Urinary Bladder Cancer

Urinary bladder cancer is a malignant tumour originating from the mucous membrane of the urinary bladder. Bloody urine is a common first symptom of bladder cancer, and urinary bladder irritation may occur sometimes. If the doctor suspects bladder cancer based on the patient’s symptoms and abnormal examination results, the doctor refers the patient for further examinations and treatment at Tays.

In Finland, approximately 1,200 new urinary bladder cancer cases are diagnosed annually. Its incidence increases significantly among people aged over 65, but the disease may be diagnosed much earlier as well. The most significant risk factor is smoking.

Cancer diagnosis at an early stage improves the prognosis. Approximately 70% of bladder cancer cases are superficial and restricted to the mucous membrane of the urinary bladder at the diagnosis phase. In such cases, the disease prognosis is good but the recurrence risk is high. Approximately 30% of bladder cancer cases already penetrate the mucous membrane to the muscular layer at the time of diagnosis and cancer may spread outside the urinary bladder.

Examinations at Tays

Examinations at Tays usually begin with urinary bladder endoscopy done at the outpatient clinic with the help of a flexible endoscope. The procedure is fairly painless and can be performed with anaesthetic gel alone. The examination reveals the size, number, location and an indication of the growth inclination of the tumour(s).

A urinary sample is given before the procedure or taken at the same time and, when necessary, exfoliative cytology of urine is also taken. Exfoliative cytology of urine is used to look for possible cancer cells in urine.

The examinations may also involve an ultrasound examination or CT scan of the urinary organs. The CT scan can be used to assess the growth method of cancer and eliminate the possibility of metastases.

Sometimes, we also take a biopsy from an abnormal manifestation and a pathologist uses it to determine its cell structure.

After the examinations, we invite the patient to the outpatient clinic for a treatment negotiation regarding the upcoming treatments. If a dysplastic tumour has been discovered in the urinary bladder, a urologist proposes its transurethral resection, i.e. electrosection.

Transurethral resection of the urinary bladder tumour

Usually the patient does not arrive at the surgical ward until the morning of the surgery for the transurethral resection. We perform the transurethral resection via the urethra endoscopically in the operating theatre under spinal or general anaesthesia. At the end, we place a catheter in the urinary bladder for flushing.

We send the shavings to a pathologist for a microscopic examination. The sample bits must be representative, because they are used to decide follow-up monitoring, repeated transurethral resection and removal of the urinary bladder.

If it seems, based on the pathologist’s statement, that the disease was safely removed from the urinary bladder with the procedure, we plan endoscopic controls to take place at the urology outpatient clinic. Superficial cancer has a high recurrence tendency, so the patient must undergo an endoscopic control every 3–4 months during the first 1–2 years.

Removal surgery of urinary bladder

If we have reason to suspect cancer growing into the muscular layer of the urinary bladder, i.e. invasive cancer, based on the shavings we discuss with the patient the need to remove the urinary bladder.

In certain cases, we recommend pre-operative cytostatic therapy to shrink cancer. The treatment of an aggressive urinary bladder cancer type may involve cytostatic therapy even after the removal of the urinary bladder.

The scope and duration of the surgery vary greatly according to cancer size, location and possible spread. The surgery is a major procedure and may impact the patient’s body and functional capacity significantly.

During the surgery, we remove the urinary bladder, pelvic area lymph nodes and the urethra if necessary. In the case of male patients, we also remove the prostate. After the removal of the urinary bladder, we use the end of the patient’s small intestine to form either a urinary stoma or intestine bladder. Usually, the surgery lasts 4-6 hours.

Treatment at the ward and discharging

Recovery from the urinary bladder transurethral resection is usually quick and the patient can be discharged on the first or second post-operative day. At the ward, we mostly monitor the clearing of urine and sufficient emptying of the urinary bladder after the catheter removal.

The removal of the urinary bladder is a more demanding surgery and involves significant risks. Post-operative recovery at the ward usually takes approximately 10 days. During the first days, the focus is on good pain management.

Eating is started carefully and we monitor the start of bowel movement. We help the patient to move about as early as possible. A stoma nurse provides instructions to patients who have undergone the removal of the urinary bladder and the construction of a urinary stoma. A physiotherapist helps the patient to recover after the surgery.

Usually the patient is discharged directly from the urology ward of Tays. If necessary, we transfer the patient to the Patient Hotel for the last days or to his/her own hospital or health centre for further rehabilitation.

Monitoring at the outpatient clinic

After the treatments, the patient usually undergoes follow-up monitoring for 5–10 years. This comprises control visits scheduled every 3–6 months at first and then every 1–2 years. Monitoring visits take place at the urology outpatient clinic of Tays or at the patient’s own central hospital.

At the time of the control visits, imaging is performed to check that the tumour has not recurred or sent metastases.

Division of work between the hospitals

Because the diagnosis, treatment and monitoring of urinary bladder cancer are challenging, the examinations, guidance and treatment of patients suffering from urinary bladder cancer are planned and implemented at treatment centres with the necessary expertise.

Urinary bladder transurethral resections are performed at several hospitals of Pirkanmaa, but urinary bladder removals are primarily done at Tays Central Hospital.

Persons in charge

Specialist Jukka Kallio
Specialist Erik Veskimäe