bladder cancer

About bladder cancer

Your bladder is a hollow, muscular, balloon-like organ that collects and stores urine. Urine is produced by your kidneys and consists of water and waste products. Tubes carry urine from your kidneys to your bladder (through your ureters) and then to the outside (through your urethra).

Your bladder is lined with a membrane (urothelium) that stops urine being absorbed back into your body. The cells of this membrane are called transitional cells or urothelial cells.

In the UK, bladder cancer is the fourth most common cancer in men and the eleventh most common cancer in women. Around 10,000 people in the UK are diagnosed with bladder cancer each year. It's rare in people under 40, but the rate rises with age.

Types of bladder cancer

There are several different types of bladder cancer. They are named after the type of cells they first occur in:

·         transitional cell carcinoma (TCC)

·          

squamous cell carcinoma (SCC)

·         adenocarcinoma

TCC is the most common type of bladder cancer in the UK.

Some bladder cancers form small mushroom-like growths on the lining of the bladder. These are called papillary cancers.

Bladder cancer is also classified according to how far it has spread.

·         Non-muscle invasive cancer - the cancer is only in the bladder lining.

·         Muscle-invasive cancer - the cancer has spread to the muscle wall of the bladder.

·         Advanced cancer - the cancer has spread through the bladder wall into nearby organs such as the prostate gland, vagina, bowel, or lymph nodes. Further spread to other organs such as bones and liver is possible.

Around eight out of 10 of bladder cancers are non-muscle invasive.

Symptoms of bladder cancer

Blood in your urine (haematuria) is the most common symptom of bladder cancer. This may come and go and is often painless.

The following symptoms aren't always due to bladder cancer but if you have any of these or notice blood in your urine, you should visit your GP: 

    

• ·            a burning feeling when passing urine
• ·         a need to pass urine frequently
• ·         feeling the need to urinate but not being able to
• ·         pain in your pelvis
• ·         recurrent urinary tract infections
• ·         blood clots in your urine; these may cause pain

Causes of bladder cancer

The causes of bladder cancer aren't fully understood at present. However, you're more likely to develop bladder cancer if you:

·         smoke - you're three to four times more likely to develop bladder cancer and passive smoking may also increase your risk

·         have been exposed to certain industrial chemicals (eg in the rubber, paint, dye, printing and textile industries, gas and tar manufacturing, iron and aluminium processing)

·         have had a long-term infection with the tropical disease bilharzia

·         have had a long-term or repeated bladder infection

Diagnosis of bladder cancer

Your GP will ask you about your symptoms and examine you, and may also ask you about your medical history. He or she may test your urine with a 'dipstick' to look for blood and signs of an infection. Your GP may refer you to a urologist (a surgeon who specialises in identifying and treating conditions of the urinary system) for further tests, such as those listed below.

Flexible cystoscopy

This is done under local anaesthetic. It allows your surgeon to look inside your bladder using a flexible, tube-like telescope with a camera at the end, called a cystoscope. This is inserted into your urethra. If your surgeon sees anything unusual in your bladder, he or she may ask you to return for a repeat flexible or rigid cystoscopy.

Rigid cystoscopy

This is done under general anaesthetic. It allows your surgeon to pass surgical instruments into your bladder and take tissue samples (biopsies) and, if necessary, remove growths. Tissue samples are examined in a laboratory to see whether cancer cells are present and, if so, what kind of cells they are.

Intravenous urogram (IVU)

This test examines your urinary system by injecting a dye into a vein in your arm - this is gradually removed from your blood by your kidneys. By watching the movement of the dye on an X-ray screen, your surgeon can see anything unusual in your urinary system.

Scans

Ultrasound, CT (computed tomography), and MRI (magnetic resonance imaging) can help your surgeon see how far the cancer has spread (if at all).

Treatment of bladder cancer

Treatment of bladder cancer depends upon the type of cancer and how far it has spread.

Treatment of non-muscle invasive bladder cancer

Transurethral resection of a bladder tumour (TURBT)

Your surgeon will use a cystoscope and "snip off" the tumour at the stem and seal the area to prevent bleeding. The procedure takes 20 minutes to one hour and is done under general anaesthetic. Non-muscle invasive tumours often come back so you will need to have regular check-ups. See Related topics for more information.

Intravesical chemotherapy and immunotherapy

Chemotherapy uses medicines to destroy cancer cells. In intravesical chemotherapy, medicines are placed directly into your bladder using a fine tube (catheter) inserted into your urethra. This is done immediately after your surgeon has removed a tumour using TURBT. Your surgeon may repeat the intravesical chemotherapy at weekly intervals, usually for six weeks. See Related topics for more information.

Immunotherapy uses your body's immune system to fight cancer cells. The Bacille Calmette-Guérin (BCG) vaccine (used to prevent tuberculosis or TB) has been shown to be effective for treating some non-muscle invasive bladder cancers. It's put directly into your bladder (intravesical BCG) using a catheter. Treatment is given at weekly intervals, usually for six weeks. See Related topics for more information.

Treatment of muscle-invasive bladder cancer

Major surgery to remove the whole bladder and surrounding tissues is usually required (complete or radical cystectomy). Your surgeon will create a new way for you to store your urine and there are various types of operation to do this.

Urostomy

Your surgeon connects your ureters to a small opening (a stoma) in your abdomen (tummy) using a short piece of your small bowel. A flat, watertight bag is placed over the stoma to collect your urine.

Continent urinary diversion

Your surgeon makes a pouch inside your abdomen to collect urine using a section of your stomach or intestine. He or she will connect this to the outside of your body via a stoma which is kept closed with a valve. You will need to empty the pouch four to five times a day by inserting a catheter into the stoma.

Bladder reconstruction

Your surgeon may be able to make a new bladder using part of your bowel. Your urine drains from your ureters into the new bladder. You will need to learn how to pass urine through your urethra by using your muscles. You will have lost the nerves that tell you when your bladder is full and so will need to remember to empty it.

Radiotherapy and chemotherapy

Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. Radiotherapy may be used instead of surgery.

Intravenous chemotherapy (into your vein) may be given if the cancer has spread into the muscle of the bladder. It may be given to shrink the tumour before surgery or radiotherapy treatment, or to reduce the chances of the tumour coming back after surgery.

Treatment of advanced bladder cancer

If the cancer has spread outside your bladder, you may have chemotherapy or radiotherapy. TURBT may be performed if you're finding it hard or painful to pass urine.

Prevention of bladder cancer

Factors that make it less likely that you will get bladder cancer include not smoking and eating a diet high in fruit and vegetables and low in fat.

Living with bladder cancer

Many hospitals have stoma nurses who can help you take care of your urostomy and give you advice. Most people who have a urostomy are able to take up their previous jobs, sports activities and hobbies again. Modern stoma appliances are hardly noticeable under your clothes and shouldn't leak.

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need.

Further information

·         Macmillan Cancer Support
0808 800 1234
www.macmillan.org.uk

·         Cancer Research UK
0808 800 4040
www.cancerhelp.org.uk

·         Urostomy Association
01889 563191
www.uagbi.org

Special thanks to

http://hcd2.bupa.co.uk