Bladder Cancer

What is bladder cancer?

Bladder cancer (sometimes referred to as urothelial cancer), is a disease of the urinary tract. The bladder is a hollow organ in the lower abdomen whose main job is to store urine. It has flexible, muscular walls that can stretch to hold urine and squeeze to send it out of the body. Bladder cancer occurs when there is a growth of abnormal tissue, known as a tumour, which develops in the bladder lining. In some cases, the tumour spreads into the bladder muscle and requires more aggressive treatment.

Bladder cancer is more common in men and in those who are over the age of 60 (the median age at diagnosis is 69 years). Other risk factors include smoking, exposure to certain chemicals at work, chronic bladder problems or repeated urinary tract infections, family history of bladder cancer and genetic conditions (e.g Lynch Syndrome). 

There are different types of bladder cancer that start from different types of cells in the bladder lining. 

The most common (about 90% of bladder cancer cases) is transitional cell carcinoma, which starts in the urothelial cells in the bladder lining. Other types of bladder cancer include squamous cell carcinoma, adenocarcinoma and small cell bladder cancer.

What are the stages of bladder cancer?

• Non muscle-invasive (Stage 0-I): These tumours are usually less aggressive and can often be treated successfully with minimal intervention. 
  
• Muscle-Invasive (Stages II-III): These cancers can invade the bladder wall and surrounding tissues, making them more aggressive and potentially leading to metastasis (spreading to other organs). 
• Metastatic (Stage IV): At this stage, bladder cancer has spread beyond the bladder to distant organs. This form is highly aggressive and more challenging to treat.
  

What are the symptoms of bladder cancer?

The most common symptom of bladder cancer is blood in the urine. Other common symptoms are painful urination and pelvic pain. 

When should you see a doctor for bladder cancer?

Signs and symptoms of bladder cancer are often mistaken for symptoms of a urinary tract infection or kidney stones. However, if you notice blood in your urine, or any of the other symptoms listed, even if they come and go, please go to the doctor so that the cause can be investigated.

How can bladder cancer be prevented?

There is no guaranteed way to prevent bladder cancer, however you can reduce your risk by:

• Not smoking
• Eating a diet rich in fruits and vegetables
• Taking regular exercise
• Following safety instructions to avoid exposure if you work with chemicals
  

How is bladder cancer diagnosed?

Tests and procedures used to diagnose bladder cancer may include: 

• Blood and urine tests: to help diagnose the bladder cancer or identify other conditions that may be causing the symptoms such as an enlarged prostate, urinary tract infection or kidney stones. 
• Cystoscopy: This is the most common and reliable test for bladder cancer. During a cystoscopy, a thin tube with a camera on the end is inserted through the urethra to allow the doctor to examine the urethra and bladder for signs of disease. 
• Biopsy: During the cystoscopy, the doctor may pass a special tool through the scope and into your bladder to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection. The cells are sent to the pathologist who will examine them under the microscope so that a diagnosis can be made. 
  
• Urine cytology: A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology. 
• Imaging tests: The most common imaging test for bladder cancer is computerized tomography (CT) urogram. During a CT urogram, a contrast dye is injected into a vein in your hand and eventually flows into your kidneys, ureters and bladder. The contrast dye provides a detailed view to help identify any areas where there might be cancer. 
  

How is bladder cancer treated?

The type of treatment recommended for bladder cancer depends on the grade and stage of the cancer. Treatment generally involves surgery to remove the cancerous tissue (transurethral resection). Removal of the bladder may be necessary if the cancer is more advanced. In cases where the bladder is removed, reconstruction is needed to create a new way for urine to exit the body. 

Chemotherapy or radiation therapy may be recommended. Chemotherapy involves administering a drug or combination of drugs to kill the cancer cells or control their growth. Radiation therapy uses powerful, focused beams of energy to kill cancer cells. A combination of treatments, e.g. surgery + chemotherapy or surgery + radiation therapy or a combination of all three may be recommended to treat bladder cancer. In some cases, immunotherapy may be recommended to trigger the body’s immune system to fight the cancer cells. 

