The bladder is a hollow, muscular, balloon-like organ that collects and stores urine in the lower part of the abdomen.
- Our kidneys produce urine, which is carried to the bladder by thin tubes called ureters. The bladder stores the urine and when full enough, the brain is told to get rid of it (passing urine).
There are different types of bladder cancer:
- Transitional cell bladder cancer (TCC): the most common type, starting in the layer of cells (transitional cells) that form the lining of the bladder.
- Papillary cancers: small growth only on the inner lining of the bladder.
- Carcinoma in situ (CIS): Type of early bladder cancer that appears as a red, ulcerated area. In CIS the cells of the cancer can grow quickly. If it’s not treated effectively, there’s a high risk that CIS will become an invasive cancer.
What causes bladder cancer?
- Men get bladder cancer much more commonly than women.
- It’s rare for anyone under the age of 50 to get it.
- Cancer of the bladder is not infectious and can’t be passed on to other people.
There are a number of factors that increase your risk of getting bladder cancer:
- Cigarette smoking: This is the biggest risk factor for bladder cancer. Chemicals that cause bladder cancer are present in cigarette smoke. These chemicals get into the bloodstream and end up in the urine after being filtered by the kidneys. It takes many years for the chemicals to cause bladder cancer.
- Exposure to chemicals at work: These chemicals have been banned since the 1960’s.
- Infection: Repeated urinary infections and kidney or bladder stones have been linked with bladder cancer. People who are paralysed are at a higher risk of getting bladder cancer.
- Untreated infections: A parasite called schistosoma (also called bilharzia) is a major cause of bladder cancer in people living in developing countries.
What are the symptoms?
The most common symptoms of bladder cancer are:
- Blood in the urine (haematuria): The most common symptom. It usually happens suddenly and may come and go. It’s not usually painful. It should always be checked by a doctor.
- Bladder changes: Some people may have a burning feeling when they pass urine, or need to pass urine more often or urgently. These are all symptoms of bladder irritation and are more likely to be due to an infection rather than cancer. If these symptoms don’t get better with antibiotics, you should contact your Doctor.
If you have any of these symptoms you should have them checked by your doctor - but remember, they are common to many illnesses other than bladder cancer.
How is it diagnosed?
First stop is the local doctor. They will ask for a sample of urine. This will be tested in the surgery to find out if there is any blood in it.
The GP may then carry out an internal examination of the patients back passage (rectum) and (in women) the vagina. This is because the rectum and vagina are very close to the bladder, so further tests may be required.
These may include:
- Cystoscopy: This is where a doctor uses a thin, flexible fiber-optic tube with a light on the end (cystoscope) to look at the inside of the bladder.
- Biopsy: Using the cystoscopy technology, under general anaesthetic (patient is asleep), they take a sample from the inside of the bladder tissue.
- Blood test
If the results of the test show bladder cancer, a referral will be made to a doctor who specialises in the treatment of the bladder (called an urologist).
Bladder cancer is graded on risk, from low risk to moderate.
- Low grade or intermediate grade Ta cancer: several cancers in the bladder or one cancer which is larger than 3cm/1inch.
- Intermediate grade T1 cancers: cancer is smaller than 3cm/1inch and there is only one cancer in the bladder.
- Low or intermediate Ta cancers which have come back (recurred) in the bladder.
How is it treated?
A team of doctors and other staff at the hospital will plan the treatment. It will depend on the size of the tumour and where it is. Treatment may be coordinated by an oncologist (a doctor who specialises in treating cancer with chemotherapy) a urologist (a surgeon who specialises in renal issues) and a radiologist (a doctor who specialises in treating cancer with radiation).
Treatment may involve:
Most people have chemotherapy to shrink to size of the tumour and to get rid of any cancer cells around the body. This is usually followed with surgery to remove the tumour. More chemotherapy and radiotherapy usually follows.
Chemotherapy for Bladder Cancer
This treatment is often given to people with bladder cancer to shrink the tumour prior to surgery, leading to less invasive surgery. After surgery, chemotherapy may be given directly into the bladder to reduce the risk of the cancer coming back.
When chemotherapy is given directly into the bladder it is described as intra-vesicle.
Surgery for Bladder Cancer
- The aim of surgery is to remove the tumour. Early bladder cancers are usually small growths (papillary cancers) and there may be more than one.
- The cancer or cancers can be usually removed surgically, using a cystoscope.
Radiotherapy for Bladder Cancer
- A course of radiotherapy for bladder cancer may last 4–7 weeks. It’s usually given as an outpatient treatment (no need for pyjamas). If a patient is having radiotherapy to relieve symptoms they will usually only need a few short sessions.
Radiotherapy does not make people radioactive or glow, like in the movies, and it is completely safe for patients to be with other people, including children, throughout their treatment.
You may want to check out the fact sheets on the left hand side for more information on other cancers and related topics.