Bladder cancer: Information and specialists for bladder cancer

Leading Medicine Guide Editors
Leading Medicine Guide Editors

Bladder cancer is a malignant tumor disease of the urinary bladder. It accounts for about 2% of cancers in women and up to 5% in men in Germany. Early diagnosis is difficult because bladder cancer first causes symptoms at a late stage and a reliable screening test does not yet exist.

Here you can find additional information about bladder cancer and recommended specialists for the treatment of bladder cancer.

ICD codes for this diseases: C67

Recommended specialists

Brief overview:

  • What is bladder cancer? A bladder tumor is a malignant disease of the urinary bladder. They often go unnoticed for a long time but are usually still easily treatable when they are diagnosed.

  • Risk factors: Bladder cancer is primarily associated with smoking. However, exposure to certain hazardous substances, bladder infections, sexually transmitted diseases, and some medications also increase the likelihood of developing tumors.

  • Bladder cancer as an occupational disease: In numerous occupations, people come into contact with hazardous substances. Common occupational groups affected include metal workers, army personnel, cleaning personnel, painters, and others.

  • Symptoms: Blood in the urine may be the first sign of bladder cancer. Other symptoms include an increased urge to urinate, problems urinating, and, later on, pain.

  • Diagnosis: The most important examination for suspected bladder cancer is a cystoscopy. During this procedure, the inside of the bladder is checked for changes with the help of a painless endoscopy and a tissue sample is taken for laboratory testing.

  • Treatment: Treatment depends on the stage of the tumor and its exact location. In the early stages, it can be removed during a cystoscopy. This is usually followed by localized chemotherapy and later regular monitoring. Radiotherapy can also be used for bladder cancer, either alone or in combination with chemotherapy (radiochemotherapy).

  • Prognosis: The earlier a bladder tumor is detected, the better the chances are of being cured. However, the cancer often returns a few years after treatment. If metastases form, the prognosis worsens.

Article overview

Bladder cancer first shows symptoms at a late stage

The urinary bladder is a muscular organ lined internally with abundant mucosa. In the majority of cases, a bladder tumor originates from this mucosa and grows unnoticed for a very long time.

Since many women and men suffer from problems with urination as they age, it’s often purely incidental findings that lead to the diagnosis of bladder cancer. Nevertheless, approximately 75% of tumors are still locally confined to the mucosa at initial diagnosis and are therefore easily treatable.

In 25% of cases, however, bladder cancer has already reached the muscular layer of the urinary bladder and in some cases has already spread to the prostate (in men) or the uterus (in women), both of which are adjacent abdominal organs.


Causes and risk factors for bladder cancer

The exact causes of bladder cancer are not currently known. Still, there are a few known risk factors that can trigger bladder cancer. First and foremost is smoking and passive smoking. Medical experts suspect that about 30 to 70% of all bladder tumors are due to smoking. These are followed in second, third, and fourth place by:

  • Occupational hazards, especially when handling organic solvents,
  • Inflammations, e.g., chronic urinary bladder infections, schistosomiasis (the so-called blood fluke from the tropics), and, as of late, pathogens of sexually transmitted diseases, such as the gonococci (pathogen of gonorrhea), and
  • Medication, e.g., cyclophosphamide (an ingredient in many cancer drugs).

Bladder cancer as an occupational disease: Frequent contact with risk substances

According to analyses, the following professions have the highest occupational risk for bladder cancer:

  • Metalworkers,
  • Army personnel,
  • Cleaning personnel,
  • Painters,
  • Hairdressers, and
  • Rubber industry workers.

They are increasingly working with aromatic amines and polycyclic aromatic hydrocarbons. These are found, e.g., in petroleum and fuels, soot, tar, tobacco smoke, dyes, rubber products, solvents, and plasticizers.

  • Brewery workers,
  • Electricians,
  • Firefighters,
  • Healthcare workers,
  • Blast furnace workers, and
  • Waiters

can also be affected.

Symptoms: Blood in the urine is always an alarm sign

The symptoms of bladder cancer are initially not noticeable or only very unspecific. Under certain circumstances, hematuria (blood in the urine) may occur, which can be the first sign of bladder cancer and always requires a medical diagnosis.

