Bladder cancer

What is bladder cancer?

Bladder cancer (also known as transitional cell bladder cancer) is the seventh most common cancer in the UK. In most cases, it's caused by changes to the cells inside the bladder lining, and there are two main types:

• Superficial tumours: These tumours can appear as little growths that develop in the bladder's inner lining or just below the inside lining. They are the most common type of bladder cancer.

• Muscle-invasive tumours: These tumours spread through the muscle layer or wall of the bladder to other parts of the body.

Bladder cancer symptoms

Common bladder cancer symptoms are:

• Blood in your pee (haematuria)

• Dark coloured pee

• Need to pee frequently and urgently

• Pain or a burning sensation when you pee

• Pain in the lower tummy (abdomen)
  If bladder cancer spreads and reaches an advanced stage, you may experience:

• Pain in your pelvis

• Pain in your bones

• Weight loss

• Leg swelling

What causes bladder cancer?

One abnormal cell can cause a cancerous tumour to form in the bladder. This can be because of damage to certain genes in the cell due to being exposed to harmful substances such as tobacco smoke over many years. However, the exact reason why this happens is still unknown.

If you have worked in manufacturing industries involving textiles, dyes, paints, plastics, rubbers and leather tanning, there are certain chemicals which are known to increase your risk of bladder cancer. These include:

• o-toluidine

• benzidine

• aniline dyes

• 4-Aminobiphenyl

• 2-Naphthylamine

• xenylamine

Reducing your risk of bladder cancer

There are some lifestyle factors that may increase your risk of bladder cancer:

• Age: Especially if you are aged over 50.

• Smoking: Some of the chemicals from tobacco are passed through urine, which can damage your bladder cells over time.

• Gender: If you are a man, you are about three times more likely to get bladder cancer than a woman.

• Ethnicity: White people are more likely to develop bladder cancer than black people.

• Repeated bladder infections.

• Going through menopause before the age of 45.

• Recurring bladder stones.

• Paralysis of the nerves in the bladder resulting from having a tube called a catheter inserted on a long-term basis.

• Having type-2 diabetes.

• A rare infection called schistosomiasis, which is caused by a freshwater parasite.

Diagnosis of bladder cancer

If you think you're having bladder cancer symptoms, you should go and see a GP straight away. Some tests they might recommend:

• Urine microscopy - A sample of your pee is checked for blood cells or infections under a microscope.

• A special urine test like a UroVysion test, ImmunoCyt test and NMP-22 test to check for any chemicals, proteins and chromosomal changes in your pee that could be caused by cancerous cells.

• A cystoscopy - Involves a thin, flexible tube with a camera at one end being passed into your urethra (the tube that carries pee out of your body) and bladder to check for any cancerous cells. The doctor may also take a small sample from your bladder to test it (this is called a biopsy), or even remove a superficial tumour if one is found.

• An ultrasound or CT scan.

If your tests find a superficial tumour in your bladder, the doctor may say that no further tests are needed as the risk of them spreading to other parts of the body is low.

However, if your tests find a muscle-invasive tumour, the doctor may recommend further tests to see whether the cancer has spread.

What is the best treatment for bladder cancer?

If you are diagnosed with bladder cancer, a multidisciplinary team will work together to provide your care. Specialist doctors involved in your treatment may include:

• Pathologist - Specialises in diseased tissue

• Urologist - A surgeon who focuses on urinary tract conditions

• A clinical oncologist: a chemotherapy and radiotherapy specialist

• A radiologist: specialises in using imaging techniques to detect disease

The treatment you have will depend on the type of bladder cancer that you have.
Treatment options may include:

• Tumour removal using a cytoscope that is passed into your bladder.

• A course of chemotherapy, which involves a special medicine to kill cancer cells, being passed into your bladder by a catheter.

• Cystectomy surgery to remove your bladder.

• Radiotherapy, where high-energy beams of radiation are targeted at your bladder cancer tumours to kill the cancerous cells.

What is the outlook with bladder cancer?

If you are diagnosed with bladder cancer, your outlook depends on the type of tumour that you have:

• Superficial tumours: Treatment provides a good chance of a cure, and routine checks will help your doctor to detect whether any tumours have returned and decide whether repeat treatment is needed.

• Muscle-invasive tumours: The earlier your tumour is found, the better the chance of a cure.

If your bladder cancer is at an advanced stage, the doctor will refer you to a palliative care team, who will be able to discuss your options for pain relief and provide practical help and support to you and your family.

Complications of bladder cancer

If your bladder cancer is very advanced and can't be cured, or you have had all of part of your bladder removed, your doctor will be able to recommend the treatments which will best ease your symptoms.
These include:

• Psychological impact – Being diagnosed with cancer can be frightening and it can make you feel stressed or depressed. Speaking to the doctor or counsellor may help. You may benefit from prescribed antidepressant medication if you are suffering from depression.

• Urinary diversion – If your bladder needs to be removed, surgery can create an alternative way for you to pee. For example, this can be through a special opening in your abdomen known as a stoma and either having a special waterproof pouch placed on top or inside your body to collect your pee.

• Urostomy - Recreating your bladder by taking a section of your colon and turning it into a balloon-like sac that collects your pee.

• Continent urinary diversion – Similar to a urostomy, however, a section of your colon will be used to create an internal pouch that collects your pee.

• Erectile dysfunction – Following a cystectomy, you may find that you are unable to obtain or maintain an erection. In this case, you may be prescribed a medicine called phosphodiesterase type 5 inhibitors (PDE5) which increase the blood supply to your penis.

• Narrowing of the vagina – If you have had radiotherapy or a cystectomy, you may find that your vagina becomes shorter and narrower, which can make sex painful and difficult. In this case, you may be prescribed hormone cream to increase moisture inside your vagina or a plastic cone-shaped device called a vaginal dilator which can gently stretch your vagina and make penetration easier.