Small cell carcinoma of the bladder
- Tanya B Dorff, MD
Tanya B Dorff, MD
- Assistant Professor of Clinical Medicine
- USC Keck School of Medicine
- Norris Comprehensive Cancer Center
- David I Quinn, MBBS (Hons I), PhD, FRACP, FACP
David I Quinn, MBBS (Hons I), PhD, FRACP, FACP
- Associate Professor of Medicine
- University of Southern California Norris Cancer Center
- Keck School of Medicine
Small cell carcinoma (SCC) of the bladder is an aggressive, poorly differentiated neuroendocrine neoplasm that is similar to SCC of the lung in clinical behavior.
Although SCC is classified as a discrete entity, molecular studies have indicated that SCC is derived from the same clonal population as urothelial carcinoma (also known as transitional cell carcinoma) . Bladder SCC is frequently found in conjunction with other histologic forms of bladder cancer [2-4]. As an example, in a series of 64 cases, 44 (68 percent) had other tumor types present, including elements of urothelial cancer in 38 cases (58 percent of the total series) . Similarly, another series of 51 cases of SCC reported that elements of urothelial carcinoma, adenocarcinoma, and squamous cell carcinoma were seen in 70, 8, and 10 percent of the cases, respectively .
SCC of the bladder will be reviewed here. Extrapulmonary SCC at other sites is discussed separately. (See "Extrapulmonary small cell cancer".)
Small cell carcinoma (SCC) of the bladder is a rare neoplasm. For example, in the United States, it accounts for roughly 500 new cases annually. The incidence of SCC of the bladder may be increasing, based upon Surveillance, Epidemiology, and End Results (SEER)-Medicare data from the United States, where the incidence rose from 0.05 to 0.14 cases per 100,000 population between 1991 and 2005 , but this still represents less than one percent of all bladder tumors .
In a 2011 analysis of patients with SCC using the SEER database, the following was noted :
- Cheng L, Jones TD, McCarthy RP, et al. Molecular genetic evidence for a common clonal origin of urinary bladder small cell carcinoma and coexisting urothelial carcinoma. Am J Pathol 2005; 166:1533.
- Cheng L, Pan CX, Yang XJ, et al. Small cell carcinoma of the urinary bladder: a clinicopathologic analysis of 64 patients. Cancer 2004; 101:957.
- Abrahams NA, Moran C, Reyes AO, et al. Small cell carcinoma of the bladder: a contemporary clinicopathological study of 51 cases. Histopathology 2005; 46:57.
- Choong NW, Quevedo JF, Kaur JS. Small cell carcinoma of the urinary bladder. The Mayo Clinic experience. Cancer 2005; 103:1172.
- Koay EJ, Teh BS, Paulino AC, Butler EB. A Surveillance, Epidemiology, and End Results analysis of small cell carcinoma of the bladder: epidemiology, prognostic variables, and treatment trends. Cancer 2011; 117:5325.
- Sved P, Gomez P, Manoharan M, et al. Small cell carcinoma of the bladder. BJU Int 2004; 94:12.
- Pasquier D, Barney B, Sundar S, et al. Small Cell Carcinoma of the Urinary Bladder: A Retrospective, Multicenter Rare Cancer Network Study of 107 Patients. Int J Radiat Oncol Biol Phys 2015; 92:904.
- Trias I, Algaba F, Condom E, et al. Small cell carcinoma of the urinary bladder. Presentation of 23 cases and review of 134 published cases. Eur Urol 2001; 39:85.
- Terracciano L, Richter J, Tornillo L, et al. Chromosomal imbalances in small cell carcinomas of the urinary bladder. J Pathol 1999; 189:230.
- Patel SG, Stimson CJ, Zaid HB, et al. Locoregional small cell carcinoma of the bladder: clinical characteristics and treatment patterns. J Urol 2014; 191:329.
- Siefker-Radtke AO, Dinney CP, Abrahams NA, et al. Evidence supporting preoperative chemotherapy for small cell carcinoma of the bladder: a retrospective review of the M. D. Anderson cancer experience. J Urol 2004; 172:481.
- Quek ML, Nichols PW, Yamzon J, et al. Radical cystectomy for primary neuroendocrine tumors of the bladder: the university of southern california experience. J Urol 2005; 174:93.
