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Bladder Cancer

I highly recommend you read Understanding Bladder Cancer: A guide for people with cancer, their families and friends from the cancer council.

What is bladder cancer?

Bladder cancer is when abnormal cells in the bladder grow and divide in an uncontrolled way. There are different types of bladder cancer:

  • urothelial carcinoma, formally known as transitional cell carcinoma, is the most common form of bladder cancer (80-90%) and starts in the urothelial cells in the bladder wall's innermost layer
  • squamous cell carcinoma begins in the thin, flat cells that line the bladder
  • adenocarcinoma is a rare form which starts in mucus-producing cells in the bladder.

In 2014, 2748 new cases of bladder cancer were diagnosed in Australia. Bladder cancer is common in people aged over 60 and is significantly more common in men than in women.

In 2016, there were 1019 deaths caused by bladder cancer in Australia. The chances of surviving bladder cancer for five years is 54%.

Non-muscle-invasive tumours – The cancer cells are found only in the inner lining of the bladder (urothelium) or in the next layer of tissue (lamina propria) and haven’t grown into the deeper layers of the bladder wall. Most bladder cancers are non-muscle-invasive tumours, sometimes called superficial bladder cancer. Muscle-invasive tumours – The cancer has spread beyond the urothelium and lamina propria into the layer of muscle, or sometimes through the bladder wall into the surrounding fatty tissue.

Bladder cancer symptoms

The most common symptom of bladder cancer is blood in the urine (haematuria), which usually occurs suddenly and is generally not painful. Other less common symptoms include:

  • problems emptying the bladder
  • a burning feeling when passing urine
  • need to pass urine often
  • blood in urine
  • lower abdominal or back pain.

Causes of bladder cancer

Some factors that can increase your risk of bladder cancer include:

  • smoking
  • workplace exposure to certain chemicals used in dyeing in the textile, petrochemical and rubber industries
  • use of the chemotherapy drug cyclophosphamide
  • diabetes
  • family history
  • chronic inflammation of the bladder.

Diagnosis for bladder cancer

Tests to diagnose bladder cancer may include:

Blood tests

Blood tests can check you general health.

Urine tests

Urine tests check for blood, bacteria and any cancer or pre-cancer cells.

CT scans

CT scans produce three-dimensional pictures of several organs at the same including the bladder which can help in the detection of any tumours.

Ultrasound scans

Ultrasound scans produce pictures of the organ, and can show the presence and size of cancer. Small tumours may be difficult to detect by ultrasound.

Cystoscopy and biopsy

A cystoscopy is the main procedure used to diagnose bladder cancer by examining the inside of the bladder. If abnormal tissues are detected, a tissue sample (biopsy) will then be taken.

Treatment for non-muscle- invasive bladder cancer

The main treatments for when the cancer cells are found only in
the bladder’s inner lining (non-muscle-invasive bladder cancer) are surgery, immunotherapy and intravesical chemotherapy. Surgery, on its own or combined with other treatments, is used in most cases.

Surgery

Most people with non-muscle-invasive bladder cancer have
an operation called transurethral resection of bladder tumour (TURBT). This is done during a cystoscopy under a general anaesthetic (see pages 14–15). It takes 15–40 minutes, and does not involve any external cuts to the body.

Treatment for muscle- invasive bladder cancer

When bladder cancer has invaded the muscle, the most common treatment is surgery to remove the entire bladder. Other treatments, such as chemotherapy, may be given before or after surgery. Some bladder cancers may be treated with a combination of chemotherapy and radiation therapy only.

Surgery

Most people with muscle-invasive disease or cancer that has invaded the lamina propria and has not responded to BCG, have surgery to remove the bladder (cystectomy).

Removing the whole bladder (radical cystectomy) – This
is the most common operation for muscle-invasive bladder cancer. The whole bladder and nearby lymph nodes are removed. In
men, the prostate, urethra and seminal vesicles may also be removed. In women, the urethra, uterus, ovaries, fallopian tubes and a part of the vagina are often removed.

Removing part of the bladder (partial cystectomy) – This type of operation is not suitable for most types of bladder cancer, so it is less common. A partial cystectomy removes only the bladder tumour and a border of healthy tissue around it.