Bladder Cancer

What is bladder cancer?

The urinary bladder has the role of holding and expelling urine. Most growths that occur in the urinary bladder are cancerous. They are usually growths of the lining cells called transitional cells or TCC. Another term is urothelial cancer. There are 2600 new cases of bladder cancer every year in Australia, and more than 1000 people die of bladder cancer every year.

What are the known risk factors for bladder cancer?

The main risk factors for bladder cancer are smoking and age. Industrial exposure to dye, rubber, plastics and textile manufacture have been associated with an increased risk of bladder cancers.

Are there any other types of bladder cancer?

Yes, bladder cancer is occasionally caused by chronic irritation to the bladder lining from recurrent infection or bladder stones, and these cancers are called squamous cell cancers. Adenocarcinoma is another type of bladder tumour.

What are the symptoms of bladder cancer?

The most likely symptom of bladder cancer is blood in the urine. This is also called haematuria. This symptom may be noticed by the patient when going to the toilet (macroscopic haematuria) or less commonly detected by a urine test performed by a GP using a test strip (microscopic haematuria). Microscopic haematuria, however, can commonly be associated with other diseases and is sometimes a normal and persistent finding in some people. If the bleeding is quite heavy and results in the passing of clots, this can lead to difficulty in passing urine, or the complete inability to pass urine. Other symptoms may include urinary frequency or urgency. When bladder cancer is very advanced it can lead to kidney failure, or symptoms related to spread to other organs.

How is bladder cancer diagnosed?

Initially your GP may look for signs of blood in your urine or malignant cells (called urine cytology) and organise an ultrasound. These tests may not be sufficient to exclude bladder cancer and referral to a urologist may be necessary to perform a cystoscopy, which is a telescopic examination of the bladder. A CT scan of the urinary tract with intravenous dye may also be necessary.

Are most bladder cancers fatal?

Many cancers that are low-grade do not result in death. High-grade cancers have the ability to invade the wall of the bladder and can spread to other organs. These cancers have a high mortality rate.

How are bladder cancers initially treated?

Bladder cancers initially undergo a special telescopic procedure called a transurethral resection of a bladder tumour (TURBT). As the name implies, it involves cutting away a bladder tumour to enable it to be sent off for pathological analysis. From this tissue the pathologist can determine the grade of the tumour and work out how far the tumour has invaded into the bladder.

What happens if the cancer is low-grade?

If the cancer is low-grade and superficial, then patients are usually placed on a surveillance program that involves regular cystoscopy. These cancers have the lowest risk of progression to more serious cancers and eventual death.

What happens if the cancer is high-grade?

If the cancer is high-grade, then patients invariably need other treatments that may include removal of the bladder, radiotherapy or BCG therapy. Some patients may also require chemotherapy.

What is carcinoma in situ (CIS)?

Carcinoma in situ is a special type of high-grade bladder cancer that is restricted to the lining of the bladder. If CIS is left untreated or even despite treatment, this cancer can start to invade the bladder wall. It is usually treated with BCG therapy within the bladder over a period of 6 weeks.

When is removal of the entire bladder necessary?

Removal of the bladder (cystectomy) may be necessary if the cancer has invaded the deeper layers of the bladder wall or if high-grade cancer (including CIS) does not respond to other treatment. This is a major operation and, apart from removing the bladder, involves reconstruction of the urinary tract into a conduit (ileal conduit) or a new bladder made from bowel (neobladder).

Is there an alternative to removal of the entire bladder?

In some older or unfit patients the bladder can be preserved with a combination of chemotherapy and radiotherapy.

What is the treatment if the bladder cancer has already spread (metastatic)?

Patients with metastatic bladder cancer may be suitable for chemotherapy or palliative therapy if the cancer is deemed too advanced.