Bladder cancer ranks as the fourth most common cancer among men and the eighth most common among women in the UK. It predominantly affects individuals aged 50 to 70.
The bladder, a hollow, muscular organ located in the lower abdomen, functions as a urine reservoir before excreting urine from the body. Two ureters connect this organ to the kidneys. Most bladder cancers originate in the inner lining of the bladder and are classified as transitional cell bladder cancers (TCC).
These cancers are categorised further based on their invasiveness:
- Non-muscle invasive cancers are confined to the bladder lining
- Muscle-invasive cancers extend into the deeper muscle layers of the bladder wall.
- Less common types of bladder cancer include squamous cell carcinoma and adenocarcinoma.
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.
Common symptoms of bladder cancer
Early symptoms of bladder cancer are crucial for timely diagnosis and management. The most prominent symptom is:
- Presence of blood in the urine (hematuria), which may be visible or microscopic.
Other early signs include:
- Increased frequency of urination
- A sensation of urgency even when the bladder is not full
- Pain or burning during urination.
These symptoms are often mistaken for urinary tract infections or bladder stones.
Severe symptoms or complications
As bladder cancer progresses, symptoms may become more severe and include pain in the pelvic area, lower back pain, and inability to urinate despite urges.
Advanced bladder cancer can lead to anaemia due to chronic blood loss, weight loss, and general fatigue. Complications arise when the cancer spreads beyond the bladder to lymph nodes or distant organs (metastasis), such as the lungs or bones, complicating treatment and worsening prognosis.
Causes of bladder cancer
The exact cause of bladder cancer is not always clear, but several risk factors have been identified:
- Smoking: The most significant risk factor, smoking contributes to a large percentage of cases due to carcinogens in tobacco that accumulate in the bladder.
- Occupational Exposure: Workers in industries that use certain organic chemicals, especially aromatic amines (such as those used in dye factories), are at increased risk.
- Radiation Exposure: Previous radiation treatment for other cancers can increase the risk of developing bladder cancer.
- Chronic Bladder Inflammation: Long-standing bladder infections or irritation may lead to cell changes in the bladder lining.
- Family History and Genetic Factors: A family history of bladder cancer can suggest a genetic predisposition to the disease.
How is bladder cancer diagnosed?
Diagnosing bladder cancer involves several types of tests and procedures:
Urine Tests
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.
Imaging
- 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, which 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 to minimise pain. This gel also acts as a lubricant to allow the camera to pass freely.
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.
Treatment options
The treatment for bladder cancer depends on the cancer’s type, stage, and grade, as well as the patient’s overall health:
Transurethral 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 is drained 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.
Intravesical treatments
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.
Radical Treatments
For muscle-invasive cancer, more extensive options like cystectomy (removal of the bladder) or radical radiotherapy are considered.
Frequently asked questions
What are the survival rates for bladder cancer?
Survival rates for bladder cancer depend significantly on the stage and grade at which the cancer is diagnosed. Generally, the five-year survival rate for those with non-muscle invasive bladder cancer (stages 0-II) can be over 90%. However, for muscle-invasive cancers (stages III and IV), the five-year survival rate can drop significantly, often to between 15% and 60%, depending on the extent of spread and response to treatment. These statistics underscore the importance of early detection and timely treatment.
Can bladder cancer be completely cured?
The possibility of a complete cure for bladder cancer largely depends on its stage and grade at the time of diagnosis. Non-muscle invasive bladder cancer, detected early, often responds well to treatment with high rates of successful management and remission. However, muscle-invasive and advanced-stage bladder cancers pose a greater challenge, requiring more aggressive treatment, and have a higher risk of recurrence and metastasis. Continuous follow-up care is crucial for all patients, even those considered in remission, to monitor for any signs of recurrence or new cancer development.
Are there any lifestyle changes that can help manage bladder cancer?
While specific lifestyle changes cannot cure bladder cancer, they can aid in management and may improve the effectiveness of treatment. Key recommendations include:
- Smoking Cessation: Stopping smoking is critical, as tobacco use is a major risk factor for bladder cancer.
- Dietary Adjustments: Consuming a diet rich in fruits, vegetables, and adequate fluids can help reduce the concentration of potential carcinogens in the bladder.
- Physical Activity: Regular exercise helps maintain overall health and can support recovery and well-being during cancer treatment.
- Limiting Exposure to Chemicals: For those in high-risk industries, minimising exposure to known carcinogenic chemicals with appropriate safety measures is crucial.
How often should someone with bladder cancer undergo screening?
The frequency of screening and surveillance for bladder cancer patients depends on the stage and grade of the disease, as well as the treatment received. Typically, individuals with non-muscle invasive bladder cancer might undergo a cystoscopy every 3 to 6 months for the first few years after treatment. If no recurrences occur, the time between cystoscopies may be extended.
For those treated for muscle-invasive cancer, besides regular cystoscopies, additional imaging tests might be recommended periodically to check for any spread of cancer to other parts of the body.
What impact does bladder cancer have on daily life?
The impact of bladder cancer on daily life can vary widely among patients. Issues can range from frequent and urgent needs to urinate, discomfort or pain, fatigue, and the psychological stress of managing a chronic illness. Treatments such as chemotherapy, surgery, and radiation can also cause side effects that affect daily life, such as fatigue, nausea, and changes in urinary and bowel habits. Support from healthcare providers, counsellors, and support groups can be beneficial in managing these challenges.
