Scientific Calendar May 2023

Bladder cancer is a malignant disease that originates from the epithelial cells of the urothelium of the bladder. Bladder cancer is distinguished using two main groups: non-muscle-invasive and muscle-invasive bladder cancer (Fig. 1).

Non-muscle-invasive bladder cancer includes the stages 0 and 1 and manifests as a spread within the urothelial layer (carcinoma in situ) or as a polyp-like structure that outgrows from the urothelium into the lumen of the bladder. From stage 1, the tumour also spreads into the Lamina propria.

Muscle-invasive bladder cancer includes the stages 2 to 4 and spreads further into the different layers of the bladder. In stage 2, the muscle layer Muscularis propria is affected, in stage 3, the perivesical fat layer is affected, and in stage 4, the tumour spreads into blood vessels and metastasizes into other tissues.

Smoking is the main cause for bladder cancer, accounting for 65 % of cases in male and 30 % of cases in female individuals, respectively. Additional drivers of bladder cancer include exposure to chemical substances, especially aromatic amines, a medical and family history of bladder cancer, previous cancer treatment, and recurrent bladder infection especially with Schistosoma haematobium.

Bladder cancer is the fourth most common type of cancer in men, predominantly affecting men of Caucasian ethnicity at the median age of 69 years. In females, the prevalence is much lower, affecting females at a median age of 71. However, changing lifestyles lead to a decline of the median age and an increased number of cases in female individuals.

Symptoms are largely unspecific and resemble those of other disorders of the urinary tract, such as urinary tract infections or urolithiasis, including dysuria, pollakiuria, lower back pain and haematuria (Fig. 2). Thus, there is the risk to misinterpret symptoms. However, gross haematuria, leading to macroscopic visibility of blood in urine is the most common symptom, driving diagnostics that lead to the diagnosis of bladder cancer.

The overall survival of bladder cancer strongly depends on the stage of the tumour at the time of diagnosis: The five-year survival rate declines from 98 % at stage T₀ and 88 % at stage T₁ down to 15 % at stage T₄ (Fig. 3).

Two years ago, a 77-year-old male patient underwent chemotherapy and trans-urethral resection (TURBT) of a stage one, non-muscle invasive bladder cancer (NMIBC). The post-treatment surveillance now includes half-yearly follow-up examinations because of the high risk of tumour recurrence. 

Recently, the patient has been suffering from fatigue and pollakiuria. An initial routine urinalysis examination revealed the presence of 2,956 RBC/µL that were characterised as isomorphic RBC, indicating a macrohaematuria of non-glomerular origin (Fig. 4). In addition, 3.9 atypical cells per µL were detected, as highlighted by the research parameter ‘Atyp.C’ (Fig. 5), suspecting the presence of malignant cells. 

Based on these findings, an extraordinary cystoscopy was requested, leading to the detection of a recurrent, papillary urothelial carcinoma. This highlights the potential of the Atyp.C research parameter to support bladder cancer surveillance. 

The image shows the lumen of the bladder with the base of the urethra in the centre. The urothelium of the bladder shows several papillary structures, representing early stages of recurrent bladder cancer. In addition, horseshoe-shaped tissue alterations show areas where transurethral resections previously took place.