A Histopathological Snapshot of Bladder Cancer: a Johannesburg Experience of 1480 Histopathology Reports

Purpose To evaluate the histopathological characteristics of bladder cancer in patients presenting to Johannesburg hospitals over a 13-year period (2010–2023). Methods Following ethical clearance, a retrospective study of 1480 histopathological reports was done. Normality of distribution was tested using the Shapiro Wilk test. Histopathological results were compared by patient gender using the Fisher's exact, and by age, using either one-way ANOVA or the Kruskal-Wallis test. Results Urothelial carcinoma accounted for 88.8% of bladder cancer cases, squamous cell carcinoma (7.7%), adenocarcinoma (1.5%), and other malignancies (2%). High-grade urothelial carcinoma was the predominant subtype, accounting for 75% of cases. Non-muscle invasive disease accounted for 72% of these cases, while 28% were muscle invasive. Data from radical cystectomies showed a high proportion of aggressive and advanced disease. Conclusions The study highlights the predominance of high-grade non-muscle invasive bladder cancer in Johannesburg, consistent with global trends. However, the presence of advanced disease at diagnosis, particularly in cases needing radical cystectomy for urothelial carcinoma, and squamous cell carcinoma, reflects the ongoing challenges in early detection and treatment in this population. The findings suggest a shift in bladder cancer trends in Africa away from assumed squamous cell carcinoma towards urothelial carcinoma, possibly influenced by increasing urbanisation, smoking and changes in risk factor profiles.