Bladder cancer develops in the lining of your bladder wall. It's caused by the uncontrolled growth of cells. In the UK, more than 10,000 people are diagnosed with bladder cancer each year.
Your bladder is a hollow, muscular, balloon-like organ that collects and stores urine. Urine is produced by your kidneys, which clean your blood by filtering out water and waste products. Urine passes from your kidneys through tubes (called the ureters) into your bladder and then outside your body (through the urethra).
There are different types of bladder cancer, named after the type of cell the cancer first starts in and the stage of disease (how far it has spread). These are described below.
The most common symptom of bladder cancer is having blood in your urine. Other symptoms may include having:
If the bladder cancer is more advanced and has spread considerably, you may have additional symptoms such as bone pain.
These symptoms aren't always caused by bladder cancer, but if you have them see your GP.
Doctors don't fully understand why bladder cancer develops. However, certain factors increase your risk of getting the disease. These are described below.
Your GP will ask about your symptoms and examine you. He or she will also usually ask you to take a urine test. You may be referred to a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system).
You may have the following tests to confirm a diagnosis.
Treatment depends on the position and size of the cancer in your bladder and how far it has spread. Your doctor will discuss your treatment options with you.
Transurethral resection of bladder tumour (TURBT)
TURBT is the main treatment option for early stage bladder cancer that hasn’t spread into your bladder wall. The procedure is carried out using cystoscopy and removes any unusual growths or tumours on your bladder wall. TURBT is usually followed by bladder treatment with mitomycin C or Bacille Calmette-Guérin (BCG) to destroy any remaining cancer cells and reduce the chance of cancer coming back.
Bladder treatment with mitomycin C or Bacille Calmette-Guérin (BCG)
Mitomycin C is a chemotherapy medicine used to destroy cancer cells. BCG is an immunotherapy that contains a weak form of the bacterium Mycobacterium bovis that works by encouraging your immune system to attack cancer cells. Mitomycin C or BCG treatment is usually given after having a TURBT procedure, though sometimes it may be used alone to treat non-muscle invasive bladder cancer.
Removing your bladder and surrounding tissues is the main treatment for muscle-invasive bladder cancer. The operation is called a complete or radical cystectomy.
Before surgery, you may have chemotherapy to shrink the tumour. Then, after removing your bladder, your surgeon will create a new area for you to store urine. There are several ways to do this.
For older people who can’t have surgery, radical radiotherapy may be a more suitable option.
If you smoke, stopping smoking can reduce your risk of developing bladder cancer.
After treatment for bladder cancer, you will have regular check-ups with your doctor. If you had a urostomy, a stoma nurse at hospital may be able to give you help and advice.
Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There are support groups where you can meet people who may have similar experiences to you. Ask your doctor for advice.
A urine test is usually done to determine if your symptoms are caused by a bladder infection and to check for any blood. Bladder cancer is usually diagnosed by taking a biopsy (small sample of tissue) from your bladder wall. There are some tests in development, but they are not yet available and are still being researched.
Bladder cancer is diagnosed by doing a cystoscopy and taking a biopsy from your bladder wall.
There are a number of tests being developed that may make it possible to diagnose bladder cancer from a sample of urine. According to the European Association of Urology, the following three tests are particularly promising.
These tests are still being investigated and aren't available in the UK yet. Even if they do become available, they are unlikely to be used alone to diagnose bladder cancer – a cystoscopy and biopsy will probably still be needed to confirm the result.
Treatment for invasive bladder cancer may result in physical changes that could affect your sex life. In men, the operation to remove the cancer may damage the nerves that control erections and in women, an operation to remove the urethra may shorten or narrow your vagina.
Although great care will be taken, there is a risk that the nerves in your pelvis will be damaged during the operation. If you have problems getting an erection after surgery, there are several options that may help.
If surgery has shorted or narrowed your vagina, it may help to use a dilator to stretch it. Dilators are metal or plastic objects that are shaped like a tampon. You put them into your vagina for a few minutes every day. Over a few weeks you gradually use larger sizes and this slowly stretches your vagina. Having regular, gentle sex will also have the same effect.
Ask your doctor if you have any concerns about sex after treatment for bladder cancer.
It may take time to get used to having a urostomy (an opening from the ureters, to allow urine to leave your body without passing through your bladder), but most people are able to return to their jobs and everyday activities. Most hospitals have specialist stoma care nurses who can give you advice and support.
When you have surgery to remove your bladder, your surgeon will create a new way for you to store urine. It can be done in several ways and one is by having a urostomy. This involves your surgeon removing a small piece of your small bowel and joining one end of the piece of bowel to your ureters and the other end to a small hole cut into the surface of your abdomen (tummy). The hole is called a stoma. The position of the stoma is usually to the right of your tummy button. However, before your operation your surgeon or nurse will help you plan the position of the stoma that best suits you.
After the operation, urine will pass down your ureters, but instead of going into your bladder it will run through the piece of bowel and out onto the surface of your abdomen. A waterproof bag (a urostomy bag) is placed over the stoma to collect your urine. The bag stays in place with glue. You will need to empty the bag as often as you would normally go to toilet to pass urine.
Your nurse will show you how to clean the stoma and change the bags. Modern urostomy bags are very well designed. They shouldn't leak and are hardly noticeable under clothing. You can wear a smaller bag for exercising or a waterproof dressing for swimming.
Talk to your nurse if you have any problems or concerns.