Urinary bladder cancerBladder cancer is a malignant tumor that develops in the lining of the bladder. Some bladder cancers grow only superficially, while others invade deeper layers of the bladder wall. Then they can spread across the organ under certain circumstances.
At a glance
– Bladder cancer is the most common cancer of the urinary tract. – Men are affected about 3 times as often as women. – In about 7 out of 10 people affected, the tumor is confined to the mucosa: This cancer is called non-muscle-invasive bladder cancer. – In the remaining patients, the cancer has grown further into the muscle layer: this is muscle-invasive bladder cancer. – The main risk factor for bladder cancer is active and passive smoking: Therefore, the most important preventive measure is to abstain from nicotine. – The prospect of cure is better for non-muscle-invasive bladder cancer than for muscle-invasive bladder cancer.
What is bladder cancer?
Bladder cancer is a malignant disease of the bladder lining, called the urothelium:
– If the cancer cells grow superficially, it is a non-muscle invasive bladder cancer. – Tumors in which the cancer cells grow into the muscle layer of the bladder are called muscle-invasive bladder carcinomas.
Most bladder cancers have not yet invaded the muscular layer when first diagnosed.
If the cancer of the urinary bladder is superficial, it is referred to as non-muscle-invasive carcinoma. If deeper layers are affected, it is a muscle-invasive carcinoma.
What are the symptoms of bladder cancer??
There are no definite indications for bladder cancer. However, the following signs of disease typically occur with bladder carcinoma:
– Blood in the urine, usually without pain, sometimes with a reddish or brown discoloration of the urine – Discomfort during urination, for example, frequent urination with only small amounts of urine at a time
Some patients have no or very general symptoms at an early stage. Men may think symptoms are prostate discomfort; women may think bladder infection.
If unusual symptoms persist for a long time, a visit to the doctor is recommended. General practitioners are already in a good position to narrow down the triggers of the symptoms and, if necessary, initiate further diagnostic steps with specialists.
Bladder cancer: What are the risk factors??
The most important risk factor for bladder cancer is both active and passive smoking. If a smoker stops smoking, his or her risk of bladder cancer also decreases.
In addition, certain chemical substances can also increase the risk of developing bladder cancer. Urinary bladder cancer is recognized as an occupational disease for workers in occupational groups that are exposed to carcinogenic substances in the course of their work. This applies to painters and varnishers, for example.
Bladder cancer is more common in people with chronic inflammatory diseases.
For more information on causes and risk factors of bladder cancer, visit the website of the Cancer Information Service, German Cancer Research Center.
Are there any offers for early detection of bladder cancer in Germany??
There is currently no statutory cancer screening for bladder cancer in Germany. In people with an increased risk of bladder cancer, such as heavy smokers, urine testing for invisible blood may be useful.
There are commercial tests that are offered as an additional service: the so-called Individual Health Service (IGeL). However, experts do not recommend such tests for the early detection of bladder cancer, as their benefit has not been sufficiently clarified in studies.
How bladder cancer is diagnosed?
Physicians perform the following tests if bladder cancer is suspected:
– Medical questioning (anamnesis): It is important for doctors to know, for example, whether the patient smokes. – physical examination – determination of blood values – ultrasound examination (sonography)
Additional measures can be taken to confirm the findings:
– Examination of the urine for blood and cancer cells – mirror examination of the urinary bladder (cystoscopy): The physician pushes a thin tube or a thin tube through the urethra into the urinary bladder of the affected person under local anesthesia. A small camera at the tip transmits images of the inside of the bladder to a screen. This allows doctors to detect changes in the mucosa. Take tie samples (biopsies) from suspicious areas. The tie samples are then examined in the laboratory under a microscope. – Transurethral resection of the bladder (TUR-B): During a cystoscopy with a rigid device under general or partial anesthesia, the suspicious tie is completely removed with an electric loop, if possible. Additional tie samples may be taken. These tie samples are also examined microscopically in the laboratory.
In a transurethral resection (TUR), a rigid tube with an electrical loop is advanced into the urinary bladder.
In the case of non-muscle-invasive bladder cancer without risk factors, no further examinations are performed. If risk factors are present and/or the cancer is muscle-invasive, the doctor will evaluate the spread of the bladder cancer with the following tests:
– Imaging procedures are performed for non-muscle invasive bladder cancer with risk factors. This includes computed tomography (CT), possibly magnetic resonance imaging (MRI) and X-ray examinations of the urinary tract with contrast medium. They provide information about the extent of the tumor. – For muscle-invasive bladder cancer, experts recommend a CT of the chest, abdomen and pelvis with contrast medium. Instead of a CT of the pelvis, an MRI can also be performed. – If bone metastases are suspected, experts recommend skeletal scintigraphy. – If brain metastases are suspected, a CT scan of the head is performed.
You would like to know how a cystoscopy is performed and what other diagnostic examinations are available? On the website of the Cancer Information Service, German Cancer Research Center, you will find detailed descriptions of the diagnostic procedure.
How bladder cancer is treated?
Since different layers of the bladder wall are affected by cancer cells in non-muscle-invasive and muscle-invasive bladder cancer, the therapies differ as well. It is also important how aggressive the tumor is and whether the bladder cancer has already spread.
Non-muscle-invasive bladder cancer
If the cancer is growing superficially, the doctor can often remove it completely during a therapeutic bladder endoscopy (cystoscopy). In this procedure, urologists, under general or partial anesthesia, insert an electrical loop through a tube or rigid tubing into the urinary bladder and remove the cancer using an electrical current. This procedure is called transurethral resection of the bladder (TUR-B).
With non-muscle-invasive bladder cancer, recurrences are common. Therefore, after surgery, experts recommend supplemental medications that the doctor injects into the bladder through a catheter. Chemotherapy or immunotherapy may be considered, which only act locally and not in the entire body.
