Bladder Cancer

Diagram illustrating the different stages of bladder cancer.

What is bladder cancer?

The urinary bladder is the organ that collects and stores urine produced by the kidneys (Fig1). Bladder cancer is the growth of abnormal tissue (tumour) in the bladder.

What causes bladder cancer?

Several factors can increase the risk of developing bladder cancer such as smoking, occupational exposure to certain chemicals and certain drugs and infections. However, sometimes bladder cancer develops without any known cause. 

What are the signs and symptoms of bladder cancer?

Blood in the urine is the most common symptom of bladder cancer. Sometimes irritative urinary tract symptoms such as needing to urinate more often, painful urination may be due to bladder cancer if an infection has been ruled out. Symptoms like pelvic pain, pain in the flank, weight loss, or the feeling of a mass in the lower abdomen may be present in some cases when tumours are more advanced.

How is bladder cancer diagnosed?

Your doctor will take a detailed medical history and ask questions about your symptoms. They may perform a physical examination including a digital rectal (men) / vaginal (women) examination. Furthers tests required may include urine and blood tests and imaging scans such as CT or ultrasound scans. In almost all cases, cystoscopy is the main test used to diagnose bladder cancer. It allows your doctor to look at the inside of your bladder and urethra using a thin, lighted tube called a cystoscope.  

What are the stages of the disease?

The stages of bladder cancer are shown in Figure 1. A tumour that is present only in the inner lining of the bladder without growing into the muscle tissue of the bladder is called non–muscle invasive. This is the most common type of bladder cancer. In most cases, these tumours are not aggressive and rarely spread to other organs, so they are not usually lethal, they can however appear again (=recurrence) or develop aggressive features (=progression).

As the cancer grows into the muscle of the bladder (muscle-invasive) and spreads into the surrounding fat, it becomes it has a higher chance of spreading to other parts of the body (metastatic disease) and is harder to treat.

What is the treatment of bladder cancer? 

Transurethral resection of bladder tumour (TURBT) is the surgical removal (resection) of bladder tumours via a cystoscope. This tissue is sent for examination under a microscope (histological assessment). This determines further treatment based on the grade of aggressiveness and stage of the cancer. In some cases, a second TURBT is required after several weeks.  

If histology shows a superficial or non-muscle invasive cancer further surveillance with cystoscopy and scans will be required. Some patients may require instillation of chemotherapy into their bladder to reduce the chance of the cancer recurring especially if the cancer is high grade. If the cancers do not respond to chemotherapy surgical removal of the bladder may be necessary.  

If histology shows a muscle invasive cancer, it has a higher chance of spreading to other parts of the body and needs a different and more radical form of treatment. Muscle-invasive bladder cancer will be fatal if untreated. Staging scans will be performed to check if the cancer has spread (metastatic) to other parts of the body. Localised muscle invasive cancer is usually treated with surgical removal of the bladder (radical cystectomy) and formation of a urine stoma (ileal conduit) or new bladder made of bowel (neobladder) to collect urine. In patients who are not fit for such surgery or who do not wish for surgery, a combination of radiation and chemotherapy may be used to control the cancer.  Such cancers are treated as a part of a multidisciplinary team of doctors specialising in cancer treatment.