Urothelial Carcinoma: Causes, Symptoms & Treatment

Urothelial carcinoma, which occurs predominantly between the ages of 60 and 70, is often the result of nicotine use and/or skipped urinary tract infections as well as bladder infections. In the early stages, various treatment methods are possible, while in later stages the success of cure is low.

What is urothelial carcinoma?

Urothelial carcinoma is the medical term for malignant (malignant) tumors located in the tissue of the urinary tract. Sometimes, however, the tumors can also occur as cancer of the ureters, the renal pelvis, the urethra or in the form of bladder cancer. The majority of those affected develop the disease between the ages of 60 and 70. About five percent of all urothelial carcinomas are located in the ureters or renal pelvis; in the remaining cases, however, the urothelial carcinoma forms in the urinary bladder.

Causes

One of the most common causes is smoking. In particular, chronic irritation of mucosal cells in the bladder, which subsequently causes bladder infections that are not completely healed and cause bladder stones, can also promote urothelial carcinoma. Bilharzia (worm infestation of the bladder, intestines, liver or reproductive organs) can also sometimes increase the risk of urothelial carcinoma. Other favoring factors include hair dyes and chemical substances that have been shown to have carcinogenic properties.

Symptoms, complaints, and signs

The first sign of urothelial carcinoma is a clearly visible admixture of blood during urination (so-called hematuria). Furthermore, the affected person complains of problems or disorders during urination. Emptying the bladder is associated with pain; pain often occurs in the bladder area for no reason. If the tumor is located at the point of entry into the ureters, the carcinoma can obstruct the outflow of urine to such an extent that a backlog of urine occurs. In that case, patients complain of flank pain. Urothelial carcinoma causes symptoms similar to those of cystitis. For this reason, it is important that individuals who have such symptoms and have passed the age of 40 see a medical professional so that urothelial carcinoma can be ruled out.

Diagnosis and disease progression

The medical doctor not only checks the patient’s medical history, but by means of a thorough abdominal examination and attention to symptoms, tries to find any cancerous growths that may be located in the urinary bladder. For this purpose he uses ultrasound, with which tissue changes can be detected. By means of blood and urine examination the physician can exclude an inflammation of the bladder. It is important that the inside of the bladder is examined by means of an endoscopic procedure. In the course of the examination, tissue samples (biopsies) are also taken, which should then provide information as to whether urothelial carcinoma is actually present. If the suspected diagnosis is confirmed, further examinations are performed. The physician must then determine the extent of the urothelial carcinoma. Magnetic resonance imaging or computer tomography can be used to determine the stage of development of the tumor. The physician then classifies the urothelial carcinoma into a TNM classification, whereby the size of the tumor, any metastases and lymph node involvement are checked and documented. If the tumor has already affected the deep tissue, the prognosis is negative. However, in about 70 percent of all cases, urothelial carcinoma is detected at an early stage, so complete recovery is possible; if the entire tumor is removed, the patient enjoys the possibility of surviving the disease.

Complications

Since urothelial carcinoma is a cancer, it can lead to the death of the affected person in the worst case. The further complications and complaints thus also depend very much on the exact extent of the tumor. For this reason, a general prediction is usually not possible. Sometimes the affected persons suffer from bloody urine. This symptom can also lead to a panic attack in some sufferers. Furthermore, urination is also associated with pain. The bladder itself can also hurt for no particular reason. The pain often spreads to the flanks, so that the patient’s quality of life is considerably reduced by the urothelial carcinoma.If metastases have already formed, treatment of the urothelial carcinoma is usually no longer possible and the affected person dies prematurely. In some cases, however, the tumor can be removed by surgery. Complications do not occur, but the affected person continues to suffer from kidney failure and requires a donor kidney or dialysis. The patient’s life expectancy is significantly reduced by urothelial carcinoma.

When should you see a doctor?

Urothelial carcinoma always requires treatment by a doctor. It is a serious disease, which in the worst case can also lead to the death of the affected person. Therefore, a doctor should be consulted at the first symptoms and signs of the disease. A doctor should be consulted in case of urothelial carcinoma if the affected person suffers from bloody urine. This complaint may also occur sporadically. Furthermore, urination itself is associated with severe pain, so that in some cases the affected person also suffers from psychological upset or depression. Furthermore, pain on the flanks or in the lower abdomen may indicate urothelial carcinoma. Patients over 40 years of age in particular should consult a doctor if they have these symptoms, so that the urothelial carcinoma can be detected and removed at an early stage. Further treatment depends on the extent of the tumor. Possibly, the disease may also lead to a reduced life expectancy of the affected person.

