15. Screening for Bladder Cancer in SCI Patients

Actionable Nuggets for SCI (3rd ed., 2016)

The Problem:Man controlling power wheelchair

The risk of a bladder cancer in the spinal cord injured (SCI) population is similar to that in the general population; however, mortality is greater (standardized mortality ratio = 6.7 [+ 1.4]).  Bladder cancer in SCI tends to have an atypical presentation because symptoms are masked by paralysis.  It tends to be detected at an advanced stage, and is often an aggressive form of the disease.

Actionable Nugget

Routine screening for bladder cancer is recommended only for high-risk patients;  that is those with indwelling or suprapubic catheters, complete lesions, >10 years since injury, bladder stones, or recurrent urinary tract infections.

Evidence-based Best Practice:

Cystoscopy is presently the best screening tool for bladder cancer in the SCI population. Screening cystoscopy in SCI patients with risk factors for bladder cancer has been shown to result in detection and diagnosis at an earlier stage, resulting in a survival advantage.  Among those screened, only 40% had advanced stage cancer, whereas 78% of those not screened were detected with advanced disease.  Five-year survival rates were 100% where screening led to early detection, versus 50% among those who were not screened.  Screening is controversial in relatively uncommon diseases, such as bladder cancer in SCI, where incidence is estimated at less than 2%.

Key reference:

    Nahm, L. S., Chen, Y., DeVivo, M. J., & Lloyd, L. K. (2015). Bladder cancer mortality after spinal cord injury over 4 decades. The Journal of urology, 193(6), 1923-1928. http://doi.org/10.1016/j.juro.2015.01.070

Additional references (chronological order):

    Elliott, S. P. (2015). Screening for bladder cancer in individuals with spinal cord injury. Journal of Urology, 193(6), 1880–1881. http://doi.org/10.1016/j.juro.2015.03.069
    Lee, W.-Y., Sun, L.-M., Lin, C.-L., Liang, J.-A., Chang, Y.-J., Sung, F.-C., & Kao, C.-H. (2014). Risk of prostate and bladder cancers in patients with spinal cord injury: a population-based cohort study. Urologic Oncology, 32(1), 51.e1–7. http://doi.org/10.1016/j.urolonc.2013.07.019
    Martins, C. F., Bronzatto, E., Neto, J. M., Magalhães, G. S., D’anconna, C. A. L., & Cliquet, A. (2013). Urinary tract infection analysis in a spinal cord injured population undergoing rehabilitation—how to treat?. Spinal cord, 51(3), 193-195.
    Welk, B., McIntyre,  a, Teasell, R., Potter, P., & Loh, E. (2013). Bladder cancer in individuals with spinal cord injuries. Spinal Cord, 51(7), 516–21. http://doi.org/10.1038/sc.2013.33
    Cheng, J. N., Lawrentschuk, N., Gyomber, D., Rogerson, J., & Bolton, D. M. (2010). Cystectomy in patients with spinal cord injury: indications and long-term outcomes. Journal of Urology184(1), 92-98.
    Weaver, F.M., & LaVela, S.L. (2007). Preventative care in spinal cord injuries and disorders: Examples of research and implementation. Physical Medicine and Rehabilitation Clinics of North America18(2007), 297-316.
    Consortium for Spinal Cord Medicine (2006). Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. Journal of Spinal Cord Medicine29(5), 527-73. http://www.pva.org/site/News2?news_iv_ctrl=-1&page=NewsArticle&id=7121
    Davies, B., et al. (2005). Efficacy of BTA stat, cytology, and surviving in bladder cancer surveillance over 5 years in patients with spinal cord injury. Urology66(4), 908-11.
http://dx.doi.org/10.1016/j.urology.2005.05.022
    Groah, S.L., et al. (2002). Excess risk of bladder cancer in spinal cord injury: evidence for an association between indwelling catheter use and bladder cancer. Archives of Physical Medicine & Rehabilitation83(3), 346-51. http://dx.doi.org/10.1053/apmr.2002.29653
    Navon, J.D., et al. (1997). Screening cystoscopy and survival of spinal cord injured patients with squamous cell cancer of the bladder. Journal of Urology157(6), 2109-11.
http://dx.doi.org/10.1016/S0022-5347(01)64687-1
    Stonehill, W.H., et al. (1996). Risk factors for bladder tumors in spinal cord injury patients. Journal of Urology155(4), 1248-50. http://dx.doi.org/10.1016/S0022-5347(01)66232-3
    Bejany, D.E., Lockhart, J.L., & Rhamy, R.K. (1987). Malignant vesical tumors following spinal cord injury. Journal of Urology138(6), 1390-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=3682066
    El-Masri, W.S., & Fellows, G. (1981). Bladder cancer after spinal cord injury. Paraplegia19(5), 265-70. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7279428
    Kaufman, J.M., et al. (1977). Bladder cancer and squamous metaplasia in spinal cord injury patients. Journal of Urology,118(6), 967-71. http://www.ncbi.nlm.nih.gov/pubmed/926277