What is bladder cancer?
Cancer is the abnormal growth of cells in the body; these cells grow in an uncontrolled way and produce masses or lumps called tumours. Bladder cancer is the formation of malignant (cancerous) tumours inside the bladder.
The bladders function is to store urine produced by the kidneys until you are ready to urinate. The bladder wall has different layers:
- Urothelium – thin surface lining the inside of the bladder
- Connective tissue layer (lamina propria)
- Bladder muscle (Detrusor muscle)
- Fat layer
Possible risk factors for bladder cancer are:
- Occupational risk – exposure to certain chemicals (for example chemical dyes, rubber and plastic industries)
- Drug exposure – for example certain chemotherapy agents (cyclophosphamide)
- Long term inflammation or repetitive infections of the bladder
- Rare conditions – for example Schistosomiasis parasite (parasite in parts of Arica and Middle East which can infect urinary tract)
Common symptoms of bladder cancer
- Haematuria (blood in the urine) - the most common initial symptom, is usually painless and occurs intermittently. Haematuria can be described as visible (you can see it in your urine) or non-visible (it is microscopic, identified with urine testing).
Less common symptoms:
- Burning sensation when passing urine
- Frequency – need to urinate a short time after you have already been to the toilet
- Lower back or abdominal pain
Types of Bladder Cancer
There are different types of bladder cancer:
- Urothelial Carcinoma – (previously known as Transitional cell carcinoma, TCC) the most common form of bladder cancer, approximately 90%. Forms in the lining of the bladder the urothelium.
- Squamous cell carcinoma (SCC) – forms in the thin flat cells that line the bladder.
- Adenocarcinoma – very rare type of bladder cancer, forms in the mucus producing cells of the bladder.
Diagnosing Bladder Cancer
A variety of assessments and tests are used to diagnose bladder cancer including:
- Urine tests – to check for blood, infection and pre-cancerous or cancer cells in the urine.
- Blood tests – to check your kidney function and overall general health.
- Ultrasound scans
- CT scans
- Cystoscopy – cystoscopy may be performed under general anaesthetic or as a flexible cystoscopy under local anaesthetic. Cystoscopy is the procedure used to diagnose bladder cancer allowing an examination of the bladder, if abnormal tissue is seen by the urologist biopsies will be taken for pathology investigation.
Treatment of bladder cancer
Staging and Grading
To plan the best treatment for bladder cancer the tumour is diagnosed for STAGE and GRADE. Tumour stage is how far the cancer cells have grown into the bladder.
Non-muscle invasive bladder cancer is where only the inner lining of the bladder is affected. CIS, Stage Ta and T1 are classified as non-muscle invasive.
Muscle invasive bladder cancer is where the cancer has spread into the muscle wall of the bladder. Stage T2, T3 and T4 are types of cancer that have extended into the bladder muscle.
Grading – tumours are given a grade based on how aggressive the cancer cells are growing, grading is determined by a scale 1-3. Grade 1 cancer cells are the slowest growing while Grade 3 are the most aggressive.
Treatment for bladder cancer
Treatment options for bladder cancer are determined by a number of factors however primarily the treatment is based on whether the cancer is non-muscle invasive or muscle invasive.
Treatment for non-muscle invasive bladder cancer
Transurethral Resection of a bladder tumour (TURBT) - is the most common treatment option for non-muscle invasive bladder cancer. This procedure is performed during cystoscopy whereby surgical instruments are used via the scope to visualise and remove the tumour tissue. Further biopsies may be taken at this stage; these biopsies will be assessed for stage and grade by pathology.
Intravesical therapy – is medication given directly into the bladder in order to treat any small areas of cancer that cannot be seen at cystoscopy, it also acts to reduce the risk of cancers recurring. Examples of medication delivered this way include BCG or Mitomycin C,
Intravesical therapy may be given at the time of surgery and this may be the only treatment required at this stage for some patients. Other patients may require further treatment to assist in the prevention of the cancer recurring.
Further treatments can include:
Intravesical therapy – (mitomycin C) the medication is given directly into your bladder via a catheter (thin tube placed through your urethra into the bladder), the catheter is then removed and you hold the medication in your bladder for 1-2 hours before you pass urine into the toilet.
Intravesical immunotherapy (Bacillus Calmette-Guerin, BCG) – this form of treatment aims to trigger the body’s immune system to attack the bladder cancer cells. This therapy is given directly into your bladder via a catheter (thin tube placed through your urethra into the bladder) the catheter is then removed and you hold the medication for 1-2hours before you pass urine into the toilet. The BCG treatments are usually given weekly for a six week period.
Treatment for Muscle invasive bladder cancer
Surgical treatment called Cystectomy may be recommended by your doctor for bladder cancer that has entered the bladder muscle or CIS, Ta or T1 cancer that has not improved or has returned after treatment.
Cystectomy involves removing the entire bladder, part of the urethra and surrounding lymph nodes. In females the uterus and other surrounding tissues may be removed, while in males the prostate and other surrounding tissues may be removed. Cystectomy may also be partial whereby a portion of the bladder may be removed.
When the bladder is removed entirely, the ureters from the kidney are joined to a small section of the bowel, a small portion of this is brought out of the body and attached to the abdomen to form what is called a stoma, a stoma bag is placed over the stoma to collect urine. The name for this type of stoma is an Ileal Conduit.
A Neobladder is a pouch created out of bowel to replace the bladder being removed for cancer. It does not function in the same way as the original bladder. It does not have the usual bladder sensation and it cannot contract to empty, but instead allows urine to be stored before emptying (either by straining or by the insertion of a catheter).