Bladder cancer

Bladder cancer is the fourth most common cancer in men in the UK affecting around 7,500 men each year. It is one of the most effectively treated of the common cancers, however over 3,000 men still die of bladder cancer each year, mainly because the cancer is detected in its late stages.

The most common type of bladder cancer is called transitional cell carcinoma (TCC) and accounts for 90% of bladder cancers. TCC starts in the lining cell layer of the bladder. Other types of bladder cancer include squamous cell carcinomas and adenocarcinomas. If the cancer is only in the bladder lining, it is called a superficial cancer. If it has spread to the muscle wall of the bladder it is called an invasive cancer. Invasive cancers can spread through the bladder wall into nearby organs such as the prostate gland, the bowel, or lymph nodes. Further spread to other organs such as the bones and liver can occur.

Causes and risk factors

Half of bladder cancers occur in people over the age of 70 and the disease is very rare in people under 40 years of age. Smoking is probably the most common cause of bladder cancer in the UK. Smokers are two to three times more likely to develop bladder cancer than non-smokers. A family history of bladder cancer, or chronic infection caused by the tropical disease bilharzia also increases the risk of bladder cancer.

Symptoms

The most common sign of bladder cancer is blood in the urine (haematuria), which is often painless and may come and go. Blood clots may form and cause pain or obstruction to the flow of urine. Other symptoms may include a burning sensation when passing urine and a need to pass urine frequently.

If you notice blood in your urine, visit your doctor as soon as possible, however, blood in the urine is more commonly due to other problems, such as infection or urinary stones, than bladder cancer.

Screening

At present there is no UK screening programme for bladder cancer.

A simple test using a “dipstick” placed in a specimen of urine can detect a number of factors including the presence of small amounts of blood. Although the presence of blood, whether visible or not, may be due to several causes, including vigorous exercise and lifting, it can also indicate the presence of bladder cancer. If a urine “dipstick” test is positive in the absence of an obvious cause such as infection (e.g. cystitis) or kidney disease, then a further test should be undertaken within a couple of weeks making sure that no physical exertion or lifting has occurred before the test. A further positive test may require further investigations thereafter.

Diagnosis

If bladder problems are suspected, your urine can be tested with a "dipstick" to look for blood, infection and other parameters. If the result is positive for the presence of blood then further tests can be undertaken, including X-rays, scans and cystoscopy. A cystoscopy uses a thin flexible telescope (a cystoscope) with a light and lens on the end, which is passed into the bladder through the urethra. A local anaesthetic is used to help reduce any discomfort. If an abnormality is seen in the bladder, you may be asked to return for a further cystoscopy, probably using a rigid cystoscope. This allows for a small surgical instrument to be passed into the bladder so that tissue samples (biopsies) can be taken and, if necessary, abnormalities removed. A general anaesthetic is used for rigid cystoscopy.

Treatment

The treatment for bladder cancer depends upon the type of cancer and whether it is superficial or invasive. Most bladder cancers are superficial and are usually removed using a device that is passed into the bladder through a cystoscope. Superficial tumours tend to recur so cystoscopy checkups every few months are often required. A technique known as photodynamic therapy, which uses a special dye, has greatly improved the ability to detect recurrences. The dye is inserted into the bladder two hours before a cystoscopy and is only absorbed by cancerous cells, which become fluorescent and so easily visible.

Sometimes chemotherapy drugs are used to "wash out" the bladder after a lesion has been removed. The drugs are introduced into the bladder using a fine tube called a catheter. The treatment is usually given weekly for 6-8 weeks. Immunotherapy is another treatment for superficial bladder cancers and involves the body's immune system to fight cancer cells. The BCG vaccine (normally used to prevent tuberculosis) has been shown to be effective for treating some superficial bladder cancers.

Invasive tumours can be treated with surgery, radiotherapy and chemotherapy, which can be used alone, or in combination. Surgery may be needed to remove the affected part of the bladder and can often be done through a cystoscope. Rarely, more major surgery to remove the whole bladder is required. A reconstruction of the bladder may be undertaken using other tissues or artificial materials.

Prevention

Stopping smoking is the most effective measure that can be done to reduce the risk of getting bladder cancer. Even if a superficial bladder cancer has been diagnosed, stopping smoking will reduce the risk of developing more tumours in the future.

A diet high in fruit and vegetables and low in fat may help reduce the risk.