Bernard Ferrie reports from the British Association of Urological Surgeons Section of Oncology Annual Meeting, held at the ICC Birmingham from 12-13 November 2009
The British Association of Urological Surgeons (BAUS) Section of Oncology now has over 550 members, and the theme for the 2009 Annual Meeting was ‘Controversies in Urothelial Cancer’.
Haematuria is now classified into visible haematuria (VH) and non-visible haematuria (NVH), and only the former is subject to the two-week referral rule. If investigations for VH are negative, there is increasing evidence that suitable patients should be referred for nephrological investigation as identifying chronic kidney disease may be more likely than finding cancer. Urinary tract ultrasound will detect more tumours than intravenous urography at a third of the cost. Patients with one plus of blood should be regarded as negative and routine urine testing should be avoided.
The BAUS Cancer Registry (BCR) now has data on 270,000 new urological cancers and 70,000 of these are bladder cancers over the period from 1998 to the present. Bladder cancer patients are getting older with a current mean age at diagnosis of 73, but still with a male preponderance of 3 to 1. Of the 7,000 or so new cases of bladder cancer per year, only about 1,200 are suitable for cystectomy, and there is good evidence that radical treatment within 90 days results in a better prognosis. The numbers of patients suitable for orthotopic bladder replacement remain small and it is too early to identify the ultimate role for laparoscopic or robotic cystectomy. Intravesical BCG is probably not much different in its results compared to Mitomycin.
With regards to transitional cell carcinomas of the upper tract, possibly 20% are related to analgesic use and the sex ratio is 1.5 to 1 male to female, unlike bladder cancer. Histological confirmation should be the standard now. Smaller tumours may be suitable for endoscopic management although ureteroscopy should not be regarded as a procedure without complications.
Finally, it was pointed out that the UK was at least 10 years behind other countries in data coding in urological cancer, leaving plenty of scope for improvement in the future.
Bernard Ferrie
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