Bladder cancer

The cause of the development of malignant tumours has not yet been definitively determined. However, there are a number of factors that increase the risk of a bladder tumour. Smoking is a major risk factor. Contact with certain chemical substances (especially aromatic amines) can increase the risk of developing a bladder tumour. People who have worked with these chemicals and have developed a bladder tumour can have this cancer recognised as an occupational illness. This can include activities in the chemical and pharmaceutical industry, rubber industry, paint applications in the painting trade, textile industry, leather processing, printing houses, refineries, coking plants, gas works or chimney sweeping. Although occupational safety measures have greatly reduced the risk today, occupational transitional cell carcinomas can still occur because the development time (latency period of up to 40 years) for this tumour is very long.

Other risk factors include chronic cystitis, frequent use of painkillers containing phenacetine or an infectious disease that lasts for years.

Approximately 29,500 new cases of bladder tumours were predicted for the year 2018 in Germany. Men are affected two to three times more frequently than women. The average age of the onset of the disease is 74 for men and 76 for women (see diagram).

Non-invasive carcinomas account for about 80% of diagnosed bladder cancers. With a proper treatment these have a good chance of recovery as they usually have a low malignant potential.
If this tumour is unilocular (occurring at one place), it is removed through transurethral resection of the bladder (Transurethral resection-B) followed by early instillation. Here, medication is flushed directly into the bladder using a catheter. Multilocular bladder Tumors (occuring in several places), tumours with high malignant potential or a CIS (carcinoma in situ) must be treated further. It is a known fact that these tumours often relapse (recurrence of the tumour) and are progressive. Depending on the classification, adjuvant (concomitant) intravesical instillation therapy with chemotherapeutics or immunotherapeutics is recommended after surgical removal of the tumour tissue.

This instillation therapy begins with early instillation, which is usually performed within two to a maximum of 24 hours after removal of the tumour. This can prevent the nesting of loosened tumour cells and thus reduce the risk of recurrence.
Only a cytostatic drug is used for early instillation. Depending on the course of surgery and the classification of tumours, the instillation therapy is continued immediately or after healing of the surgical wound either with chemotherapeutics (substances that damage or kill tumour cells in the organism) or immunotherapeutics (activation of the immune system through pharmaceutically active substances).

This chemotherapy is the so-called intravesical (into the bladder) chemotherapy. The cytostatic drug (substance that inhibits cell growth or cell division) is instilled (flushed) directly into the bladder using a catheter (tube). The most widely used drug in Germany is mitomycin (MMC). It can inhibit the growth of cancer cells and kill them.
The most important immunotherapeutic agent is BCG (Bacillus Calmette-Guerin). It is an attenuated bacterium. This means that the bacteria can no longer cause infection, but they can cause an immune response. The BCG causes a defence reaction that is concentrated on the bladder. As a result, residual tumour cells can be combated and an immune response to the tumour cells can be generated.

The method used is the same for both substances:
The substance is dissolved in a saline solution and introduced into the bladder using a disposable catheter. It remains there for one to two hours and is then excreted normally into the toilet.
For detailed information on these treatment methods, please refer to the Mitomycin Patient Guide and Mitomycin Patient Alert Card.