder cancer. Studies assessing this issue are few and have given conflicting results. Because, smoking has a well-known causal association with bladder cancer, one could hypothesize that, there is also a relationship between smoking status and clinical prognosis concerning the chances of recurrence and progression. This study was designed to evaluate the role of smoking in prognostic characteristics of transitional cell carcinoma of the urinary bladder.