15. Screening for Bladder Cancer in SCI Patients

Actionable Nuggets for SCI (2nd ed., 2013)

Screen for bladder cancer annually in SCI patients with indwelling catheter, hematuria, bladder stones, or recurrent urinary tract infections.

The Problem:

The risk of a bladder cancer in the spinal cord injured (SCI) population is 16-28 times higher than in the general population. Factors that increase this risk include recurrent urinary tract infections, the use of an indwelling catheter, and the occurrence of bladder stones.

Evidence-based Best Practice:

Annual screening cystoscopy should be completed for all individuals with SCI who have indwelling catheters. Cystoscopy should also be completed for any patient with hematuria, recurrent urinary tract infections, or bladder stones.

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 an earlier stage at diagnosis and appears to convey a survival advantage. One study showed that 78% of SCI patients presenting with symptoms of bladder cancer were diagnosed at an advanced stage of cancer while only 40% of those diagnosed via screening cystoscopy had an advanced stage of cancer. Five-year survival rates were 50% among those who were not screened, and 100% where screening led to early detection.

Key reference:

    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.

Additional references:

    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
    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.
    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
    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
    Kaufman, J.M., et al. (1977). Bladder cancer and squamous metaplasia in spinal cord injury patients. Journal of Urology118(6): 967-71. http://www.ncbi.nlm.nih.gov/pubmed/926277
    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.
    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
    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.