Bladder cancer
This factsheet is for people who have bladder cancer or for people who would like information about bladder cancer.
Bladder cancer is one of the most effectively treated of the common cancers. It is rare in people under 50, but thereafter the rate rises with age.
The bladder
The bladder is a hollow, muscular, balloon-like organ that collects and stores urine. Urine consists of water and waste products not needed by the body and is produced by the kidneys. The bladder expands like a balloon as the volume of urine increases and when full, empties to the outside through the urethra.
The bladder is lined with a membrane (urothelium) that stops urine being absorbed back into the body. The cells of this membrane are called transitional cells or urothelial cells.
Illustration showing the urinary system
What is bladder cancer?
A bladder tumour is a lump created by an abnormal and uncontrolled growth of cells. It can either be malignant (cancerous) or benign.
Cancerous tumours can grow through your bladder and spread to other parts of your body (through the bloodstream or the lymph system) where they may grow and form secondary tumours. This spread of cancer is called a metastasis.
Types of bladder cancers
There are several different types of bladder cancer.
- Transitional cell carcinoma (TCC) is the most common type of cancer and starts in the layer of cells that forms the lining of the bladder.
- Squamous cell carcinomas (SCC) originate in one of the types of cell in the bladder lining.
- Adenocarcinomas originate in glandular cells.
Bladder cancer is also classified according to how far it has spread.
- If the cancer is only in the bladder lining, it is called a superficial cancer.
- If the cancer has spread to the muscle wall of the bladder it is called an invasive cancer.
Invasive cancers can spread through the bladder wall into nearby organs such as the prostate gland in men, the vagina in women, the bowel, or lymph nodes. Further spread to other organs such as the bones and liver is possible.
Symptoms
The most common symptom of bladder cancer is blood in the urine (haematuria). This may come and go and is often painless. Sometimes blood clots may form and cause pain or obstruction to the flow of urine.
Other symptoms include:
- a burning feeling when passing urine
- a need to pass urine frequently
- pain in the pelvis
If you notice blood in your urine, you should visit your GP. Although it is not usually a sign of bladder cancer, if you experience these symptoms, you should seek medical advice.
Causes
The causes of bladder cancer aren't fully understood at present. But there are certain factors that make bladder cancer more likely, including those listed below.
- Smoking - cancer-causing chemicals in tobacco smoke are absorbed into the blood, filtered out by the kidneys and then, as part of the urine, stored in the bladder. In the long term, this appears to cause damage to the bladder lining. Smokers are two to three times more likely to develop bladder cancer than non-smokers. Stopping smoking can reduce the risk of getting bladder cancer and if you have been diagnosed with superficial bladder cancer, stopping smoking will reduce the risk of developing more tumours in the future.
- Environmental factors including certain chemicals once used in the rubber, paint, dye, printing and textile industries can also increase the risk of developing bladder cancer.
- In the developing world a chronic infection with the tropical disease bilharzia increases the risk of bladder cancer.
- There is currently limited evidence that diet plays a part in the development of bladder cancer, but a diet high in fruit and vegetables and low in fat may help reduce the risk.
Diagnosis
Your doctor will ask you about your symptoms and will examine you. He or she may test your urine with a "dipstick" to look for blood and infection. Your doctor may refer you to a specialist (urologist) for further tests including the following.
- A flexible cystoscopy allows the urologist to see the inside of your bladder and detect abnormalities. If the urologist sees anything unusual in the bladder, you may be asked to return for a further cystoscopy, probably using a rigid cystoscope. This allows for special surgical instruments to also be passed into the bladder so that tissue samples (biopsies) can be taken and, if necessary, abnormalities removed. Samples taken are examined in a laboratory to see whether cancer cells are present and, if so, what kind of cells they are. A general anaesthetic is used for rigid cystoscopy.
- An intravenous pyelogram (or urogram) examines the urinary system by using a dye that is injected into a vein. This dye is removed from the bloodstream (excreted) by the kidney as part of urine production. By taking X-ray pictures while the kidneys are excreting the dye, the urologist can see any abnormalities in the outline of your urinary system.
- CT (computerised axial tomography), MRI (magnetic resonance imaging) and bone scans can help your doctor see how far the cancer has spread (if at all). A bone scan involves injecting a small amount of radioactive liquid into your vein. This can show if the cancer has spread to the bone.
Treatment
The treatment for bladder cancer depends upon the type of cancer and whether it is superficial or invasive.
Superficial tumours
Most bladder cancers are superficial and can usually be removed using a probe that is passed into the bladder through a cystoscope. These tumours can occur individually or in greater numbers. Superficial tumours often come back so you will need to have cystoscopy checkups every few months.
Sometimes chemotherapy drugs are used to "wash out" the bladder after a lesion has been removed. These are passed into the bladder using a fine tube called a catheter. The treatment is usually given weekly for six to eight weeks.
Immunotherapy uses the body's immune system to fight cancer cells. The BCG vaccine (normally used to prevent tuberculosis) has been shown to be effective for treating some superficial bladder cancers. Other forms of immunotherapy include interferon alpha.
Invasive tumours
Surgery, radiotherapy and chemotherapy can be used alone, or in combination, to treat invasive bladder cancer. Surgery may be needed to remove the affected part of the bladder. This can often be done through a cystoscope. Major surgery to remove the whole bladder is sometimes required. A reconstruction of the bladder may be possible using other tissues (from parts of the bowel for example) or artificial materials.
Further information
Search for "bladder cancer" on healthinsite.gov.auSources
- UK bladder cancer statistics. Cancer Research.
www.cancerresearchuk.org
accessed 26 July 2006 - Bladder cancer. UK Department of Health. Prodigy.
www.prodigy.nhs.uk
accessed 27 July 2006 - Bladder cancer. Cancerbackup.
www.cancerbackup.org.uk
accessed 27 July 2006 - Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press, 2002:557
- Renal Disease. Population Screening For Bladder Cancer and Glomerulonephritis. A Review of the Evidence with Policy Recommendations. National Screening Committee. October 2002.
www.library.nhs.uk - Guidance on Cancer Services, Improving Outcomes in Urological Cancers - The Manual. National Institute of Clincial Excellence (NICE), September 2002.
www.nice.org.uk - Management of transitional cell carcinoma of the bladder. A national clinical guideline 85. Scottish Intercollegiate Guidelines Network (SIGN), December 2005.
www.sign.ac.uk - Bladder cancer including upper tract tumors and urothelial carcinoma of the prostate. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology. Version 1. 2006
- Laparoscopic cystectomy. Understanding NICE guidance - information for people considering the procedure, and for the public. December 2003.
www.nice.org.uk
The information on this factsheet is intended to be a guide only and is not intended to be nor should be relied on as a substitute for professional medical advice. It is also not intended to be for medical diagnosis or treatment. BUPA Australia makes no warranties or representations regarding the quality, accuracy or completeness of the information. BUPA Australia is not liable to readers of the information for any loss or damage suffered arising out of the use of or reliance on the information, except that which can be excluded by law.