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  • What is bladder cancer?

    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.

    Frequently asked questions

    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
    • ultrasound
    • 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
    https://www.ukaachen.de/kliniken-institute/klinik-fuer-urologie/hivec.html

    St. Barbara-Hospital Gladbeck – Prof. Bernhard Planz
    http://www.kkel.de/kliniken-zentren/kliniken-abteilungen/urologie-kinderurologie/start/

    Kliniken Maria Hilf Mönchengladbach - Prof. Herbert Sperling
    http://www.mariahilf.de/de/Urologie.htm

    Ev. Diakonie-Krankenhaus Bremen - Dr. Martin Sommerauer
    http://www.diakobremen.de/fachabteilungen/urologie_und_kinderurologie/

    Klinikum Lippe GmbH - Dr. Alfons Gunnemann
    http://www.klinikum-lippe.de/patienten/kliniken-institute/urologie.html

    Helios Klinikum Salzgitter – Dr. Wigand Wucherpfennig
    https://www.helios-gesundheit.de/kliniken/salzgitter/unser-haus/aktuelles/detail/news/mit-hoher-temperatur-gegen-den-blasenkrebs/

    Uniklinikum Köln – Prof. Axel Heidenreich
    https://urologie.uk-koeln.de/

    Klinikum der Universität München (LMU) – Dr. Boris Schlenker
    http://www.klinikum.uni-muenchen.de/Blasentumorzentrum/de/index.html

    St. Agnes Hospital Bocholt – Dr. Frank Oberpenning
    http://www.klinikum-westmuensterland.de/bocholt/leistungen/fachabteilungen/urologie-und-kinderurologie/

    Marien-Hospital Wesel – Dr. Andreas Stammel
    https://www.urologie-wesel.de/standorte/marienhospital/

    Klinikum Kassel – Prof. Björn Volkmer
    http://www.klinikum-kassel.de/index.php?parent=1216

    Helios Klinikum Krefeld - Prof. Martin G. Friedrich
    https://www.helios-gesundheit.de/kliniken/krefeld/unser-angebot/fachbereiche/urologie-und-kinderurologie/

    Burgapotheke Königstein - Herr Uwe-Bernd Rose (Verleih durch Apotheke)
    https://www.apotheke-koenigstein-app.de/

    Franziskus Hospital Aachen - Herr Oliver Ting
    https://uro-euregio.de/index.php/de/praxisklink-franziskushospital

    St. Elisabeth Hospital Iserloh - Prof. Marcus Schenk
    https://kkimk.de/st-elisabeth-hospital-iserlohn/fachabteilungen/urologie-und-kinderurologie/

    Additional information: Bladder cancer - classification of the tumour types and stages

     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:       

    1. non-muscle invasive bladder cancer
    2. muscle-invasive bladder cancer
    3. 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.

     

    TX

    Primary tumour cannot be assessed

    T0

    No evidence of primary tumour

    Ta

    Non-invasive papillary carcinoma

    Tis

    Carcinoma in situ: ‘flat tumour’

    T1

    Tumour invades subepithelial connective tissue

    T2

    Tumour has invades muscle:

    T2a

    Tumour invades superficial muscle (inner half)

    T2b

    Tumour invades deep muscle (outer half)

    T3

    Tumour has grown into perivesical tissue:

    T3a

    as seen through a microscope

    T3b

    macroscopically (extravesical mass)

    T4

    The tumour has spread to any of the following organs:
    Prostate, seminal vesicle(s), uterus, vagina, pelvic wall, abdominal wall

    T4a

    The tumour has spread to the prostate, seminal vesicle(s), uterus or vagina

    T4b

    The tumour has spread to the pelvic wall or abdominal wall

    NX

    Regional lymph nodes cannot be assessed

    N0

    No evidence of metastasis in regional lymph nodes

    N1

    Metastasis in single lymph node in the pelvis
    (hypogastric, obturator, external iliac or presacral lymph nodes)

    N2

    Metastasis in several lymph nodes in the pelvis
    (hypogastric, obturator, external iliac or presacral lymph nodes)

    N3

    Metastasis in the common iliac lymph nodes

    M0

    No evidence of distant metastasis

    M1

    Distant metastasis

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