Bladder cancer is the fourth most common cancer in men and eighth most common in women in the UK and occurs most commonly in people between 50 and 70 years.
The bladder is a hollow, muscular organ sited in the lower abdomen and pelvis and connected to the kidneys by two tubes called ureters. Majority of the bladder cancers start in the lining and are called transitional cell bladder cancers (TCC). These can be non-muscle invasive or superficial bladder (affecting only the lining) cancer. In cases where the tumour involves the muscle wall of the bladder, it is called a muscle-invasive bladder cancer.
Other types of bladder cancer are squamous cell cancer and adenocarcinoma, however, are rare.
These can be seen like outgrowths on the inside lining of the bladder. These are called papillary cancers. They have a short stem attached to the lining of the bladder. Sometimes they go on to spread into the wall of the bladder.
Grading and Staging
Bladder cancers are graded G1 (low-risk) to G 3 (high-risk). Higher grade bladder cancers have more potential to return or spread in the future than lower grade cancers.
Staging is a measure of the extent of the cancer. The widely used method to stage these cancers is the TNM staging:
T (tumour) – how much the cancer has grown and spread.
N (nodes) – whether the cancer has spread into nearby lymph nodes.
M (metastasis) – whether the cancer has developed in another part of the body such as the lungs or bones (also called secondary cancer).
It is usual for a patient’s individual diagnosis and circumstances to be discussed as part of a multi-centre, multi-disciplinary team (MDT) review meeting.
Diagnostic tests for Bladder Cancer
Urinary cytology does not have absolute accuracy, it can sometimes detect abnormal cells even though there is no cancer present (a false-positive result), or it can fail to detect abnormal cells when cancer is present (a false-negative result). It is therefore used selectively.
- Kidney ultrasound (USScan KUB) – a non-invasive scan of the kidneys, urethras and bladder using ultrasound waves.
- CT scan – a series of X-rays taken to create a detailed picture of the inside of the body; this may involve an injection of contrast dye to provide better quality images and highlight abnormal areas
Cystoscopy (Flexible or Rigid)
Cystoscopy usually involves a flexible instrument known as a cystoscope (a thin tube with a camera and light at the end) to examine the inside of the bladder and takes about five minutes. A cystoscopy is usually performed in an outpatient setting.
During a flexible cystoscopy, a local anaesthetic gel is applied to the urethra in order to minimise any pain and this acts as a lubricant as well to allow the free passage of the camera.
Once all of the tests have been completed it should be possible to tell you the grade of the cancer and what stage it is. Click here to visit our page on cystoscopy.
Trans-urethral resection of bladder tumour (TURBT)
TURBT is carried out under general anaesthetic. The surgeon uses an instrument called a resectoscope to locate the visible tumours and shaves them away from the lining of the bladder using a mild electrical current. The removed tumours are then sent to a laboratory for Histopathology.
Following this procedure, a catheter is inserted into the bladder through the urethra and urine drains into a bag. The catheter is used to drain away any blood and debris from the bladder. Once the bleeding has settled, the catheter is removed before discharge from the hospital, usually within 24-48 hours.
Blood in the urine and bladder discomfort after TURBT can occur intermittently for up to four weeks following this procedure. Click here to visit our page on TURBT.
Intravesical Mitomycin C® – Intravesical means given directly into the bladder. Depending on the Surgery and type of tumour, immediately after TURBT you may be offered a single dose of Mitomycin C® which is administered directly into the bladder in the postoperative period.
Intravesical immunotherapy using Bacillus Calmette-Guérin (BCG) – This is usually offered to patients with high grade superficial disease. This helps by reducing cancer progression and recurrence. The BCG vaccine was originally used to treat tuberculosis (TB), but a variant of the vaccine has also proved to be an effective treatment for some bladder cancers when given directly into the bladder. BCG works by stimulating a person’s own immune system to help to fight the disease.
BCG is given as an ongoing course of outpatient treatments alongside regular surveillance cystoscopies. (? Link to BAUS consent and procedure form)
Muscle-invasive bladder cancer
In case of the above diagnosis, radical options of Surgery and Radiotherapy may be required along with further staging investigations.