BLADDER-CANCER IN PATIENTS WITH MULTIPLE-SCLEROSIS TREATED WITH CYCLOPHOSPHAMIDE

Purpose: We define the risk of bladder cancer in multiple sclerosis re lated to the use of indwelling catheters and cyclophosphamide administ ered as an immunomodulating agent. Materials and Methods: We retrospec tively reviewed the records of 2,351 patients with multiple sclerosis referred to the National Center for Multiple Sclerosis. Results: Of th e 2,351 patients 2 women and 5 men (0.29%) had bladder cancer. Of the 850 chronically catheterized patients the incidence was 0.7%. One pati ent with cancer performed intermittent catheterization for a rate of 0 .23% in this group. In a subgroup of 70 patients treated with cyclopho sphamide 5 chronically catheterized patients (5.7%) had bladder cancer . Hematuria was the most common presenting symptom. These data were co mpared with those in the literature on bladder cancer in spinal cord i njury. Conclusions: These data suggest a possible synergistic role of cyclophosphamide and chronic catheterization in the induction of secon dary bladder cancer. Regular cystoscopy is warranted in these patients to allow early detection of bladder tumors. Nitric oxide metabolism m ay be an important factor in the carcinogenesis of this type of bladde r cancer.