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[Cyclophosphamide-induced bladder cancer: three case reports].

Toshiki Kijima¹, Hitoshi Masuda, Masahito Suzuki

¹Department of Urology and Reproductive Medicine, Graduate School, Tokyo Medical and Dental University.

Hinyokika Kiyo. Acta Urologica Japonica

|October 2, 2003

Summary

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Cyclophosphamide (CPM) can induce transitional cell carcinoma (TCC) of the bladder. This report details three cases, adding to the known literature on CPM-induced bladder tumors, highlighting a significant risk associated with this chemotherapy agent.

Area of Science:

Urology
Oncology
Pharmacology

Background:

Cyclophosphamide (CPM) is an alkylating agent used in chemotherapy.
Transitional cell carcinoma (TCC) is the most common type of bladder cancer.
Drug-induced cancers are a recognized but rare complication of long-term chemotherapy.

Observation:

Three patients developed bladder cancer after receiving CPM for conditions like Wegener's granulomatosis and breast cancer.
Symptoms included macrohematuria, and cystoscopy revealed bladder tumors with hemorrhagic cystitis.
Histological examination confirmed TCC (Grade 2 and 3) in all three cases.

Findings:

The reported cases contribute to the 17 documented instances of cyclophosphamide-induced bladder tumors in Japanese literature.

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The total doses of CPM ranged from 57g to 104g.

Treatment involved transurethral resection and intravesical Mitomycin C therapy.

Implications:

This study underscores the potential oncogenic risk of cyclophosphamide, particularly with cumulative dosing.
Clinicians should maintain a high index of suspicion for bladder cancer in patients with a history of CPM treatment presenting with urinary symptoms.
Further research into risk stratification and monitoring strategies for patients on long-term CPM therapy is warranted.