Bladder cancer surgery

Non-muscle invasive bladder cancer is usually treated by: 

• Transurethral resection of bladder tumour (TURBT). Under anaesthesia, the surgeon uses an instrument called a resectoscope inserted through the penis to remove the tumour tissue one piece at a time, using a special wire loop. The pieces of tissue are flushed out at the end of the operation. 
• Intravesical therapy. After surgical resection, chemotherapy agents such as mitomycin or immunotherapy such as BCG (Bacille Calmette Guerin) therapy may be given through a catheter into the bladder to reduce the risk of recurrence and disease progression. Immunotherapy uses substances made by the body or in a laboratory to boost, direct, or restore the body’s natural defenses against cancer. 

Muscle-invasive bladder cancer which has a high chance of spreading to other parts of the body is usually aggressively treated by: 

• Surgery which involves removal of the entire bladder (radical cystectomy). Under general anaesthesia, the surgeon removes the entire urinary bladder and the surrounding lymph nodes in the pelvis. The prostate is removed in males. And in females, the uterus, ovaries, fallopian tubes and part of the vagina is removed. When the entire bladder is removed, the ureters are disconnected from the bladder and joined to a loop of small intestines specially fashioned to contain urine. Depending on the patient’s pre-operative medical condition and stage of disease, the loop of small intestine may be connected directly to the abdominal wall for urine to flow out through a urinary stoma (ileal conduit) or fashioned into a sphere (ileal neobladder) and reattached to the urethra so that urine passes out through the normal passage. Some patients may need to catheterise their urine passage regularly every day to empty the bladder, as the neobladder does not have the sensory and contractile properties of the native bladder. 
• Radiation therapy is used to treat the cancer by using high-energy x-rays to kill cancer cells or keep them from growing. 

Sometimes a combination of treatment with chemotherapy with surgery or radiation is needed to improve the chances of cure in patients with advanced bladder cancer. 

Q1: Is bladder cancer usually curable? 

Bladder cancer can often be treated successfully, especially when detected early. The likelihood of a cure depends on several factors, including: 

1. Stage of the Cancer: Early-stage bladder cancers (such as superficial or non-invasive types) are more likely to be curable. Advanced stages, where the cancer has invaded deeper layers or spread to other organs, can be more challenging to treat. 
2. Type of Bladder Cancer: The most common type is transitional cell carcinoma, which can vary in aggressiveness. Other less common types may have different prognoses. 
3. Treatment Options which may include: 
• Surgery: Removing the tumour (transurethral resection) or the entire bladder (cystectomy). 
• Chemotherapy: Can be used before surgery (neoadjuvant) or after (adjuvant) to kill remaining cancer cells. 
• Immunotherapy: Helps the immune system fight the cancer. 
• Radiation Therapy: Sometimes used, especially if surgery is not an option for the patient 
4. The patient’s overall health, age, and response to treatment also play significant roles in the likelihood of successful treatment. 

Q2: What is the expected life expectancy for someone diagnosed with bladder cancer? 

The life expectancy for someone diagnosed with bladder cancer varies based on several factors, including the stage of cancer at diagnosis, the specific type of bladder cancer, the patient's overall health, and how well the cancer responds to treatment. 

General statistics indicated that for early-stage bladder cancer (localised or non-invasive), the 5-year survival rate can be around 70% to 90%. Many people with early stage bladder cancer can be effectively treated and remain cancer-free. 

For more advanced stages of bladder cancer (muscle-invasive or metastatic), the 5-year survival rate drops significantly to about 30% to 60%, depending on how far the cancer has spread. 

Q3: What are the first signs and symptoms of bladder cancer? 

The most common symptom of bladder cancer is blood in the urine, painful urination and pelvic pain. The symptoms of bladder cancer are often mistaken for those of a urinary tract infection or kidney stones, therefore individuals experiencing these symptoms should seek medical attention so that the doctor can investigate the cause of the symptoms. 

Q4: How aggressive is bladder cancer? 

Bladder cancer can vary in aggressiveness, influenced by several factors, including the stage of the cancer at diagnosis, the specific type of bladder cancer, the patient’s overall health, and how well the cancer responds to treatment.