- Swanson PE, Brooks R, Pearse H, Stenzel P. Small cell carcinoma of urinary bladder. Urology 1988; 32:558.
- Siefker-Radtke AO, Kamat AM, Grossman HB, et al. Phase II clinical trial of neoadjuvant alternating doublet chemotherapy with ifosfamide/doxorubicin and etoposide/cisplatin in small-cell urothelial cancer. J Clin Oncol 2009; 27:2592.
- Mukesh M, Cook N, Hollingdale AE, et al. Small cell carcinoma of the urinary bladder: a 15-year retrospective review of treatment and survival in the Anglian Cancer Network. BJU Int 2009; 103:747.
- Ismaili N, Arifi S, Flechon A, et al. Small cell cancer of the bladder: pathology, diagnosis, treatment and prognosis. Bull Cancer 2009; 96:E30.
- Bex A, de Vries R, Pos F, et al. Long-term survival after sequential chemoradiation for limited disease small cell carcinoma of the bladder. World J Urol 2009; 27:101.
- Lester JF, Hudson E, Barber JB. Bladder preservation in small cell carcinoma of the urinary bladder: an institutional experience and review of the literature. Clin Oncol (R Coll Radiol) 2006; 18:608.
- Moretto P, Wood L, Emmenegger U, et al. Management of small cell carcinoma of the bladder: Consensus guidelines from the Canadian Association of Genitourinary Medical Oncologists (CAGMO). Can Urol Assoc J 2013; 7:E44.
- Kaushik D, Frank I, Boorjian SA, et al. Long-term results of radical cystectomy and role of adjuvant chemotherapy for small cell carcinoma of the bladder. Int J Urol 2015; 22:549.
- Lynch SP, Vu TT, Kamat AM, et al. The impact of neoadjuvant chemotherapy in small cell carcinoma of the bladder: The M. D. Anderson Cancer Center experience. J Clin Oncol 28:15s, 2010 (suppl; abstr 4566).
- Asmis TR, Reaume MN, Dahrouge S, Malone S. Genitourinary small cell carcinoma: a retrospective review of treatment and survival patterns at The Ottawa Hospital Regional Cancer Center. BJU Int 2006; 97:711.
- Lohrisch C, Murray N, Pickles T, Sullivan L. Small cell carcinoma of the bladder: long term outcome with integrated chemoradiation. Cancer 1999; 86:2346.
- Walenkamp AM, Sonke GS, Sleijfer DT. Clinical and therapeutic aspects of extrapulmonary small cell carcinoma. Cancer Treat Rev 2009; 35:228.
- Eckert F, Gani C, Bamberg M, Müller AC. Cerebral metastases in extrapulmonary cell carcinoma. Implications for the use of prophylactic cranial irradiation. Strahlenther Onkol 2012; 188:478.
- Ismaili N, Heudel PE, Elkarak F, et al. Outcome of recurrent and metastatic small cell carcinoma of the bladder. BMC Urol 2009; 9:4.
- Bex A, Sonke GS, Pos FJ, et al. Symptomatic brain metastases from small-cell carcinoma of the urinary bladder: The Netherlands Cancer Institute experience and literature review. Ann Oncol 2010; 21:2240.
- Naidoo J, Teo MY, Deady S, et al. Should patients with extrapulmonary small-cell carcinoma receive prophylactic cranial irradiation? J Thorac Oncol 2013; 8:1215.
- Bex A, Nieuwenhuijzen JA, Kerst M, et al. Small cell carcinoma of bladder: a single-center prospective study of 25 cases treated in analogy to small cell lung cancer. Urology 2005; 65:295.
- CLINICAL PRESENTATION
- DIAGNOSTIC WORK-UP
- Disease localized to the bladder
- - Neoadjuvant chemotherapy plus definitive local therapy
- Neoadjuvant chemotherapy plus cystectomy
- Neoadjuvant chemotherapy plus radiation therapy
- - Is there a role for cystectomy alone?
- - Is there a role for prophylactic cranial irradiation?
- Metastatic disease
- - Treatment
- SUMMARY AND RECOMMENDATIONS