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Bladder cancer

Bladder cancer is an uncontrolled growth of cells lining your bladder wall. In the UK, around 1 in every 10,000 people gets bladder cancer, which makes it the seventh most common cancer in the UK. It mainly affects people over 55 years of age. It’s also more common in men than it is in women.

Your bladder is a hollow, muscular, balloon-like organ that collects and stores urine made by your kidneys. Carcinogens (things that can cause cancer) are filtered out of your body (by your kidneys) and go into your bladder with your urine. Any carcinogens that collect here are stored in high amounts and for long lengths of time. This gives them the chance to damage your bladder cells. It’s this damage that can lead to bladder cancer.

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How cancer develops
Cells begin to grow in an uncontrolled way

Details

  • Types Types of bladder cancer

    There are different types of bladder cancer that you could be diagnosed with. However, nine out of 10 people with bladder cancer have what’s called urothelial carcinoma. This is cancer of the cells that line your bladder wall. There are other types of bladder cancers that involve different types of cells. These include squamous cell carcinoma and adenocarcinoma, but in the UK, urothelial carcinoma is the most common.

    If you have bladder cancer, it will be called either non-muscle invasive or muscle invasive. This shows the stage of your cancer. Around eight out of 10 people with bladder cancer have the non-muscle invasive type. If you do, it means your cancer hasn’t grown down into the muscle that surrounds your bladder.

    Bladder cancer is also graded. The grade shows how different the cells are from those that normally line your bladder wall and therefore, how likely it is to spread. The cells are described as either well-differentiated (similar) or poorly differentiated (not so similar).

    Well-differentiated cells are called low grade. They work similarly to the cells that are meant to be there, so they are not as much of a risk to your health as poorly differentiated cells. Poorly differentiated cells are called high grade. They don’t look or work how they should. Well-differentiated tumours grow and spread slower than poorly differentiated tumours.  Most people with bladder cancer have the low-grade, non-muscle invasive type.

    Another term you may hear is papillary. Bladder cancers are usually papillary, meaning they are branch-like and grow into the hollow space inside your bladder. However, a small number of people with bladder cancer have carcinoma in situ (CIS). This type grows along the surface of your bladder making it a type of non-muscle invasive bladder cancer. But sometimes CIS can begin to grow down into (invade) the muscle layer surrounding your bladder.
  • Symptoms Symptoms of bladder cancer

    The most common symptom of bladder cancer is passing blood in your urine. Although this usually doesn’t happen every time you urinate, it’s important that you don’t ignore it if you see it.

    Some other symptoms that you may notice include:

    • painful urination (dysuria) — when urinating you may feel a burning sensation
    • needing to urinate more often than usual
    • needing to pass urine more urgently

    If you have these symptoms, you might not have bladder cancer. These symptoms can be caused by other things. For example, if you have a bladder infection, you may also find it painful to pass urine. Similarly, urgency to pass urine can also be a sign of having either an overactive bladder or, specifically for men, an enlarged prostate.

    It’s not uncommon however for people with more advanced bladder cancers to have dysuria, and bladder infections are also quite uncommon in men. So, if you have any of the above symptoms, you should contact your GP surgery for advice.

    If you have advanced bladder cancer, you may have other symptoms. These may include:

    • pelvic pain
    • back pain
    • bone pain
    • swelling in your feet

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  • Diagnosis Diagnosis of bladder cancer

    Your GP will ask you about your symptoms. He or she may refer you to a urologist. This is a doctor who specialises in identifying and treating conditions that affect your urinary system.

    You will be referred to a urologist if you’re over the age of 45, have blood in your urine and no sign of your symptoms being caused by a bladder infection. You’ll also be referred if you’ve already been treated for a bladder infection but your symptoms are still there. If you’re aged 60 or older, you may be referred to a urologist for some more investigations.

    Your urologist will organise for you to have a cystoscopy. This is an essential procedure to diagnose bladder cancer. During the procedure your urologist passes a small tube-like camera up into your bladder and looks to see if there is anything unusual. If there is, he or she may take some samples. These samples are then sent to the laboratory and tested.

    To help with your diagnosis, you may be asked to give a sample of your urine. See our FAQ Can bladder cancer be detected with a urine test? for more information on how a urine sample can be used during diagnosis.

    You may also need to have some scans to make images of your bladder and the areas around it. These scans may include:

    • ultrasound
    • CT urogram
    • intravenous pyelogram
    • chest X-ray
    • CT scan
    • MRI scan
    • MR urogram
    • bone scan

    If you’re unsure how any of these tests relate to your diagnosis, ask your specialist for advice.

  • Treatment Treatment of bladder cancer

    Which treatments you’ll be offered will depend on:

    • whether your bladder cancer is non-muscle invasive or muscle invasive
    • how much of a risk it is to your health

    Treatment will usually involve both surgical and non-surgical treatments. Your doctor will discuss your treatment options with you.

    Surgical treatments

    Transurethral resection of a bladder tumour (TURBT)

    Transurethral resection of your bladder tumour (TURBT) is the best way to diagnose and treat non-muscle invasive bladder cancer. This procedure is done under general anaesthesia and allows your surgeon to remove any unusual growths or tumours from your bladder wall. TURBT is often followed by chemotherapy or immunotherapy treatment which destroys any remaining cancer cells and reduces the chance of your cancer coming back. After TURBT, you might find it a little uncomfortable to pass urine and you might also see some blood in your urine. Try not to worry, this will settle shortly after the procedure.

