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 cancerin women

Who?

Anyone, but most commonly

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

Blood in the urine (visible or microscopic) is the most common presenting sign.

Cystoscopy is the number one test. Imaging as required for the upper tracts.

Resection for microscopic confirmation.

How Serious?

Wide variation. 3 general categories

  1. Superficial: often times manageable with minor surgery, sometimes medications placed in the bladder. Some tumors are more likely to progress to very serious, muscle invasive disease. Require strict surveillance, often times lifelong.
  2. Muscle invasive but localized: serious, but can be curable with removal of the bladder or a combination of chemotherapy and radiation
  3. Systemic/metastatic: tumors which have spread beyond the bladder into the lymph nodes or elsewhere in the body are usually lethal and incurable.

 

 

TREATMENT OVERVIEW

 

The treatment of bladder cancer is individualized based on the risk associated with the tumor and the patient's circumstances. Bladder cancers are not all the same and some are associated with much more aggressive behavior than others. Not all types of treatments for bladder cancer are applicable for every situation. The following are general guidelines and your treatment may differ based on your unique situation.

 

For patients who have muscle-invasive thorugh localized disease, aggressive treatment with either removal of the bladder and urinary reconstruction or a combination of chemotherapy and radiation are advised in an attempt to cure the cancer. The reason is that untreated muscle invasive bladder cancer will spread and then there is no hope for cure.

 

Intravesical Therapy (IVT) for Superficial Bladder Cancer

There are several strategies to minimizethe risk of bladder cancer recurrence and progression. The administration of medication directly to the bladder through a catheter has been used for superficial tumors. There are 2 available treatments.

  1. mitomycin-C
  2. Bacillus Calmette Guerein (BCG)

BCG is an attenuated (weakened) strain of tuberculosis. It produces a very specific immune reaction which in addition to clearing the bladder of the bacteria also is capable of killing bladder cancer cells. This treatment was developed many years ago by a Canadian urologist and is the mainstay for treatment of high-grade non-invasive (superficial) bladder cancer throughout the world. it is indicated for any kind of high risk noninvasive tumor including carcinoma in situ, tumors with submucosal invasion (stage T1), high-grade tumors (Grade 3/3), and for multifocal tumors.

 

Treatment is typically with held until the blood has cleared from the tumor resection - usually about 4 weeks. It is also with held if there are any concerns regarding immunodeficiency or active urinary tract infection. Administration occurs at the hospital with placement of a catheter into the bladder and then instillation of a small volume of the active bacteria. The treatment is always administered weekly.

  1. Induction: This is a 6 week course (once per week) following which a bladder biopsy is usually performed to confirm complete response. The biopsy typically occurs 6 weeks after completion of the induction course. induction is the most important component of BCG treatment
  2. Maintenance: this can reduce the frequency of recurrence is but is not always tolerated. These are 3 week treatments given at 3, 6, 12, 18, 24, 30 and 36 months

Side effects are generally well tolerated but can be similar to infection. There are a number of uncommon side effects which will be discussed with you by the medical oncologist. Ongoing evaluation with cystoscopy is necessary during this time.

 

 

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.