An estimated 32,000 new cases of cancer of the kidney and bladder will occur in the United States this year, and there will be approximately 15,000 deaths. Blood in the urine and difficulty of urination are the common warning signals. About 38 percent of patients with bladder cancer and 20 percent of those with cancer of the kidney live 5 years or longer after diagnosis.
Kidney and bladder combined constitute a leading site of cancer in the United States. The common kidney cancer of children, Wilms' tumor, may be cured by treatment with a combination of surgery, irradiation, and drugs.
Bladder cancer may occur as an occupational disease among workers in the dye and chemical industries; some cases are also associated with heavy cigarette smoking; others, with a rare parasitic infection (bilharziasis) transmitted through tropical waters. Some kidney tumors may be associated with kidney stones and infections; the common kidney cancer of children, Wilms' tumor, seems to be congenital in origin (page 39).
Kidneys are paired organs in the back of the abdominal cavity, which through secretion of urine carry waste materials from the blood. Surgery is the preferred treatment for cancer of the kidney. Radiotherapy is administered if the tumor is inoperable, if cancer recurs after surgery, or in elderly or poor-risk patients who might not tolerate an operation. Apart from the successful use of chemotherapy in conjunction with surgery and radiotherapy in Wilms' tumor, drug therapy has not been beneficial. Scattered reports of objective remissions in a few patients with kidney cancer have been ascribed to a variety of agents; the most promising ones are hormonal agents.
The urinary bladder is a muscular, membranous sac in the front of the lower abdomen that stores urine brought from the kidneys. Supervoltage radiotherapy, or insertion of radium or other radioactive materials, appears to be the best treatment for bladder cancer. However, surgery to remove part or all of the organ may sometimes be preferred, depending on the size, location, and cell type of the cancer and the extent of infiltration and involvement of surrounding tissues.
Chemotherapy in the treatment of disseminated bladder tumors has generally been ineffective. Transient, palliative benefit is sometimes obtained with 5-FU alone or in combination with radiotherapy. ThioTEPA instilled into the bladder appears to be of benefit as primary treatment in patients with superficial, small well-differentiated papillary tumors, and may prevent recurrence i' given after surgical removal of these papillary tumors of the bladder.