Cuidados paliativos y medicina

Abstracto

Metastatic Urothelial Cancer of the Bladder Cancer Presented for the First Time in its Final Stage: Case Report and Literature Review

Lorenzo-Gómez MF, Padilla-Fernández B, Arcila-Piedrahita A, Antúnez-Plaza P, Valverde-Martínez S and Silva-Abuín JM

Introduction: According to the European Urologic Guidelines up to 85% of urothelial cancer of the bladder (UCa) is diagnosed at the non-metastatic stage, being gross haematuria the most common symptom in 70-80% of the cases. This report introduces the case of a T4 G3 metastatic UCa proved to be asymptomatic until its final stage, when an effective treatment is unavailable.
Case report: A 68-year-old male has been presenting dizziness and mild haematuriafor fourteen days before arranging a doctor’s appointment. Physical examination goes as follows: Apyretic, lightly painful, abdomen. Serum creatinine 1.3 mg/dl, Hemoglobin 11.7 gr/dl. Abdominal ultrasound: Both kidneys were standard, bladder contained a heterogeneous mass. History: He remembers a single gross haematuria monosymptomatic episode 12 years before. Three months after the aforementioned episode, a pituitary macroadenoma 7 cm is size was diagnosed and surgically dissected; for this reason, the haematuria drew no attention. The patient had no spouse or close relatives. He had never had other gross haematuria episodes or other urologic symptoms before. Urine cytology: UCa grade 3. Chest radiography: Multiple metastases. Computed Tomography (CT) of thorax-abdomen-pelvis showed pulmonary, pleural, liver, mesenteric and bone metastases; positive lymphatic nodes in pleural membrane and between aorta and lung. Both kidneys were normal. The urinary bladder appeared to be filled with mass. Due to both clinical and personal circumstances, the patient, in agreement with his family, signed up for palliative care only. He passed away out of acute respiratory failure 41 days after the first consult.
Conclusions: Metastatic UCa at diagnosis shows a very poor survival rate. Chemotherapy with methotrexate + vinblastine + adriamicyn + cisplatin can have a success rate of 30%, improving survival to 11-14 months with high toxicity.