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Cystitis in patients with cancer

INTRODUCTION

Cystitis is common in patients with cancer. The most serious form, hemorrhagic cystitis (HC), occurs in 10 to 40 percent of patients receiving high dose chemotherapy [1]; autologous hematopoietic cell transplantation (HCT) recipients are particularly at risk [2,3]. Severe HC is less frequent even in HCT recipients, accounting for 10 percent or less in several series; however, it can be fatal.

Cystitis in patients with cancer can be separated into three broad categories.

  • Cystitis can result from primary bladder cancer or adjacent cancers that encroach upon the bladder from the prostate, uterus, cervix, or rectum. These neoplasms can lead to tumor necrosis with ulceration.
  • Infectious cystitis can develop since cancer patients are immunocompromised.
  • HC can result directly from antineoplastic treatment. Radiation cystitis may result when the bladder is within the radiation field during treatment for pelvic neoplasms such as prostate or cervical cancer. Chemotherapy-induced cystitis can arise from agents directly instilled into the bladder as part of a treatment program for superficial cancer of the bladder or from toxic metabolites of renally excreted anti-neoplastic agents which come in contact with the bladder.

The etiologies, manifestations, and treatment of cystitis secondary to cancer treatment will be reviewed here.

SIGNS AND SYMPTOMS

Cystitis is inflammation of the mucosal surface of the bladder and/or ureters. Patients may experience urgency, frequent urination of small volumes, and a painful burning sensation with urination. Suprapubic pain is common; however, flank or back pain should raise the possibility of upper urinary tract disease. In men, bladder spasms often produce severe referred pain in the glans penis. Pain or lesions in the external genitalia can also be associated with herpetic disease or mucosal candidal infection.
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