Bladder cancer

Every year, around 850 men and around 250 women in Switzerland are diagnosed with bladder cancer. The majority of them are over 70 years old, whereas the disease is rarely diagnosed in people under 50. The earlier a bladder carcinoma is detected, the better the prognosis for the affected person.

What is bladder cancer

Urothelial carcinoma develops in the mucous membrane of the bladder, the ureters and the renal pelvis. A good 90 percent of all urothelial carcinomas are localized in the bladder, with the remaining ten percent in the ureters or renal pelvis. If the bladder carcinoma develops from squamous epithelial cells or glands, it is referred to as squamous cell carcinoma or adenocarcinoma, two very rare forms of bladder carcinoma. The following section deals specifically with urothelial carcinoma of the bladder. A distinction is made between two different types:

• Non-muscle-invasive, superficial or early bladder cancer
• Muscle-invasive bladder cancer that is either localized or already metastasized

Non-muscle-invasive bladder carcinoma spreads in the superficial mucosa. It has therefore not yet grown into the bladder muscle and can occur in one place, so-called unifocal, or in several places, so-called multifocal. The prognosis for these bladder tumors is generally favorable. If the bladder carcinoma has already penetrated deeper into the bladder muscles, it is referred to as a muscle-invasive tumor. In some patients, the bladder cancer has already spread to other organs in the pelvis, particularly the lymph nodes. In these cases, multimodal therapy with additional chemotherapy is usually necessary before or after extensive surgery. The prognosis is worse compared to non-muscle-invasive tumors. Metastases from bladder tumors preferentially form in the lymph nodes, liver, lungs, bones and, rarely, the brain. The course of the disease always depends on the stage of the tumor. Regular follow-up care with local checks is particularly important for early bladder cancer in order to detect a recurrence of the tumor (relapse) and subsequently treat it adequately.

Bladder cancer: causes and risk factors

There are factors that can increase the risk of bladder cancer. However, it must be emphasized that people also develop bladder tumors without these risk factors being present:

• Smoking: Tobacco smoke contains cancer-causing aromatic amines, which are excreted via the kidneys and from there enter the bladder. Years of heavy cigarette consumption increase the risk of developing bladder cancer.

• Chemical substances: Aromatic amines are also used in many branches of industry. If employees are not adequately protected with safety precautions, a bladder tumor can occur decades later. This is then recognized as an occupational disease.
• Bladder infections: Untreated or chronic bladder infections are also a risk factor.
• Medication: There are medications that can damage the bladder with their side effects. This also includes various cancer drugs.
• Genetic predisposition: Bladder cancer occurs more frequently in some families.
• Radiotherapy: Cancer patients who received radiotherapy in the pelvic area years ago have a higher risk of developing bladder cancer. The modern radiation techniques developed today help to reduce this risk.

Symptoms: Bladder cancer

The growth of tumor cells in the bladder initially proceeds without symptoms. The first sign may be blood in the urine. This should be clarified immediately. Another sign may be a frequent urge to urinate in the sense of inflammation. Here, too, a medical examination should always be carried out to distinguish between inflammation and a tumor. Pain only occurs in advanced stages of bladder cancer. They occur, for example, when the ureter is narrowed by the tumor. The back pressure can also cause pain in the kidney or back area.

Bladder cancer – diagnosis with us

The first step is a detailed evaluation of your medical history (anamnesis), possible symptoms and your specific risk factors. This is followed by a physical examination and an analysis of the urine. This is followed by further diagnostics with ultrasound and cystoscopy and, if necessary, removal of a tissue sample (biopsy).

During cystoscopy, an endoscope (thin tube with a viewing device and possibly a surgical instrument) is inserted through the urethra to the bladder under local anesthesia, sometimes also under a short anesthetic. In this way, the bladder and the mouths of the ureters can be examined more closely and, if necessary, some tissue can be removed. By means of a transurethral resection (TUR), smaller and superficial tumors can also be removed at the same time in the same session.

Imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) can supplement cystoscopy and provide more precise examination results of the kidneys, ureter and urethra and show whether metastasis has already occurred in lymph nodes or other organs.

Bladder cancer - progression and prognosis

The prognosis depends on whether the tumor is non-muscle-invasive or muscle-invasive, the stage of the tumor and whether it has already metastasized. In the case of non-muscle-invasive bladder cancer, statistically eight out of ten patients are still alive five years after bladder removal and treatment. Non-muscle-invasive bladder cancer often returns in the bladder itself after treatment, which is why regular follow-up checks using cystoscopy are necessary.

In principle, risk factors that can lead to the development of bladder cancer should be avoided.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.

Bladder cancer - Treatment

In the treatment of bladder cancer, it is important whether the tumor is non-muscle-invasive or has already infiltrated the bladder muscles (muscle-invasive bladder cancer)

In the case of non-muscle-invasive bladder cancer, the tumor can be removed via the urethra using TUR (transurethral resection) as described above. The diseased tissue is removed using an electric snare and the tissue samples are examined to determine whether it is a superficial tumor or whether it is already at a higher tumor stage. As a rule, a resection is performed after a few weeks. Studies have shown that this can reduce the relapse rate. Sometimes these tumors also require so-called intravesical therapy. Frequently used drugs here are BCG and mitomycin.

Multimodal therapy is usually necessary for muscle-invasive bladder cancer. The standard treatment worldwide is a combination of chemotherapy followed by radical surgery (cystectomy with lymphadenectomy). The prerequisite is good kidney function and the absence of comorbidities. Urinary diversion after a cystectomy can be either continent in a bladder newly formed from bowel (“neobladder”) or incontinent in an external bag (via a so-called “conduit”). As an alternative, so-called bladder-preserving trimodal therapy is used. In this case, the above-mentioned TUR is supplemented by combined radiation chemotherapy.

If bladder cancer is already metastasized at the time of diagnosis, systemic therapy (currently platinum-containing chemotherapy, in some cases also immunotherapy alone) should be the primary treatment.