Cancers of Bladder and Kidneys

and Karl Reinhard Aigner³

(1)

Department of Surgery, The University of Sydney, Mosman, NSW, Australia

(2)

The Royal Prince Alfred and Sydney Hospitals, Mosman, NSW, Australia

(3)

Department of Surgical Oncology, Medias Clinic Surgical Oncology, Burghausen, Germany

In this chapter, you will learn about:

Bladder cancer
Kidney cancers
- Wilm’s tumour (nephroblastoma)
- Adenocarcinoma (Grawitz tumour or hypernephroma)
- Carcinoma of the renal pelvis or ureter

17.1 Bladder Cancer

Many years ago bladder cancer was found to be increased in industrial workers who were exposed to aniline dyes and certain other chemical compounds. It has since been found to be more common in smokers and in people who abuse the use of analgesics. Cancer may also develop in a papilloma, a small, benign, fern-like or cauliflower-like tumour of the bladder. Some patients have several small papillomas in the lining of the bladder wall and any one of these can change to become a cancer if not treated. In some countries, including Egypt and some other North African countries, infestation with the fluke parasite, Schistosoma or bilharzia, is common. If these flukes infest the bladder, they can cause inflammation and erosions of the mucosa and penetrate into the bladder wall. In those countries this is a well-recognised cause of bladder cancer.

Most bladder cancers develop in the transitional cells that line the bladder cavity. They are about twice as common in males as in females and in both sexes are more common in developed than developing countries. They most commonly present in men between 50 and 70 years. The most common symptom of bladder cancer is blood in the urine (haematuria). The blood may be intermittent at first but becomes more constant as the tumour grows and invades the bladder wall. At a later stage, there may be discomfort in passing urine (dysuria) and symptoms of bladder infection (cystitis) such as frequency, burning and pain when passing urine. Sometimes a ureter may become obstructed by the growth and pain may be felt in the loin due to backpressure on the kidney.

After losing blood in the urine for some time, anaemia may develop and symptoms of anaemia (pallor, tiredness, palpitations, etc.) may be noticed.

17.1.1 Investigations

The urine is examined for blood and may also be centrifuged and examined for cancer cells. Excretory urograms (IVP X-rays as described in Sect. 7.4) may show a filling defect or lump in the bladder. They may also show evidence of obstruction to a ureter if present.

CT scans may reveal a lump in the bladder wall but the ultimate investigation is with a cystoscope. The cystoscope (described in Sect. 7.4) is passed into the bladder through the urethra usually under general anaesthesia, and the inside of the bladder is examined. A section of any suspected cancer together with a small piece of adjacent bladder wall is taken as a biopsy for microscopic examination.

17.1.2 Types of Bladder Cancer (Pathology)

There are various degrees of bladder tumours ranging from a single benign cauliflower-like papilloma to an invasive ulcerated thickened cancer.

There are various degrees of bladder tumours ranging from a single benign cauliflower-like papilloma to an invasive ulcerated thickened cancer. Between these extremes, there may be several papillomas, one or more of which may show signs of early malignancy, or there may be a malignant lump or malignant ulcer in the bladder wall. Superficial non-penetrating bladder cancers tend to remain confined to the bladder wall for a long time before they spread, but more penetrating bladder cancers often metastasise at an early stage. After a time, bladder cancers may involve the whole thickness of the bladder wall and even invade the rectum or other organs nearby. Penetrating cancers often spread to nearby lymph nodes but they do not commonly metastasise more widely.

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