Bladder Cancer

Bladder cancer is the result of cell changes in the inside wall of the urinary bladder.

About 10,000 people in the UK get this cancer and is far more common in men. It’s rare for anyone under the age of 50 to get it but it becomes more common as people get older.

Risk factors

  • Cigarette smoking. This is the biggest risk factor for bladder cancer. The longer a person smokes for and the more cigarettes they smoke, the greater the risk. Chemicals present in the cigarette when breathed in get into the bloodstream. When the blood is filtered by the kidneys, the chemicals find their way to the urinary bladder where they concentrate and due to prolonged retention of urine in the urinary bladder they cause cancer of the mucous lining by interfering with the cell’s DNA.
  • Exposure to chemicals at work such as aniline dyes and aromatic amines. These are chemicals previously used in dye factories, rubber, gasworks, plastics, paints and in other chemical industries. These chemicals were banned in the UK in 1967.
  • Infection
  • Repeated urinary infections and kidney or bladder stones (which can cause infections) have been linked with bladder cancer. People who are paralysed have more bladder infections and a higher risk of getting bladder cancer.
  • Schistosoma hematobium is a major cause of bladder cancer in people living in developing countries where the parasite is prevalent.


Types of bladder cancer

  • Transitional cell (urothelial) tumours - most common type
  • Adenocarcinoma
  • Squamous cell tumours


Symptoms

  • Painless or sometimes painful haematuria - This is the most common symptom. It is usually painless and be intermittent in occurrence.
  • Recurrent urinary tract infections – commonly present with burning sensation during urination, and also have to pass urine more often and urgently. These are symptoms of irritation of the urinary bladder and more likely to be infection than cancer.


Diagnostic tests

  • Cystoscopy with biopsy of the inner lining of the urinary bladder is diagnostic.


A fibre optic cable with a lens at the end is inserted up the urethra into the urinary bladder, under local or general anaesthesia to study the inner lining of the urinary bladder and to harvest tissue for biopsy.

  • Urinary test such as microscopy, culture and cytology to look for cancerous cells.
  • Ultrasound of the bladder and liver to look for cancerous growths or metastatic growths.
  • IVU or intravenous urogram. A dye is injected into a vein in your arm which then gets filtered by the kidneys and maps out the urinary system.
  • CT scan and lymphangiogram to look for involvement of pelvic lymph nodes.
  • Chest x ray to study the health of the lungs which can be affected when the cancer in the bladder can spread to the lungs.


Treatment

Depends on
  • Type of cancer
  • Stage of cancer
  • Grade of cancer


Several modalities of treatment are available

For early cancer and small growths
  • Cystoscopy with diathermy, whereby a fine tube is inserted into the urinary bladder and the tumour is burnt with mild electrical current which is otherwise known as transurethral resection of a bladder tumour.


Intravesical chemotherapy, which is administering anti cancer drugs such as mitomycin-c and epirubicin into the urinary bladder, is mostly done after transurethral resection of bladder tumour to prevent recurrence of the tumour.

In some early stages and grades of cancer BCG is also used as intravesical chemotherapy. BCG is a vaccine which is used to prevent tuberculosis (TB). The exact mechanism of action is not known, but seems to stimulate the body’s immune system and destroys cancer cells acting like an immunotherapy.

Surgical options

  • Partial cystectomy – where a part of the urinary bladder containing the tumour is surgically removed.
  • Cystectomy – where the entire urinary bladder and nearby lymph nodes are surgically removed.


Radiotherapy

  • Invasive bladder cancer – Radiotherapy is often given instead of an operation to remove the urinary bladder.
  • Advanced bladder cancer – Radiotherapy is used to shrink the cancerous growth in advanced cancer to relieve symptoms such as pain, urinary obstruction etc.


Chemotherapy

Anti cancer drugs are administered mostly intravenously (into the vein) to destroy cancer cells that has spread to other parts of the body. This is done so that they can circulate in the bloodstream and reach the cancer cells anywhere in the body.

In bladder cancer chemotherapy may be given:

  • Before surgery or radiotherapy to shrink the cancer and reduce the risk of it coming back (called neo-adjuvant chemotherapy).
  • At the same time as treatment with radiotherapy (chemoradiation) to make treatment more effective.
  • After surgery (adjuvant chemotherapy). This is usually given if there’s a high risk of the cancer coming back. This is being researched in clinical trials because we still don’t know how effective it is.
  • As a treatment on its own for advanced bladder cancer.


The drugs most commonly used to treat bladder cancer are cisplatin, carboplatin, methotrexate, vinblastine, gemcitabine and doxorubicin.

A combination of the drugs methotrexate, vinblastine, doxorubicin and cisplatin (called MVAC for short) is often used to treat bladder cancer.

Please consult the online doctor for bespoke, evidence based and confidential medical advice.