Bladder cancer is when abnormal cells in the bladder grow and divide in an uncontrolled way.
There are different types:
- urothelial carcinoma, formally known as transitional cell carcinoma, is the most common form of bladder cancer (90%) and starts in the urothelial cells in the bladder wall’s innermost layer
- squamous cell carcinoma begins in the thin, flat cells that line the bladder
- adenocarcinoma is a rare form which starts in mucus-producing cells in the bladder.
Bladder cancer symptoms
The most common symptom of bladder cancer is blood in the urine (haematuria), which usually occurs suddenly and is generally not painful.
Other less common symptoms include:
- problems emptying the bladder
- a burning feeling when passing urine
- need to pass urine often
- lower abdominal or back pain.
Causes of bladder cancer
The exact causes of bladder cancer are not known, however factors that put some people at higher risk are:
- workplace exposure to certain chemicals used in dyeing in the textile, petrochemical and rubber industries
- use of the chemotherapy drug cyclophosphamide
- family history
- chronic inflammation of the bladder.
Screening for bladder cancer
There is currently no screening for bladder cancer available.
Diagnosis for bladder cancer
A number of tests are used to diagnose bladder cancer including:
Blood tests can check you general health.
Urine tests check for blood, bacteria and any cancer or pre-cancer cells.
CT scans produce three-dimensional pictures of several organs at the same including the bladder which can help in the detection of any tumours.
Ultrasound scans produce pictures of the organ, and can show the presence and size of cancer. Small tumours may be difficult to detect by ultrasound.
Cystoscopy and biopsy
A cystoscopy is the main procedure used to diagnose bladder cancer by examining the inside of the bladder. If abnormal tissues are detected, a tissue sample (biopsy) will then be taken.
Treatment for bladder cancer
A CT scan, bone (radioisotope) scan and chest x-ray are done to determine the extent of the cancer (its stage).
The most common staging system used for bladder cancer is the TNM system, which describes the stage of the cancer from stage I to stage IV.
Types of treatment
Superficial bladder cancers are treated with surgery and/or immunotherapy, or sometimes chemotherapy instilled into the bladder.
Surgery (transurethral resection) is done using a cystoscope which has a wire loop which the doctor uses to remove any tumours. Other ways to kill the cancer cells can include burning the base of the tumour or high-energy laser to damage or kill the cells
Non-invasive bladder cancers an also be treated with immunotherapy. A vaccine called Bacillus Calmetter-Guérin, developed to prevent tuberculosis, can be used to stimulate the immune system in order to stop or delay bladder cancer.
Chemotherapy drugs are used to destroy or damage cancer cells. For non-invasive bladder cancers, chemotherapy drugs are instilled into the bladder (intravesical chemotherapy).
Invasive bladder cancers are most commonly treated with surgery, although radiotherapy is an alternative treatment. In some cases chemotherapy may be added.
If surgery is not an option, the cancer may be treated with radiotherapy, with or without chemotherapy, or chemotherapy alone (platinum and gemcitabine).
Depending on your treatment, your treatment team may consist of a number of different specialist staff, such as:
- urologist, who specialises in surgery of the urinary system
- radiation oncologist, who prescribes and coordinates radiotherapy treatment
- medical oncologist, who prescribes and coordinates the chemotherapy
- cancer care coordinators and nurses
- other allied health professionals such as a dietician, social worker and counsellor.
Prognosis for bladder cancer
It is not possible for a doctor to predict the exact course of a disease as it will depend on the person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of your disease, based on the type of cancer you have, your test results, the rate of tumour growth, as well as your age, fitness and medical history.
Bladder cancer can be effectively treated if it is found early, before it spreads outside the bladder.
Preventing bladder cancer
While it is not possible to prevent bladder cancer, it is possible to reduce your risks such as not smoking or quitting smoking, and avoiding exposure to chemicals listed above.