- Each year about 10,000 people in the UK are diagnosed with bladder cancer.
- Of these, 8 out of 10 (80%) are diagnosed with early bladder cancer.
- Smoking is one of the most common causes of bladder cancer.
- Bladder cancer becomes more common as people get older.
The bladder is a hollow, muscular, balloon-like organ in the lower part of the abdomen that collects and stores urine. It is connected to the kidneys by tubes called ureters, and it opens to the outside of the body through a tube called the urethra. In women the urethra is a short tube that lies in front of the vagina. In men the urethra is longer and passes through the prostate gland to the tip of the penis.
The inside of the bladder is covered with a urine-proof lining called the urothelium, which stops urine from being absorbed back into the body. The cells that make up this lining are called transitional cells or urothelial cells.
Bladder cancer causes and risk factors
Some of the possible causes of bladder cancer, or risk factors for bladder cancer developing include:
This is the biggest risk factor for bladder cancer. The longer a person smokes and the more cigarettes they smoke, the greater the risk. Chemicals that cause bladder cancer are present in cigarette smoke. It’s thought that these chemicals get into the bloodstream and end up in the urine after being filtered by the kidneys. They then damage the cells that line the inside of the bladder. It takes many years for these chemicals to cause bladder cancer.
Exposure to chemicals at work
These include chemicals previously used in dye factories and industries that worked with rubber, textiles, printing, gasworks, plastics, paints and chemicals. The link between these chemicals and bladder cancer was discovered in the 1950s and 60s, so many of them were banned. However, it can take more than 25 years after exposure to these chemicals for bladder cancer to develop.
It’s unusual for anyone under the age of 40 to get bladder cancer. It becomes more common as one gets older.
Bladder cancer is more common in men than in women.
Repeated (chronic) urinary infections and untreated bladder stones have been linked with a less common type of bladder cancer called squamous cell cancer.
Types of bladder cancer
Bladder cancer may appear in different forms, and these include:
- Transitional cell bladder cancer (TCC)
- Carcinoma in situ (CIS)
- Papillary cancer
- Rarer types of bladder cancer
Transitional cell bladder cancer (TCC)
TCC, also known as urothelial carcinoma, is the most common type of bladder cancer. The cancer starts in cells, called transitional cells, in the bladder lining (urothelium).
Some bladder cancers begin as an invasive tumour growing into the muscle wall of the bladder. Others begin at a non-invasive stage that involves only the inner lining of the bladder - this is early stage (superficial) bladder cancer. Some non-invasive cancers develop into invasive bladder cancer.
Carcinoma in situ (CIS)
This is a type of non-invasive bladder cancer that appears as a flat, red area in the bladder. CIS can grow quickly if not treated effectively, and there’s a high risk that CIS will develop into an invasive bladder cancer.
Papillary bladder cancer is a form of early bladder cancer. It appears as mushroom-like growths. Some people may have both papillary cancer and CIS.
These include squamous cell cancer and adenocarcinoma. Squamous cell cancers start from another type of cell in the bladder lining. Adenocarcinoma starts from glandular cells. Both of these types of bladder cancer are usually invasive.
Symptoms of bladder cancer
The most common symptoms of bladder cancer are blood in the urine, bladder changes and pain in the lower part of the tummy or back.
- Blood in the urine (haematuria)
- Bladder changes
- Pain in the lower part of the tummy or back
Blood in the urine (haematuria)
This is the most common symptom. It generally happens suddenly and may come and go, but it’s usually not painful. Blood in the urine may make the urine look red or brown, or you may be able to see streaks or clots of blood in the urine. Sometimes blood in the urine can’t be seen and is picked up microscopically by a urine test.
If you have other bladder symptoms, your Urologist will usually check your urine for microscopic amounts of blood. It’s important that people over 50 years who have microscopic haematuria are investigated for cancer. If you see blood in your urine at any age, you should always go to your GP or Urologist and get it investigated.
Bladder irritation symptoms include having a burning feeling when urinating or feeling the need to pass urine more often or urgently. These symptoms are more often caused by infection rather than cancer. However, sometimes more tests may be needed.
Pain in the lower part of the tummy or back
This is less common, but it may occur in some people.
These symptoms may not be bladder cancer. Common conditions such as an infection or stones in the bladder or kidneys are often the cause.
How bladder cancer is diagnosed
- Seeing your GP or Urologist
- Tests for bladder cancer
Tests for bladder cancer
Your Urologist will ask you about your symptoms and general health, and arrange the following test.
Blood and urine tests
Cystoscopy - a specialist nurse or doctor uses a cystoscope (a thin tube with a camera and light on the end) to look at the inside of your bladder.
Ultrasound scan - this uses sound waves to look at internal organs
CT scan (computerised tomography) - a series of x-rays that builds up a three-dimensional picture of the inside of the body.
Intravenous urogram (IVU) - a dye is injected into the bloodstream and passes through the urinary system to show if there are any problems.
MRI scan (magnetic resonance imaging) - uses magnetic fields to build up a series of cross-sectional pictures of the body.
Bone scan - a scan of the whole body to show any abnormal areas of bone.
Grading and staging of bladder tumours
- Grade 1 tumours are less aggressive
- Grade 2 tumours are moderately aggressive
- Grade 3 tumours are most aggressive and most likely to spread.
The extent of the tumour is called its stage. Treatment option depends on the stage and the grade of the tumour.
- Carcinoma in situ – bladder cancer cells are completely contained on the inner surface of the bladder lining.
- Stage Ta – affects the epithelium. In most superficial cancer stage, the tumour is confined to the inner layer of transitional cells. Provided the grade is 1-2, this is very unlikely to progress.
- Stage T1 – the tumour has started to invade the inner layer of muscle of the bladder (lamina propria), but has not reached the detrusor muscle.
- Stage T2 – the tumour has spread into the muscle layers of the bladder wall.
- Stage T3 – the tumour has spread through the deeper muscle layers into the surrounding fat.
- Stage T4 – the tumour has spread beyond the bladder into areas around the bladder, e.g. prostate, vagina, bowel and or other parts of the body.
After treatment, it is normal to have regular check cystoscopies, every 3 months to check that the tumour has not returned.
Sometimes these checks can be performed using flexible cystoscopies every 6 or 12 months to ensure that if the tumour does return, it is removed as early as possible.
Treatment option for invasive bladder cancer
- Cystectomy with: ileal conduit formation, neo bladder replacement and continent urinary diversion
- Intravesical- directly into the bladder (chemotherapy and immunotherapy)
- Intravenous- into the bloodstream, via a vein
- BCG treatment