Bladder cancer is a malignant change in the urinary bladder. More than 90 per cent of all bladder cancers originate in the cells that line the inside of the bladder, the so-called urothelial cells. As with many cancers, there is initially no pain when bladder cancer starts developing. A typical symptom of bladder cancer is the presence of blood in the urine (haematuria), which is usually painless.
With almost 16,000 new cases a year, bladder cancer is the fifth most common type of cancer in men in Germany. Bladder cancer is a cancer of advanced age. It accounts for around 4.6 per cent of all malignant tumours in men, and for two per cent in women. Approximately 4,000 people a year die of bladder cancer in Germany. Men are three times more often affected as women.
Chronic bladder infection (cystitis) increases the risk of developing bladder cancer. The most significant environmental risk factor of bladder cancer is smoking. After lung cancer, bladder cancer is the second most common cancer in smokers. Occupational contact with different chemicals may also cause bladder cancer.
The most significant risk factor of bladder cancer is smoking. After lung cancer, bladder cancer is the second most common cancer in smokers.
A typical symptom of bladder cancer is the presence of blood in the urine (haematuria), which is usually painless.
In contrast, there is for instance a condition called haemorrhagic cystitis which young women frequently suffer from and which causes severe problems when urinating.
If patients complain of blood in the urine they must urgently see their doctor, preferably an urologist.
The most important examinations for diagnostic purposes:
- urine test
- cystoscopy, with fluorescent dye if applicable
If a tumour is present, the tumour type and depth of penetration are determined here.
- Computer tomography and urography (x-ray with contrast material)
This is used to determine whether the tumour has spread to surrounding tissue or other organs.
Treatment of bladder cancer depends on its location and spread. Bladder cancer which has not invaded the muscle wall (non-muscle invasive) can be removed surgically with an endoscope inserted in the urethra. This operation is known as transurethral resection (TUR-B). Non-muscle invasive bladder cancer has a high recurrence rate, i.e. in up to 70 per cent of cases the cancer will come back sooner or later following resection. For this reason, the bladder is often flushed with a medicinal product (intravesical instillation therapy) after the transurethral resection. Using a catheter, the (chemotherapeutic or immunotherapeutic) medicinal product is instilled in the bladder where it acts on the lining and regions threatened by the tumour. This reduces the risk of the cancer recurring. Intravesical instillation therapy aims at destroying the cancer cells present in the bladder (in situ) and preventing recurrence of the tumours.
If the tumour has invaded the muscle the bladder is removed entirely.
A further treatment alternative is thermo-chemotherapy; a combination of intravesical chemotherapy and heat. During the so-called HIVECTM therapy (Hyperthermic Intravesical Chemotherapy) a warm chemotherapeutic medicinal product is instilled into the bladder with the help of a system consisting of a small machine and a special catheter.
In Germany, there are currently 15 HIVEC machines in use:
Uniklinikum RWTH Aachen - Prof. Vögeli
St. Barbara-Hospital Gladbeck – Prof. Bernhard Planz
Kliniken Maria Hilf Mönchengladbach - Prof. Herbert Sperling
Ev. Diakonie-Krankenhaus Bremen - Dr. Martin Sommerauer
Klinikum Lippe GmbH - Dr. Alfons Gunnemann
Helios Klinikum Salzgitter – Dr. Wigand Wucherpfennig
Uniklinikum Köln – Prof. Axel Heidenreich
Klinikum der Universität München (LMU) – Dr. Boris Schlenker
St. Agnes Hospital Bocholt – Dr. Frank Oberpenning
Marien-Hospital Wesel – Dr. Andreas Stammel
Klinikum Kassel – Prof. Björn Volkmer
Helios Klinikum Krefeld - Prof. Martin G. Friedrich
Burgapotheke Königstein - Herr Uwe-Bernd Rose (Verleih durch Apotheke)
Franziskus Hospital Aachen - Herr Oliver Ting
St. Elisabeth Hospital Iserloh - Prof. Marcus Schenk
At the time of diagnosis, around 70% of all bladder cancers are so-called non-muscle invasive cancers. That means that the cancer is contained within the lining of the bladder and the connective-tissue layer immediately below it (lamina propria).
If the bladder cancer has already invaded the deeper layers of the bladder and thus the muscle it is called muscle-invasive bladder cancer.
The disease is at an even more advanced stage if metastasis has already occurred.
Depending on the clinical picture, there are three stages of bladder cancer:
- non-muscle invasive bladder cancer
- muscle-invasive bladder cancer
- metastatic bladder cancer
Classification of the tumour spread is in accordance with the TNM system. T is for tumour, N is for lymph nodes and M is for metastasis.
The tumour size is described using the Ta or T1-T4 categories.
A special type of bladder cancer is known as Tis (tumour in situ) or Cis (carcinoma in situ); a flat tumour. Non-muscle invasive bladder cancer includes all Ta and T1 tumours as well as the Tis/Cis.
Primary tumour cannot be assessed
No evidence of primary tumour
Non-invasive papillary carcinoma
Carcinoma in situ: ‘flat tumour’
Tumour invades subepithelial connective tissue
Tumour has invades muscle:
Tumour invades superficial muscle (inner half)
Tumour invades deep muscle (outer half)
Tumour has grown into perivesical tissue:
as seen through a microscope
macroscopically (extravesical mass)
The tumour has spread to any of the following organs:
The tumour has spread to the prostate, seminal vesicle(s), uterus or vagina
The tumour has spread to the pelvic wall or abdominal wall
Regional lymph nodes cannot be assessed
No evidence of metastasis in regional lymph nodes
Metastasis in single lymph node in the pelvis
Metastasis in several lymph nodes in the pelvis
Metastasis in the common iliac lymph nodes
No evidence of distant metastasis