However, blood in the urine also occurs in other diseases, such as kidney stones, bladder infections, or severe urinary tract infections. Therefore, only a urologist can determine what is actually causing the symptoms.

These symptoms may indicate bladder cancer:

  • Painless hematuria (blood in the urine),
  • Increased urge to urinate,
  • Problems with urination, and
  • Pressure on the bladder.

Pain occurs late in bladder cancer and is then usually a sign that the tumor has already penetrated deep into the muscle layer.

Diagnosing bladder cancer: Cystoscopy 

The suspected diagnosis of bladder cancer is naturally a shock for most people, but it is nevertheless necessary to confirm this suspicion diagnostically. There is no reliable urine or blood test for diagnosing a bladder tumor, which is why performing a cystoscopy brings the most clarity.

The doctor will first inquire about the medical history to clarify any risks such as smoking or occupational dangers for bladder cancer. Usually, a routine palpation of the kidney and bladder region is then performed by a urologist.

Urine test strips help detect hidden blood in the urine, which is considered an important indicator of bladder cancer.

However, the most important examination for suspected tumors is cystoscopy. This involves inserting a thin, soft tube (cystoscope) through the urethra into the bladder under local anesthesia and using a lubricant. Since the physician must overcome the resistance of the urinary sphincter when inserting the cystoscope, there is a brief sensation of pressure at the junction of the urinary sphincter.

The cystoscopy itself is painless. The urologist will use a camera inside the tube to get a picture of the inside of the bladder and locate the possible tumor foci. It is also possible to cut off a piece of tumor tissue using small tissue forceps without any problems. This so-called biopsy is then later examined by a pathologist to determine the type of bladder cancer and its stage. This is imperative in order to plan the best possible treatment.

Blasenspiegelung - Bild vom Blaseninneren
Image of the bladder mucosa from a cystoscopy © Courtesy of Dr. Robert Hefty, MD, Urology, Heidenheim Hospital.

If the cancer is already far advanced and has grown into the muscle layer, surgery is usually performed as quickly as possible and the bladder is removed completely (= radical cystectomy).

In follow-up care, it is then necessary to determine using X-rays or a CT scan whether there are any metastases. In bladder cancer, these tend to settle in the lymph nodes, liver, lungs, and bones and usually lead to a poor prognosis.

What are the treatment options for bladder cancer?

As indicated previously, treatment depends very much on the type of tumor and its stage, but also on where exactly the tumor is located. From the physician's point of view, a distinction is made between bladder tumors growing superficially and those infiltrating the tissue.

If the cancer is localized, small, and has not yet penetrated far into the bladder wall, the tumor is usually removed via cystoscopy. The procedure is painless and takes place under local anesthesia. Depending on whether the surgical margins are pathologically clean or if they also contain mainly tumor cells, a second surgical procedure may be necessary.

After that, treatment immediately transitions to localized chemotherapy to kill any remaining smaller tumor foci. The drug is delivered directly into the bladder, which means the side effects are less severe. Immunotherapy using BCG (tuberculin) administration is also helpful in preventing recurrences of bladder cancer.

In principle, however, regular follow-up examinations are advisable in bladder cancer due to the high recurrence rates. Shortly after the start of treatment, a medical check-up is performed approximately every 3 months.

The treatment regime is different for advanced bladder tumors that have already grown into the muscle layer. In these cases, the adjacent lymph nodes, which are considered a preferred early metastatic site, are removed in addition to completely excising the urinary bladder.

The frequent consequences in men and women are libido disorders and urinary incontinence. Subsequently, systemic chemotherapy is mandatory and very fraught with side effects.

In recent years, systemic immunotherapy has been shown to be very effective. Substances are, e.g., pembrolizumab or nivolumab. In a sense, the tumor is unmasked by the medication and the patient's own immune system can act against the tumor.

In some cases, attempts are made to restore continence by creating a new bladder (neobladder) from a section of the body's own small intestine or creating an artificial urinary outlet (ileum conduit) with a collection bag.

Prognosis for bladder cancer

The earlier bladder cancer is detected and the less advanced the disease, the better the chances of curing it are. Nevertheless, it must always be kept in mind that urinary bladder carcinoma often recurs after only a few years.

Such recurrences, as well as the spread of metastases to other organs or the skeleton, reduce the chances of recovery and are generally associated with a poorer prognosis.

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