Because the muscle layer of the bladder is not affected by cancer, the urinary bladder can be preserved in most patients. Doctors only recommend removing the bladder if the risk of recurrence is particularly high.
The goal of treatment for non-muscle-invasive bladder cancer is complete cure. In muscle-invasive bladder cancer, the cancer has already spread into the deeper bladder wall. In some circumstances, the cancer may have grown into the surrounding area.
Typically, doctors then remove the bladder completely. This surgery is called a radical cystectomy. During this surgery, surgeons remove the urinary bladder and nearby lymph nodes; in women, they also remove the uterus, fallopian tubes, ovaries, and parts of the vaginal wall; or in men, they remove the prostate and seminal vesicles.
Under certain circumstances, patients with muscle-invasive bladder cancer may also receive chemotherapy before or after surgery. Chemotherapy can reduce the risk of disease recurrence.
Sometimes the urinary bladder can be preserved even with muscle-invasive bladder cancer. For these patients, doctors recommend transurethral resection (TUR-B). It is used to remove the tumor as completely as possible. Surgery is followed by radiation and chemotherapy. The goal of treatment is to cure the cancer.
If the urinary bladder had to be removed, the affected person is surgically given an artificial form of urinary diversion to excrete urine. Patients can talk with their doctor to decide which is best for them.
There are two basic forms of artificial urinary diversion:
– the dry (continent) urinary diversion and – the wet (incontinent) urinary diversion.
In dry drainage, urine is stored and drained in a newly created reservoir. Most commonly, doctors use the neobladder. They form a reservoir from a piece of small or large intestine in which the urine collects and which sits in the place of the former urinary bladder.
Over time, some patients with neobladder can pass urine almost as they would with their healthy bladder. Others need a catheter inserted into their bladder from time to time to drain urine.
In a wet drainage system, the urine continuously drains through an opening in the abdominal wall. In the most common procedure, the conduit, surgeons remove a piece of intestine. This is sutured to the two ureters at one opening and to the abdominal wall at the other opening. The opening in the abdominal wall is called a stoma. A removable bag is placed there, called an ostomy bag. The urine collects in this reservoir.
Metastatic bladder cancer
If the cancer has spread, a cure is no longer probable. The goal for these patients is:
– to delay the progression of the disease as long as possible. Maintain quality of life as much as possible. Relieving cancer-related symptoms.
In most cases, the urinary bladder is not removed at this stage of the disease. Systemic therapy, which works throughout the body to stop further progression of the disease. Depending on the situation, the following drugs may be considered:
– chemotherapy: here, drugs (cytostatics) slow down cell growth or inhibit cell division. – Immunotherapy: Here, drugs stimulate certain of the body's own immune cells to fight the cancer cells directly.
The above treatment options may have side effects.
Detailed information on the course of therapies, side effects and how to deal with treatment consequences in non-muscle-invasive bladder cancer and muscle-invasive bladder cancer can be found on the website of the Cancer Information Service, German Cancer Research Center.
After bladder cancer therapy: rehabilitation
Medical rehabilitation (rehab) after cancer therapy is intended to help patients regain their strength. It is also designed to help them cope with the consequences of the disease and treatment in the best possible way. Therefore, the program of a rehab is based on the personal medical history and the present limitations.
Possible contents of urologic rehab after bladder cancer therapy include:
– Dealing with a replacement bladder – Dealing with other types of conduit, such as a stoma – Helping with digestive problems and diet – Dealing with the effects of chemotherapy, such as fatigue or nerve pain
What happens next? Aftercare for bladder cancer
After treatment, the attending physicians perform follow-up examinations, first at shorter intervals and then at longer intervals. They determine the intervals of the examinations depending on the individual risk of relapse of an affected person.
Non-muscle-invasive bladder cancer has a high risk of recurrence: within five years of treatment, recurrence is common. Therefore, control examinations are very important.
Through follow-up examinations, doctors detect possible consequences of the therapy at an early stage. They can also detect a relapse at an early stage. Start further treatment quickly. The most important follow-up examination is a cystoscopy. Follow-up care also includes urine and blood tests.
How does bladder cancer affect everyday life??
The extent to which daily life is altered after bladder cancer depends on how severe the cancer is and what therapies were necessary.
If the urinary bladder has been completely removed, the patient should expect that sexual function and urinary output will be impaired.
Patients with an artificial urinary diversion can turn to various specialized professionals who specialize in dealing with the consequences of cancer of the urinary bladder. These are, for example, specially trained nursing staff, the so-called stoma therapists, nutritionists and social workers. Psychosocial support can make living with the disease easier.
Which contacts are there for bladder cancer?
Hospitals with a particularly high level of experience in the treatment of patients with bladder cancer are called "certified bladder cancer centers.
The addresses of the certified centers can be found on the OncoMAP website.
The urological university hospitals in Germany can be found on the joint website of the German Society of Urology e.V. And of the urologic professional association. You have further questions on how to deal with the disease in everyday life. For further support options? You can find information about this on the website of the Cancer Information Service, German Cancer Research Center.
If you have any questions about bladder cancer, you can also contact the Cancer Information Service in person by calling toll-free 0800 – 420 30 40 or by emailing [email protected]
– German Cancer Society, German Cancer Aid, AWMF: Early Detection, Diagnosis, Therapy and Follow-up of Urinary Bladder Cancer. Long version 2.0. S3 guideline. AWMF registration number 032/038OL. 03.2020. Retrieved 20.05.2020. – Center for Cancer Registry Data (ZfKD) of the Robert Koch Institute (RKI): urinary bladder cancer. Retrieved 20.05.2020.