Bladder cancer treatment in Germany
Bladder cancer, also known as bladder carcinoma, is most commonly diagnosed in older adults. At the time of diagnosis, the average age is 73 for men and 77 for women. This condition is diagnosed more frequently in men than in women. In Germany, around 30,000 people are diagnosed with bladder cancer each year, of whom around 22,000 are men.
Bladder cancer usually develops in the lining of the bladder
Treatment for bladder cancer in Germany is provided at specialised centres for urological oncology, where patients receive expert care to manage their cancer. Specialised centres for urological oncology in Germany are certified by the German Cancer Society (Deutsche Krebsgesellschaft). Only clinics that meet the following criteria receive certification:
- clear specialisation in the field of urological oncology;
- a full range of care for the treatment of genitourinary system cancers, from diagnosis to treatment and post-operative follow-up;
- collaboration among all key specialists, including urologists, oncologists, radiologists and pathologists;
- an established and documented quality control system with regular reporting and internal audits;
- treatment based on current international clinical guidelines (S3 guidelines).
Certified centres for urology and oncological urology confirm the quality of their work annually through audits. Regular independent inspections are conducted by OnkoZert, an organisation affiliated with the German Cancer Society.
Causes and risk factors
It has been proven that smoking, including secondhand smoke, is the primary risk factor for bladder cancer. Tobacco smoke contains around 5,300 chemical compounds that can cause cancer, 90 of which are known carcinogens.
An increased risk of developing cancer is present in certain industries. In sectors such as textiles, paints and chemicals, bladder cancer is considered an occupational disease.
Aromatic amines, which are organic compounds used in the production of epoxy resins, dyes, pharmaceuticals and many other products, also cause mutations in bladder cells. It should be noted that many years may pass before cancer develops.
Furthermore, certain medications can increase the risk of developing bladder cancer. These include pioglitazone and cyclophosphamide, for example.
Radiation exposure received many years ago as a result of radiation therapy can also cause bladder cancer.
Additional risk factors include chronic inflammatory diseases of the bladder lining. These include chronic cystitis, kidney stones, residual urine and the prolonged use of a catheter.
Symptoms of bladder cancer
The most common symptom is a change in the colour of the urine, which turns reddish-brown due to the presence of blood. Other symptoms may include a frequent urge to urinate, during which only a small amount of urine is passed. As the disease progresses, urination becomes difficult and painful. Pain in the lower abdomen, weakness and anaemia may also develop.
The late stage of the disease is accompanied by:
- pain in the flank and groin area;
- enlarged lymph nodes;
- impaired lymphatic drainage;
- bone pain.
However, these symptoms may indicate not only cancer, but also other changes in the urinary tract and kidneys. Blood in the urine may also be a result of bladder inflammation. Therefore, if you experience any of these symptoms, you should consult a doctor immediately to detect the problem in time.
Diagnosis of bladder cancer
If bladder cancer is suspected, the urologist will first perform a physical examination of the patient and test their urine for blood. Further laboratory analysis of the urine involves a detailed examination of its composition. This is primarily done to detect malignant cells.
The doctor can obtain additional information by examining the bladder and kidneys using ultrasound. However, cystoscopy is considered the most informative method for examining the urethra and bladder. Cystoscopy involves the use of an endoscope to collect tissue samples from areas of the bladder mucosa that appear suspicious and analyse them for the presence of a tumour.
If cancer is suspected, a special bipolar electric loop is used to remove the tumour, which is then safely extracted through the urethra. This procedure is called transurethral resection (TUR) and is performed under anaesthesia.
For superficial tumours affecting only the mucous membrane, transurethral resection serves both diagnostic and therapeutic purposes. This method enables the complete removal of non-muscle-invasive cancer with millimetre precision.
In cases of muscle-invasive cancer, where the tumour has already penetrated the muscle layer of the bladder, the doctor must first rule out metastases in other organs. This is usually done using computed tomography (CT) scans of the abdomen, chest and pelvis. A chest X-ray is only performed if a CT scan cannot be performed. A CT scan of the skull is only necessary if there are symptoms in that area of the body.
Types of bladder cancer
There are two types of bladder tumour: superficial tumours (non-muscle-invasive carcinoma) and tumours that invade the muscle layer of the bladder wall (muscle-invasive carcinoma).
Non-muscle-invasive carcinoma
Depending on the extent to which the tumour has spread, there are various stages of cancer:
- T0: no evidence of a primary tumour.
