Urothelial Cancer of the Bladder and Upper Tracts

Urothelial Tumors at a Glance

What is it?

Tumors involving the lining of the urinary system

Bladder far more common than upper tract or urethra.

How common?

About 5,000 new cases in Canada per year.

#4 cancer in men

#8 cancer in women

Who?

Anyone, but more commonly

  • Older (>50)
  • Male
  • Caucasian
  • Smokers
Diagnosis

Hematuria (blood in the urine) which can be visible or microscopic is the most common presenting sign. ANY blood may be from bladder cancer. This holds regardless of whether the blood is visible or if the patient is taking antiplatelet (e.g. ASA, Plavix) or anticoagulant (e.g. coumadin, apixaban).

Cystoscopy IS THE MOST IMPORTANT TEST. There is NO subsubstitute for cystoscopy to check for bladder cancer.

CT IVP is the preferred test to evaluate the upper tracts if cancer is found.

Urine and blood tests to check kidney function.

THERE IS NO BLOOD OR URINE TEST THAT CAN ESTABLISH OR EXCLUDE THE PRESENCE OF BLADDER CANCER.

How Serious?

Wide variation in the risk these tumors present with a spectrum of virtually no risk of death to from cancer to lethal disease for which palliation is the only avaible option. Classification in order of increasing level of risk:

  1. NON-METASTASTATIC/NON-SYSTEMIC (No evidence of distant spread outside the bladder)
    1. Non-muscle invasive bladder cancer (NMIBC). Note the distinction between non-ivasive vs. invasive vs. muscle invasive. Traditionally, these have been classified as 'superficial' but there is marked variation in risk such that they shouldn't be lumped together. Most commonly initital management strategy is NOT radical. The risk of high grade tumors is that they progress to muscle-invasive disease which is generally a pre-requisite to systemic disease. Risk stratification is an important part of initial assessment.
    2. Muscle invasive bladder cancer (MIBC): These have significant risk though not uniformly lethal
      1. These tumors are at high risk of having unrecognized systemic
      2. Delay in recognition and appropriate treatment are important
      3. Mainstays of treatment is either surgery (radical cystectomy, often combined with chemotherapy) or radiation (with chemotherapy).
  2. METASTATIC/SYSTEMIC (spread to lymph nodes or elsewhere in the body is apprant based on examination and imaging). Characteristics
    1. Incurable
    2. Chemotherapy available but palliative
    3. Novel treatments such as immunotherapy and other clinical trials are often utilized because the prognosis is poor with currently available treatments
    4. Radiation and surgery may have a role for palliation (relieve of symptoms) but are incapable of cure.

 

PART I: BACKGROUND AND DIAGNOSIS

 

 

PART II: TREATMENT

 

The treatment of bladder cancer is individualized based on the risk associated with the tumor with further consideration of the patient's circumstances. Bladder cancers are not all the same - some are associated with much more aggressive behavior than others. The following are general guidelines and your treatment may differ based on your circumstances.

 

 

PART III: TOOLS FOR ASSESSMENT

 

 

Note that we offer the full spectrum of bladder cancer surgery and treatments:

 

On the Web

American Cancer Society Information on Bladder Cancer

Superficial (Non-Muscle Invasive) Bladder Cancer

Radical Cystectomy for Muslce-invasive Bladder Cancer


General Information on Cancer

UNDERSTANDING CANCER - Metrovan Urology info on the principles of diagnosis, staging, prognosis and more.

American Cancer Society

BC Cancer Agency: Good general website from the British Columbia Cancer Agency. Has contact information on locations.

National Cancer Institute: Excellent source of understandable and mainly unbiased information. Several very good brochures on every stage of prostate cancer.

National Comprehensive Cancer Network: peer-reviewed expert content/prostate cancer guidance on evidence-based cancer diagnosis and management. Best for Prostate and Kidney Cancer. The most in-depth information is located in the physician section and requires registration.

General Urology Websites

Canadian Urological Association  Extenstive library of downloadable pamphlets on a wide range of urological conditions

Cleveland Clinic

Mayo Clinic

Medline Plus Produced by the US National Institutes of Health with information on virtually every health topic and extensive list of links

UrologyHealth.org The patient information site of the American Urological Association.