Bladder Cancer

Introduction

National Statistics UK data for 2005 reveal that the commonest cancers are breast, prostate, lung, colorectal and bladder. Each year more than 10,000 people are diagnosed with bladder cancer, and it is the most frequently occurring tumour of the urinary system.

The good news, according to charity Cancer Research UK data for 2002, is that the incidence of bladder cancer in the UK is falling for both men and women. The disease is often discovered early, when survival rates are excellent - the five-year survival rate for patients with superficial tumours is between 80-90 per cent. Patients with muscle-invasive bladder cancer have five-year survival rates of less than 50 per cent.

What is bladder cancer?

Cancer of the bladder occurs when a tumour grows in the lining of the bladder wall.  A tumour develops when cells divide abnormally and bunch together to form a lump, which, if malignant (cancerous) can spread to other parts of the body.

Bladder cancersare split into different types:

• Transitional cell canceris the most common.  About nine out of 10 bladder cancers in the UK are this type.  It develops in cells that form the lining of the bladder wall
• Squamous cell cancersstart from one of the types of cell in the bladder lining.  Only about two per cent of bladder cancers in the UK are squamous cell cancers
• Adenocarcinomais a cancer of the cells in the lining of the bladder that produce mucus.  It is a very rare type of bladder cancer at only one to two per cent of cases

Bladder canceris also grouped according to how far it has spread:

• Asuperficialbladder cancer only affects the inner lining of the bladder
• Aninvasivebladder cancer has spread into the muscle wall of the bladder

What does the bladder do?

The bladder is like a muscular balloon which collects and stores urine. The bladder stretches as the amount of urine increases and, when full, empties out of the body through a tube called the urethra.

The wall of the bladder is made up of three main layers:

• An inside mucous membrane (mucosa)
• A middle layer of muscle (detrusor muscle)
• An outer layer covered by the peritoneum (a membrane that forms the lining of the abdominal cavity)

Who's at risk?

• Bladder cancer is more common in men than in women. It is the fourth commonest cancer for men and the tenth commonest cancer for women (not counting non-melanoma skin cancer)
• Smoking cigarettes is the main known cause of bladder cancer in the UK.  Specific chemicals that cause it have been found in cigarette smoke.  US researchers estimate that nearly half of all bladder cancer in men, and almost a third in women, are the result of smoking
• As the disease usually takes a long time to develop, it is most common in older people.Over 70 per cent of people with bladder cancer are older than 65 years
• You are more susceptible to bladder cancer, if you are of white European ethnic origin. Significantly lower levels of this cancer are found in people of African or Asian origin
• Certain industrial chemicals may affect your chance of developing the disease. You may be more at risk if, in the past, you worked in an industry, such as rubber, leather making or security printing
• If you have had many bladder infections in the past, or suffer from chronic bladder infection, you may be more at risk also
• In countries such as Iraq and Egypt, a parasite called a schistosome can cause schistosmiasis, a disease which can increase the risk of squamous cell cancer

What are the symptoms?

The commonest symptom of bladder cancer is blood in the urine (haematuria).  You may be able to see the blood, or it might be in such minute amounts that it can only be picked up by a urine test.

If you see blood in your urine, even if it's only off and on, you should consult your GP. Other symptoms can include needing to urinate frequently or urgently, and pain or a burning feeling when urinating.

Most of these symptoms can also be the signs of other medical conditions, such as an infection or a bladder or kidney stone.  However, it is important to seek the advice of your GP.

Diagnosis:your GP will give you an examination and you will be asked for a urine sample which will be sent for laboratory testing.

Your doctor may also suggest that you have these further tests:

• Cystoscopyis used to examine the inside of the bladder and other parts of the urinary system.  Under a general anesthetic or local anaesthetic, a cystoscope (thin flexible tube with lenses similar to a telescope) is passed up the urethra and into the bladder to examine the lining.  Biopsies (small tissue samples) can be taken through the cystoscope
• Intravenous urogram /pyelogram (IVU / IVP)can show if cancer has spread to other organs.  A special dye is injected into a vein in your arm or hand.  As it travels from the kidneys to the bladder, it outlines the urinary system, showing up any abnormalities
• Other tests- an abdominal ultrasound, a CT scan or an MRI scan.  These tests may be used to assess the size of the cancer and if it has spread

What treatment will I have?

There are a number of different ways of treating bladder cancer depending on how advanced the cancer is and whether it has spread; your age, general health and fitness will also be taken into account, as well as your own personal wishes as to which course of action to take.

Treatments for superficial bladder cancer:

• Surgery: most cancers which only affect the lining of the bladder can be removed by surgery, using a cystoscope.  This operation (called a transurethral resection of bladder tumour or TURBT) is done under a general anaesthetic.  If necessary, several tumours can be treated at the same time.  The operation usually takes up to an hour and you will need to stay in hospital for two to three days. After this you will have regular cystoscopy checks to ensure that the bladder cancer hasn't returned
• Intravesical chemotherapy: anti-cancer drugs are put directly into the bladder through a catheter. This puts the drugs into direct contact with the cancer cells in the lining of the bladder and causes fewer side effects
• Intravesical BCG: BCG is the vaccine used to prevent tuberculosis (TB) and it can be an effective treatment in preventing some tumours from growing back

Treatments for invasive bladder cancer:

• Surgery:if the tumour has spread into the muscle of the bladder wall, an operation to remove part, or all of, the bladder may be necessary. In women, the surgeon may also want to remove the uterus (womb) and ovaries at the same time. In men, the prostate gland is normally removed as well. If the bladder has been removed, you will need a new way of collecting urine
• Radiotherapy:Radiation therapy uses high energy X-rays to kill cancer cells.  The main side effects of radiotherapy are urinary and bowel problems (cystitis or diarrhoea) and patients can suffer from lower abdominal pain or discomfort. Radiotherapy can also affect sexual arousal and feelings
• Chemotherapy:Chemotherapy may be given to shrink the tumour before surgery or radiotherapy takes place. It is also sometimes given after surgery - to reduce the risk of the tumour returning

When your doctor discusses surgery with you, the different available options should also be discussed. For more information, talk to your specialist nurse or visit Cancerbackup.

Life after treatment

If you have been treated for superficial bladder cancer, life should return to normal quite quickly. You will, however, need to have regular cystoscopy examinations to check that the cancer has not returned.

If you have had your bladder removed after invasive bladder cancer, it can take up to three months to fully recover. You will also need to adjust to the method in which your urine is removed from your body - which may take time.

Recovering from radiotherapy can take some time and you will need regular follow-up cystoscopy examinations for up to four to seven weeks after treatment.

Clickthrough information and support links:

Association for International Cancer Research
Cancer Research UK
Cancer Help UK
CancerBACUP
Macmillan Cancer Support