Bladder tumors

The frequency of bladder tumors is age dependent with a maximum between 60 and 75 years of age. The incidence is 1:500, which means that about 200 pro 100000 inhabitants of Switzerland are affected. Bladder cancer occurs 3 times more often in men than in women. Smoking and organic solvents are risk factors, as is an excessive consumption of analgesics with phenacetine.

There are different types of tumors, of which the superficial bladder tumors (so-called cauliflower tumor or papilloma) are the most common. These tumors originate from the inner epithelial cell layer of the bladder.

These tumors are most commonly first diagnosed when the patient visits his doctor because of blood in the urine. Other symptoms, which may indicate a bladder tumor are a strong urge to urinate, a burning sensation during urination and occasionally pain in the flank region. Following a physical examination your doctor will first examine your urine. After that further diagnostic procedures, usually by an urologist, such as cystoscopy and an examination of the exfoliated cells in the urine, as well as x-ray imaging test, intravenous urography and voiding urography will be necessary. After the diagnosis has been confirmed, as a rule, the tumor is removed transurethrally with an electric cautery wire (transurethral bladder tumor resection) and the material will be examined by a pathologist under the microscope. If this shows a superficial tumor, the patient will be followed for the next 5 years at regular intervals with cystoscopy and urine cytology, because bladder tumors tend to recur at different localizations in about 70% of cases. Some of these so-called recurrences can be treated by intravesical instillation, that is medication administered directly into the bladder. These may be chemotherapeutic or immune modulating agents such as the tuberculosis vaccine BCG. In 10 - 20% of patients these recurrences grow invasively with the tumor extending into the deeper layers of the bladder wall.

If the microscopic examination reveals a tumor infiltrating deeper layers of the bladder wall, this is a so called invasive tumor. As a rule this is an indication for radical surgical removal of the entire bladder. In exceptional cases conservative management is possible.

If an invasive tumor is diagnosed, further diagnostic procedures to exclude metastases are necessary. These are a chest x-ray (lung metastases), a computer tomogram of the pelvis and the abdomen to detect lymph node and regional metastases, a bone scintigram to detect bone metastases, as well as a biopsies of the prostatic urethra to exclude infiltration of the prostatic urethra. If these are all negative, radical surgery is indicated. 

After radical surgical removal of the bladder with the prostate and seminal vesicles in men and with the uterus in women, different types of urinary diversion are possible. One is through a short piece of small intestine which leads directly through the skin, the so-called Bricker bladder. Another is the construction of a bladder substitute from a segment of small intestine or ileal conduit. A continent pouch, which can be catheterized, or implantation of the ureters into the large intestine, whereby the urine is eliminated with the stool, are further forms of urinary diversion. The type of diversion chosen depends upon the tumor localization, kidney function and other factors. 

The prognosis depends on tumor stage and cellular differentiation, that is how the tumor compares to normal tissue microscopically. The less differentiated and more invasive (aggressive) the tumor is, the worse the prognosis becomes. For these reasons it is of utmost importance to rapidly evaluate patients with blood in the urine and identify a possible bladder tumor in an early stage and initiate treatment as quickly as possible.