Haematuria literally means blood in the urine. It is usually divided into microscopic bleeding that is detected on a urine test or macroscopic bleeding that is visible.
Macroscopic haematuria almost always mandates a cystoscopy. Bladder cancer is especially prevalent in the Newcastle region, particularly as the area still involves a lot of industry. Other common causes of visible haematuria include severe infections, an enlarged prostate, bladder stones and previous radiation changes to the lower urinary tract.
Microscopic haematuria is a very common problem and does not necessarily denote disease. Your local doctor will usually check to ensure there is not associated protein or deformed red blood cells (dysmorphic) suggestive of a glomerular cause of haematuria which is usually managed by a renal physician. If you are older or have risk factors for a sinister source of the bleeding such as smoking, a cystoscopy will usually be offered as well.
Generally, you local doctor or urologist will organise some form of imaging of your kidneys prior to the cystoscopy such as an ultrasound or CT.
Bladder cancer is the second most common cancer treated by urologists after prostate cancer.
It commonly is picked up due to blood in urine (haematuria) or imaging demonstrating a growth in the bladder. The cell lining of the bladder is called urothelium and bladder cancer is properly called a urothelial carcinoma or previously a transitional cell carcinoma. Smoking exposure is the major risk factor.
After seeing a GP and usually being referred to a urologist, imaging of the bladder and kidneys with an ultrasound or CT is commonly requested. Sometimes this can demonstrate a growth in the bladder but not always. Urine cytology may be requested that looks for cancer cells excreted in the urine.
A cystoscopy is required to directly visualise the lining of the bladder. Contrast is often injected into the ureters and kidneys at the same time to outline the urine parts of the kidneys and ureters to ensure a similar cancer is not present in this part of the urinary tract as well. The abnormal bladder or cancerous tissue is treated at the same time by taking a specimen to remove and cauterise the tumour. Larger tumours may require shaving or resection of the cancer off the bladder wall.
The treatment of bladder cancer is dependent on whether it has invaded into the wall of the bladder or has spread. Localised bladder cancer can very simply be divided into superficial or muscle invasive stages. Like other cancers, advanced bladder cancer can spread to other parts of the body.
Superficial bladder cancers are generally treated with a surveillance cystoscopy program. This involves repeating a cystoscopy at regular intervals to check that no new cancers have developed. In a similar way that skin cancers require regular skin checks, a surveillance cystoscopy can pick up developing cancers early when they are easily treatable. For stable cancers, the cystoscopy may only need to be performed on an annual basis.
Intravesical instillations are often used for tumours that look aggressive under the microscope but have not yet invaded into the bladder muscle. A preparation of BCG immunotherapy can be instilled into the bladder through a catheter that creates an inflammatory reaction to help the immune system fight the cancer. Mitomycin is a common chemotherapy agent that can be similarly instilled into the bladder allowing direct contact between the agent and tumour.
A radical cystectomy is a major operation to remove the bladder and divert urine into a segment of bowel that is brought out to the abdominal wall as a stoma were urine is collected into a “bag”. It is usually reserved for bladder cancer that has invaded beyond the muscle layer or aggressive cancer that has not responded to the above measures.
In circumstances where a patient not fit enough to undergo major surgery or the cancer has spread to other parts of the body, chemotherapy or radiotherapy, or a combination may be offered. This is done in consultation with a medical oncologist and radiation oncologist.