Treatment and therapy

Treatment depends primarily on the extent of the tumor. If the tumor has already reached the bladder wall or nested in the surrounding tissue, the medical profession already speaks of an advanced stage. However, tumors that have only spread to the mucous membrane of the bladder can be removed endoscopically – through the patient’s urethra. This treatment is called transurethral electroresection (TUR). However, this procedure is only used for superficial tumors. It is important that the urinary bladder is rinsed afterwards. By means of immunotherapeutic or chemotherapeutic agents, a regression of the tumor can be prevented. Tumors that have already grown directly into the muscle of the bladder must be removed together with the bladder. The patient then receives an artificial bladder, which consists of the small intestine and the urethra. With this variant it is possible that the patient can be cured. However, if it is not possible to remove the bladder or to form a suitable replacement, because the patient is in need of care or has kidney failure, or because the patient already has a tumor in the urethra, the urine is secreted directly into a bag through the abdominal wall (via a short piece of intestine). In a few cases, partial removal of the urinary bladder can also lead to success. There are also so-called combined chemo-radiotherapies. However, this therapy is only performed in selected patients. If it is a metastasized urothelial carcinoma, the physician can – by means of chemotherapy – destroy the fast-growing cancer cells. Radiation therapy – that is, radiotherapy – is usually given only before surgery; sometimes radiotherapy may be used as part of follow-up treatment.

Prevention

It is important that all risk factors – such as smoking – be abandoned if urothelial carcinoma is to be prevented. Most importantly, individuals who are definitely exposed to carcinogens should focus on their protective measures and attend regular screenings. It is important that urinary stones and any urinary tract infections are treated consistently, so that no chronic course of the disease develops, which not only provokes the mucosal cells, but sometimes also promotes the formation of urothelial carcinoma.

Follow-up

After the actual treatment of urothelial carcinoma, follow-up care is initiated. Here, the focus is on the timely detection of a possible recurrence. For this reason, follow-up examinations take place at short intervals. They include regular ultrasound examinations and urinary checks. In the case of bladder-preserving therapy, cystoscopy (cystoscopy of the bladder) is also used. If a radical cystectomy has been performed, imaging procedures such as computed tomography (CT) or magnetic resonance imaging (MRI) follow.If there are no abnormal findings over a longer period of time, the intervals between the individual examinations can be extended. After a cystectomy as well as a urinary diversion, follow-up treatment is required that is adapted to the specific needs of the patient. However, it is considered useful only when concomitant chemotherapy has been completed. In the context of rehabilitation, the focus is on postoperative functional disorders. These primarily include bladder emptying disorders, urinary incontinence, dealing with a urostomy, and sexual functional impairments. For older patients, therapists adapt treatment to their physical and mental capacity. Working patients should be enabled to return to work. If lymphedema appears on the legs after therapy for urothelial carcinoma, the affected persons receive special compression stockings or elastic wraps. Manual lymphatic drainage is also considered helpful if a lymphocele can be ruled out. The quality of life of patients is usually also a focus of follow-up care. Among other things, quality-of-life questionnaires can be completed.

Here’s what you can do yourself

Urothelial carcinoma is associated with various symptoms. Patients can alleviate these symptoms on their own by maintaining a healthy lifestyle and taking some supportive measures. First, it is recommended to change the diet, because carcinomas cause gastrointestinal discomfort such as irritable stomach or heartburn. An adapted diet reduces the discomfort by relieving the stomach and increasing well-being. In addition, a diet rich in vitamins and minerals provides the body with all the necessary substances it needs to fight urothelial carcinoma. For pain in the bladder or urinary tract, simple home remedies such as cooling or hot compresses, massages, and treatments with pain-relieving oils and ointments can help. Sufficient sleep inhibits the sensation of pain. Sufferers should make sure that their bedroom is well ventilated so that their night’s sleep is restful. Accompanying distraction helps to forget the pain. Patients can pursue their hobbies or spend time with other people. Talking to other sufferers is found to be particularly liberating. Suitable places to start are, for example, self-help groups or Internet forums. There, sufferers can find like-minded people who can provide valuable tips on how to effectively support urothelial carcinoma therapy.