Bladder cancer

Published by Bupa's Health Information Team, November 2010.

This factsheet is for people who have bladder cancer, or who would like information about it.

Bladder cancer is caused by the uncontrolled growth of cells that line the bladder wall. In the UK, more than 10,000 people are diagnosed with bladder cancer each year. Bladder cancer is usually treated with surgery, chemotherapy, immunotherapy or radiotherapy.

How cancer develops

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About bladder cancer

Bladder cancer develops in the lining or the wall of your bladder. It's caused by the uncontrolled growth of cells. Bladder cancer mostly affects people over 50 and is more common in men than in women.

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 to make urine. The urine is passed from your kidneys through tubes (called the ureters) into your bladder and then to the outside (through the urethra).

Types of bladder cancer

There are different types of bladder cancer, named after the type of cell the cancer first occurs in and how far it has spread. These are described below.

• Transitional cell carcinoma (TCC). This type of cancer is the most common bladder cancer and develops in the top layer of cells that line the bladder wall. These cells come into contact with waste products in the urine that may cause cancer.
  
• Squamous cell carcinoma (SCC). This type of cancer develops in the flat cells that line the bladder wall.
  
• Adenocarcinoma. This is a very rare type of bladder cancer that develops in the mucus-producing cells that line the bladder wall.
  
• Superficial (non-muscle invasive) bladder cancer. The cancer is only in the bladder lining and hasn't spread into the deeper layers of the bladder wall. Superficial bladder cancer is usually early stage transitional cell bladder cancer. It usually appears as a small mushroom-like growth on the lining of the bladder (called papillary cancer).
  
• Invasive bladder cancer. The cancer has spread into the muscle wall of the bladder. Transitional cell bladder cancer can become invasive. Depending on how far it has spread, invasive bladder cancer is divided into T2, T3 or T4. For more information, see cancer staging and grading.

Symptoms of bladder cancer

Symptoms of bladder cancer include:

• a burning feeling when passing urine
  
• a need to pass urine frequently
  
• feeling the need to urinate but not being able to
  
• pain in your pelvis
  
• blood in urine

These symptoms aren't always due to bladder cancer but if you have them, visit your GP.

Causes of bladder cancer

Doctors don't fully understand why bladder cancer develops. However, certain factors make bladder cancer more likely.

• Smoking triples your risk of bladder cancer. Passive smoking may also increase your risk.
  
• Exposure to certain industrial chemicals (for example, those used in printing and textiles, gas and tar manufacturing, iron and aluminium-processing industries).
  
• A long-term infection with the tropical disease, schistosomiasis (bilharzia).
  
• A long-term or repeated bladder infection.

Diagnosis of bladder cancer

Your GP will ask about your symptoms and examine you. 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 diagnosis.

• Cystoscopy. This is a procedure used to look inside the bladder and urinary system. During the procedure, your surgeon may take a biopsy (a small sample of tissue). This will be sent to a laboratory for testing to determine the type of cell and whether they are benign (not cancerous) or cancerous.
  
• Intravenous urogram (IVU). This is a special type of X-ray procedure used to look inside the bladder and urinary system. A dye is injected into your bloodstream through a vein in your arm. The dye is removed from your blood by your kidneys and X-ray images show the dye travelling through your urinary system. This helps your surgeon check for anything unusual.
  
• Ultrasound, MRI scan or CT scan. These scans can help doctors to check your urinary system to see if the cancer has spread.

Treatment of bladder cancer

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)

This is a procedure used to remove any unusual growths or tumours on the bladder wall. Using a rigid cystoscope a special wire loop is passed into your bladder. An electric current is passed down the wire loop and used to cut or burn off the growth or tumour and a border of healthy tissue around it. For more information, see transurethral resection of bladder tumour, TURBT.

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, which is also used to vaccinate against tuberculosis (TB). BCG works by encouraging the immune system to attack cancer cells. Mitomycin C or BCG treatment is usually given after bladder surgery, sometime it may be used alone to treat bladder cancer. For more information, see bladder treatment with mitomycin C or Bacille Calmette-Guérin (BCG).

Surgery (complete or radical cystectomy)

Removing your bladder and surrounding tissues is the main treatment for muscle-invasive bladder cancer. The operation is called a complete or radical cystectomy. It is usually followed by radiotherapy.

You may be given radiotherapy or chemotherapy to shrink the tumour before surgery.

After removing your bladder, your surgeon will create a new area for you to store urine. There are several ways to do this and the three main options are listed here.

• Urostomy. Your ureters are connected to a small opening (a stoma) in your abdomen (tummy) using a short piece of your small bowel. A flat, watertight bag is placed over the stoma to collect your urine.
  
• Continent urinary diversion. A section of bowel is used to make a pouch inside your abdomen to collect urine. The pouch is connected to the outside of your body via a stoma which is kept closed with a valve. You will need to empty the pouch four to five times a day by inserting a catheter into the stoma.
  
• Bladder reconstruction. A new bladder is made using part of your bowel. Your urine drains from your ureters into the new bladder. You will need to learn how to pass urine through your urethra by using your muscles. You will have lost the nerves that tell you when your bladder is full and so will need to remember to empty it.

Prevention of bladder cancer

If you smoke, stopping smoking can reduce your risk of developing bladder cancer.

Getting enough vitamin D may reduce your risk of developing a number of cancers, including bladder cancer – although more research needs to be done to be certain. Vitamin D is also well known to be important for bone health.

Vitamin D is produced naturally by your body when your skin is exposed to sunlight and can also be obtained from some foods, such as oily fish. You may get enough vitamin D during summer by spending frequent short spells in the sun without wearing sunscreen (the exact time you need is different for everyone, but is typically only a few minutes in the middle of the day). However, do not let your skin redden. If you don't get much sun exposure and particularly during winter months, taking up to 25 micrograms of vitamin D a day (two high-strength 12.5 microgram capsules) can help to make sure you get enough.

Always read the patient information leaflet that comes with your supplements and if you are pregnant or breastfeeding, ask your pharmacist or GP for advice first. Talk to your GP before taking vitamin D supplements if you are taking diuretics for high blood pressure or have a history of kidney stones or kidney failure.

Living with bladder cancer

After treatment for bladder cancer, you will have regular check-ups with your doctor. Many hospitals have stoma nurses who can help you take care of your urostomy and give you 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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.