The common early symptom of bladder cancer is blood in the urine. In most cases, the cancer is confined to the inside lining of the bladder. Treatment of these superficial bladder cancers is relatively easy and often curative. If the cancer has spread into or through the muscle layer of the bladder wall then treatment is less likely to be curative, but can often slow the progress of the cancer.
The bladder is part of the urinary tract. It is at the bottom of the abdomen. It fills with urine and we pass urine out from time to time through a tube called the urethra. The urethra passes through the prostate gland and penis in men. The urethra is shorter in women and opens just above the vagina.
Urine is made in the kidneys and contains water and waste materials. A tube called a ureter comes from each kidney and drains the urine into the bladder.
The cells that line the inside of the bladder are called transitional cells or urothelial cells. There is a thin layer of cells beneath the lining, called the lamina propria.
The outer part of the bladder wall contains a thick layer of muscle tissue which contracts from time to time to push out the urine.
Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are many different types of cell in the body, and there are many different types of cancer which arise from different types of cell. What all types of cancer have in common is that the cancer cells are abnormal and multiply out of control.
A malignant tumour is a lump of tissue made from cancer cells which continue to multiply. Malignant tumours can invade into nearby tissues and organs, which can cause damage.
Malignant tumours may also spread to other parts of the body. This happens if some cells break off from the first (primary) tumour and are carried in the bloodstream or lymph channels to other parts of the body. These small groups of cells may then multiply to form secondary tumours (metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues, and spread again.
Some cancers are more serious than others; some are more easily treated than others (particularly if diagnosed at an early stage); some have a better outlook (prognosis) than others.
So, cancer is not just one condition. In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will enable you to get reliable information on treatment options and outlook. (See separate leaflet called 'Cancer - What are Cancer and Tumours?' for general details about cancer.)
Bladder cancer is a common cancer. About 10,000 people develop bladder cancer in the UK each year. In most cases in the UK, the bladder cancer develops from the transitional cells which line the inside of the bladder. This type of cancer is called transitional cell bladder cancer. Other types of bladder cancer are rare in the UK.
The rest of this leaflet only deals with the common type of bladder cancer - transitional cell bladder cancer.
Transitional cell bladder cancer is divided into two groups:
The treatment and outlook for each of these two groups are very different. Superficial tumours rarely spread and can usually be cured. However, if left untreated, in some cases they can develop into muscle invasive tumours. Muscle invasive tumours have a high chance of spreading to other parts of the body (metastasise), and treatment has less chance of being curative.
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control. (See separate leaflet called 'Cancer - What Causes Cancer?' for more detail.)
In many cases, the reason why a bladder cancer develops is not known. However, there are factors which are known to alter the risk of bladder cancer developing. These include:
In most cases, the first symptom is to pass blood in the urine (haematuria). Haematuria caused by an early bladder tumour is usually painless. You should always see your doctor if you pass blood in your urine. The blood in the urine may come and go as the tumour bleeds from time to time.
Some tumours may cause irritation of the bladder and cause symptoms similar to a urine infection. For example, passing urine frequently or pain on passing urine. If the cancer is a muscle-invasive type, and grows through the wall of the bladder, then other symptoms may develop over time. For example, pain in the lower abdomen.
If the cancer spreads to other parts of the body, various other symptoms can develop.
Urine microscopy - a sample of urine can be sent to the laboratory to look for cancerous cells under the microscope. This test may detect cancer cells. However, if no cancer cells are seen it does not rule out bladder cancer. Further tests are done to confirm or rule out the diagnosis if symptoms suggest bladder cancer.
Cystoscopy - this test is commonly done to confirm a bladder tumour. A cystoscopy is where a doctor or nurse looks into the bladder with a special thin telescope called a cystoscope. The cystoscope is passed into the bladder via the urethra. A cystoscopy which is done to just look into the bladder is normally done under local anaesthetic. If a procedure is done, such as removing a tumour via a cystoscope, then a general anaesthetic is usually used.
During cystoscopy a doctor or nurse can:
See separate leaflet called 'Cystoscopy' for more detail.
Special urine tests - urine tests have been developed which can detect bladder cancer. For example, urine tests called the BTA test, the NMP-22 test and the MCM5 test. These tests detect chemicals and proteins in urine that are made by bladder cancer cells. However, these tests are still not sensitive enough to diagnose all bladder cancers so are not routinely used.
Ultrasound scan - this is a safe and painless test which uses sound waves to create images of organs and structures inside your body. It may be used to diagnose a bladder cancer.
