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Bladder Cancer

bladder cancer

The bladder is part of the urinary tract. It is at the bottom of the abdomen. It fills with urine made by the kidneys and supplied to the bladder through two tubes called the ureters and we pass urine out from time to time through a tube called the urethra.

The cells that line the inside of the bladder are called transitional cells or urothelial cells.

What is bladder cancer and how common is it?

Bladder cancer is a common cancer. In most cases, the bladder cancer develops from the transitional cells which line the inside of the bladder. This type of cancer is called transitional cell bladder cancer.

Transitional cell bladder cancer is divided into two groups:

Superficial tumors. These occur in most cases. These tumors are confined to the inner lining, or just below the inside lining, of the bladder. Superficial tumours rarely spread and can usually be cured. However, if left untreated, in some cases they can develop into muscle invasive tumours.

Muscle invasive tumors. These are rare. These tumors have spread to the muscle layer of the bladder, or right through the wall of the bladder. Muscle invasive tumours have a high chance of spreading to other parts of the body (metastasise), and treatment has less chance of being curative.

What causes bladder cancer?
The exact cause is still unknown. However, there are factors which are known to alter the risk of bladder cancer developing. These include:

  • Increasing age. It is rare in people aged younger than 40.
  • Smoking. Bladder cancer is four times more common in smokers than non-smokers.
  • Other chemicals. Certain workplace and environmental chemicals have been linked to bladder cancer - for example, substances used in the rubber and dye industries.
  • Gender. Bladder cancer is about three times more common in men than women.
  • Bladder cancer is more common in white people than in black people.
  • People who eat plenty of fruit and vegetables have a lower risk of developing bladder cancer than those who do not.
  • Previous radiotherapy or chemotherapy increases the risk.
  • Schistosomiasis. This bladder infection, which is caused by a parasite in certain hot countries, increases the risk.
  • Repeated bouts of other types of bladder infection may also slightly increase the risk

What are the symptoms of bladder cancer?

  • Blood in urine
  • Passing urine frequently or pain on passing urine.
  • Pain in the lower abdomen.

How is bladder cancer diagnosed and assessed?

  • Urine microscopy - a sample of urine can be sent to the laboratory to look for cancerous cells under the microscope.
  • Cystoscopy - A cystoscopy is where a doctor or nurse looks into the bladder with a special thin telescope called a cystoscope. The cystoscope is passed into the bladder via the urethra. During cystoscopy a doctor can:
    • See any areas on the lining of the bladder which look abnormal.
    • Take biopsies of suspicious areas.
    • Remove a superficial tumour with instruments which can be passed down a side-channel of the cystoscope.
  • Special urine tests - For example, urine tests called the BTA test, the NMP-22 test and the MCM5 test. These tests detect chemicals and proteins in urine that are made by bladder cancer cells. However, these tests are still not sensitive enough to diagnose all bladder cancers.
  • Ultrasound scan.
  • Computed tomography (CT) scan.

Assessing the extent and spread

A CT scan, a magnetic resonance imaging (MRI) scan, or other tests. This assessment is called staging of the cancer. The aim of staging is to find out:

  • How much the tumour in the bladder has grown, and whether it has grown to the edge, or through the outer part of the bladder wall.
  • Whether the cancer has spread to local lymph nodes.
  • Whether the cancer has spread to other areas of the body (metastasised).
  • By finding out the stage of the cancer, it helps doctors to advice on the best treatment options. Also.
  • It gives a indication of outlook.

What is the treatment for superficial bladder tumours?

Removal of the tumour

Most superficial bladder tumours are removed by a specialist with the aid of a cystoscope  This is called transurethral resection (TUR), as the tumour is removed (resected) via a cystoscope which is passed up the urethra.

Immediate chemotherapy

Following a TUR, it is usual to have one dose of intravesical chemotherapy (chemotherapy in the bladder). This is usually done within 24 hours of having a TUR. It involves inserting a liquid into the bladder via a catheter which then remains for a few hours. The aim is to kill any cancer cells that have been left behind following the TUR.

The tumour that is removed during a TUR is examined under the microscope. This enables the exact stage and type of the tumour to be determined. Depending on the stage and type of the cancer, further intravesical chemotherapy may be advised. This is done by using a catheter and may be done every 1-4 weeks for several months.

The most commonly used medicine for further chemotherapy is called BCG. This is actually a vaccine which is used to prevent tuberculosis (TB). It is not clear how it works for bladder cancer. It may stimulate the immune system in some way to clear any abnormal cells in the bladder lining.

After a superficial tumour is removed, you will need a cystoscopy often. The time interval between check cystoscopies is every 3-4 months at first but may become longer if the bladder remains free of tumour at each check.

What are the treatment options for muscle-invasive tumours?

Treatment options that may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer and your general health.

Some bladder muscle-invasive cancers can be cured, particularly if they are treated in the early stages of the disease.

Treatment may aim to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly.

Treatment may aim to ease symptoms. If a cure is not possible, treatments may be used to reduce the size of a cancer which may ease symptoms such as pain.

Surgery

An operation to remove the bladder is the most common treatment. This is a major operation. Before surgery you need a full discussion with a surgeon to understand the implications of the operation planned. Most importantly, you will need an alternative way of passing urine if you have your bladder removed. One way for this is by a urostomy. The surgeon uses a technique to arrange a system for urine to drain into a bag which you wear on the outside of your abdomen. An alternative operation may be possible where the surgeon creates an artificial type of bladder from a part of the gut.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying.

Chemotherapy

Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying. Prior to surgery or radiotherapy, a course of chemotherapy may be advised. This is called neoadjuvant chemotherapy.

What is the prognosis ?

Superficial bladder tumours. There is a good chance of a cure with treatment. Muscle-invasive bladder tumours. A cure is less likely than with a superficial tumour. As a rule, the earlier the stage of the tumour, the better the chance of a cure with the treatments listed above.


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