- Ta: non-invasive papillary carcinoma.
- Tis: carcinoma in situ (CIS): the tumour is locally confined and affects only the upper layer of the mucous membrane.
- T1: the tumour invades the connective tissue (lamina propria) located beneath the mucous membrane.
After the early stage, the cancer may progress and take the following forms:
Muscle-invasive carcinoma
- T2: The tumour invades the superficial muscle layer (T2a) or the deep muscle layer (T2b).
- T3: The carcinoma extends into the surrounding fatty tissue.
- T4: The cancer involves adjacent organs.
- T4a: Involvement of the prostate, seminal vesicles, uterus or vagina.
- T4b: Involvement of the pelvic or abdominal wall.
Prognosis for bladder cancer
The prognosis for bladder cancer depends on the stage of the cancer. The best chance of recovery is in the early stage (Ta). For non-invasive carcinomas in stages Ta and T1, the five-year survival rate is 84–95 percent. Carcinoma in situ, on the other hand, has a poor prognosis.
Treatment of bladder cancer
As with other types of cancer, the prognosis for bladder cancer depends on the stage of the disease.
If the tumour is confined to the inner lining of the bladder, it can be removed via transurethral resection (TUR). During this procedure, the surgeon inserts a tube containing an electric loop into the bladder, removes the affected tissue and extracts it through the urethra.
Adjuvant drug therapy is administered in addition to TUR to reduce the risk of recurrence. For this, medication is introduced into the bladder via a catheter. The drug therapy plan depends on whether the tumour belongs to one of three risk groups: low, intermediate or high.
If the tumour has already invaded the muscle layer and there are no signs of metastasis, the entire bladder is removed. In men, the prostate and seminal vesicles are also removed in addition to the bladder.
In women, the uterus, both ovaries, the fallopian tubes and part of the vaginal wall are removed along with the bladder. Once the bladder has been removed, the surgeon creates a new reservoir to collect and drain urine.
Radiation therapy
Radiation therapy is considered when a patient’s condition does not allow for surgery or the patient declines it. In late-stage disease, the aim of radiation therapy is to improve the patient’s quality of life.
Chemotherapy
The goal of chemotherapy is to reduce the likelihood of recurrence. It may be prescribed both before and after surgery. The most appropriate treatment options are determined on an individual basis, and doctors always discuss bladder cancer treatment methods with the patient.
Immunotherapy
Another approach to treating bladder cancer is immunotherapy. This method involves supporting and restoring the patient’s immune system. Specialised medications boost the activity of immune cells, which are effective in fighting the tumour.
As recurrence can occur even after successful treatment, patients must undergo regular follow-up examinations.
If you would like more information about the cost of bladder cancer treatment in Germany, please submit an online request on our website or contact us by phone on +49 170 62 47 020.
Leading university cancer centres in Germany
Below is a list of university hospitals and cancer centres in Germany that are certified by the German Cancer Society (DKG) for treating genitourinary cancers. These hospitals are among the best cancer centres in Germany:
Charité University Hospital – Charité Comprehensive Cancer Center, featuring leading specialists in urological oncology.
Heidelberg University Hospital is the oldest multidisciplinary medical institution and one of the largest oncology centres in Germany. The hospital is home to the National Center for Tumor Diseases (NCT), offering cutting-edge treatment and diagnostic methods for all types of cancer.
The Cancer Center at Dresden University Hospital is a certified, interdisciplinary center for urological oncology. It specialises in diagnosing and treating prostate, kidney, bladder, testicular and penile cancers, and works closely with the National Cancer Centre Dresden (NCT/UCC).
Ludwig Maximilian University Hospital in Munich is a top-tier medical facility offering a full range of diagnostic and therapeutic services for urological diseases, including oncological conditions.
Freiburg University Hospital is a centre with a strong urology department, renowned for its innovative minimally invasive diagnostic and surgical techniques.
The University Hospital of Aachen is a major German university medical centre in the city of Aachen with its own certified departments of urology and oncourology. The department offers a comprehensive range of modern diagnostic and therapeutic methods for urinary tract diseases in adults and children, including minimally invasive and robot-assisted surgery.
The University Hospital Mannheim is an interdisciplinary oncology centre. Alongside the University Hospitals of Freiburg and Heidelberg, the clinic is actively involved in researching new cancer treatment regimens. The hospital has a certified paediatric urology centre, which is part of the European Reference Network for rare urological diseases and complex congenital anomalies.