Computed tomography (CT) scan - another test called CT urogram is a special type of CT scan that obtains pictures of your urinary tract. This is sometimes done to look for a bladder tumour.
If initial tests confirm that the cancer is a superficial tumour then no further tests may be necessary. Superficial bladder tumours have a low risk of spread to other parts of the body.
However, if you have a muscle-invasive tumour, then further tests may be advised to assess if the cancer has spread. For example, a CT scan, a magnetic resonance imaging (MRI) scan, or other tests. (See separate leaflets which describe each of these tests in more detail.) This assessment is called staging of the cancer. The aim of staging is to find out:
By finding out the stage of the cancer, it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called 'Cancer - Staging and Grading Cancer' for more detail.
Doctors and patients can use Decision Aids together to help choose the best course of action to take.Compare the options for Bladder Cancer.
Most superficial bladder tumours are removed by a specialist with the aid of a cystoscope (described earlier). This is called transurethral resection (TUR), as the tumour is removed (resected) via a cystoscope which is passed up the urethra. It does not involve an operation to cut into the bladder. Thin instruments can be passed down a side-channel of the cystoscope to remove the tumour.
Following a TUR, it is usual to have one dose of intravesical chemotherapy (chemotherapy in the bladder). This is usually done within 24 hours of having a TUR. It involves inserting a liquid into the bladder via a catheter which then remains for a few hours. The liquid contains a chemotherapy medicine. Chemotherapy medicines kill cancer cells, or stop them from multiplying. The aim is to kill any cancer cells that have been left behind following the TUR. Studies have shown that one dose of intravesical chemotherapy reduces the chance of the tumour recurring in the future. See separate leaflet called 'Chemotherapy' for more detail.
The tumour that is removed during a TUR is examined under the microscope. This enables the exact stage and type of the tumour to be determined. Depending on the stage and type of the cancer, further intravesical chemotherapy may be advised. This is done by using a catheter (as described above) and may be done every 1-4 weeks for several months. The aim is to be as certain as possible that all cancer cells are killed, which reduces the chance of recurrence of the tumour.
The most commonly used medicine for further chemotherapy is called BCG. This is actually a vaccine which is used to prevent tuberculosis (TB). It is not clear how it works for bladder cancer. It may stimulate the immune system in some way to clear any abnormal cells in the bladder lining. So, strictly speaking, treatment with BCG is immunotherapy. Other chemotherapy medicines are sometimes used instead of BCG.
After a superficial tumour is removed, you will need a cystoscopy every so often. A recurrence of a tumour occurs in some cases, and routine check cystoscopies will detect these at an early stage. If one recurs, it can be treated again. The time interval between check cystoscopies is every 3-4 months at first but may become longer if the bladder remains free of tumour at each check. You may need a check cystoscopy every now and then for several years to make sure the tumour has not returned.
As mentioned above, urine tests have been developed to diagnose bladder cancer. If trials are successful, a urine test may become the way to check if a tumour has recurred, rather than a cystoscopy.
Treatment options that may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and if it has spread), and your general health.
You should have a full discussion with a specialist who knows your case. He or she will be able to give the pros and cons, the likely success rate, the possible side-effects, and other details about the various possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
An operation to remove the bladder is the most common treatment. This is a major operation. Before surgery you need a full discussion with a surgeon to understand the implications of the operation planned. For example, you will need an alternative way of passing urine if you have your bladder removed. One way for this is by a urostomy. This is where a surgeon uses a technique to arrange a system for urine to drain into a bag which you wear on the outside of your abdomen. An alternative operation may be possible where the surgeon creates an artificial type of bladder from a part of the gut.
Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, if the passage of urine is blocked by a tumour then placing a catheter or other techniques may be appropriate.
Radiotherapy is sometimes used instead of surgery. Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. See separate leaflet called 'Radiotherapy] for more detail.
Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells, or stop them from multiplying. Prior to surgery or radiotherapy, a course of chemotherapy may be advised. This is called neoadjuvant chemotherapy. Chemotherapy used before surgery may improve the outlook (prognosis). In some cases a course of chemotherapy is given following surgery. See separate leaflet called 'Chemotherapy' for more detail.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information above about outlook is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.
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Provides information and support to anyone affected by cancer.
Provides facts about cancer, including treatment choices.
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See www.patient.co.uk/selfhelp.asp for a list of self-help and support groups for cancer.