    Cystectomy

    If you have more advanced muscle invasive bladder cancer, your doctor will recommend that you have your bladder surgically removed (cystectomy). Your doctor may also give you the option to have this treatment if you have high-risk non-muscle invasive bladder cancer. But it’s not usually necessary.

    If you have the muscle invasive type and it’s just in your bladder, you may be able to have what’s called a partial cystectomy. This is when only a portion of your bladder is removed. However, having the whole of your bladder and surrounding areas removed in a radical cystectomy is usually the best option. Any affected areas are taken away, so it’ll stop your cancer from getting worse.

    After removing your bladder, your surgeon will discuss with you the different options available for you to pass urine. This may involve:

    • having a bag on the outside of your body to collect your urine
    • using a catheter to drain urine from a new area inside your abdomen (tummy) that’s been created to collect your urine
    • having a new bladder created – allowing you to pass urine by tensing your tummy muscles

    If you have a cystectomy, you may be offered chemotherapy with or without radiotherapy either before or after your surgery to help get the best outcome.

    Non-surgical treatments


    Localised chemotherapy

    If you have non-muscle invasive bladder cancer, your doctor will recommend that you have intravesical chemotherapy, after having TURBT (transurethral resection of a bladder tumour).

    Intravesical means the chemotherapy medicine is put straight into your bladder. Mitomycin C is the most commonly used intravesical chemotherapy medicine. It works by destroying any cancer cells that remain in your bladder after TURBT. This helps to stop your bladder cancer from coming back. Depending on the risk of your cancer, you may have one or several doses of this medicine (sometimes around six or more). The greater the risk, the more doses you’re likely to have.

    Whole body chemotherapy

    If you have muscle invasive bladder cancer, your doctor will suggest that you have chemotherapy that treats your whole body (systemic chemotherapy), not just your bladder. You may have this chemotherapy treatment before or after you have other treatments. Having it before will help to shrink your cancer, having it after will help stop your cancer from coming back. You’ll also be offered this type of treatment if your bladder cancer has spread (metastasised) to other parts of your body.

    Some of the chemotherapy drugs used include:

    • cisplatin
    • methotrexate
    • gemcitabine

    If you have systemic chemotherapy, you’re likely to get some of the well-known side-effects. You may feel sick, tired and lose your hair. However, if you have intravesical chemotherapy, you won’t get these side-effects because the chemotherapy goes into, and stays in, your bladder.

    Immunotherapy

    Bacillus Calmette–Guérin (BCG) is an immunotherapy treatment containing a weak form of the bacterium Mycobacterium bovis. You’ll be offered this treatment if you have non-muscle invasive bladder cancer that’s more of a risk to your health than the low-risk non-muscle invasive type. It’s usually given after you have a TURBT procedure and works by encouraging your immune system to attack any cancerous cells left in your bladder.

    Your doctor will put the treatment directly into your bladder through a catheter (a thin tube passing into your bladder). It will stay in your bladder for between one-and-a-half and two hours and will be flushed out when you urinate. You’ll have one dose every week for around six weeks.

    It’s unlikely that you’ll get any side-effects after the first few doses. You might however start to get a bit of irritation in your bladder, or perhaps, some flu-like symptoms after having some more doses. These symptoms are usually mild and can be easily controlled. If you have any of these effects, seek your doctor’s advice.

    Radiotherapy

    Radiotherapy (like whole body chemotherapy) is generally used alongside surgical procedures to get the best results when treating muscle invasive bladder cancer. If you can’t have surgery, perhaps because you have another condition, your doctor will discuss with you the option to have radiotherapy on its own. Radiotherapy usually involves a number of short, painless, treatments given five days a week, over six or seven weeks. Feeling tired after having radiotherapy is the most common side-effect. Even though you may feel tired, try to keep as active as you can. Other side-effects can include passing urine more frequently, some discomfort when passing urine and, sometimes, bowel upset such as diarrhoea.

    Make sure that you have discussed the benefits, risks and outcomes of each treatment type so that your decision is as well informed as it can be.

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  • Causes Causes of bladder cancer

    Although we don’t know all of the causes of bladder cancer, there are certain things that have been found to increase your chances of getting it. These are called risk factors. If you develop bladder cancer, you may have one, several or none of these risk factors.

    • Getting older. This is the main risk factor linked to bladder cancer. Around nine out of 10 people who have recently been diagnosed with bladder cancer are aged 55 or older.
    • Smoking. Tobacco smoke contains harmful chemicals that can damage the cells that line your bladder wall. In men, half of all bladder cancers are linked to smoking. The figure is slightly lower for women, where a third of all bladder cancers are linked to smoking.
    • Industrial chemicals. Contact with certain industrial chemicals that were used in the rubber, dye, aluminium, coal and roofing industries is another risk factor. If you’ve worked in these industries, you may be at more of a risk of getting bladder cancer.
    • Some types of medical treatment. These include:
      • some chemotherapy treatments
      • radiotherapy to your pelvis – you may have had this to treat prostate cancer
      • treatment with a drug called pioglitazone – a drug used to treat type 2 diabetes.
    • Having an inflamed bladder lining. This may be caused by either:
      • an infection – for example, with the parasite Schistosoma which causes schistosomiasis
      • having a permanent catheter inserted into your bladder – this might apply to you if you have a spinal injury.
    • Having a family history of bladder cancer. This can also mean that you’re more at risk of getting it. However, bladder cancer isn’t thought to be hereditary. This means there isn’t a specific gene that you can inherit or pass onto your children that will mean they’ll develop bladder cancer. Instead, it’s most likely that any family link is because your family are likely to share, or be exposed to, similar risk factors. However, scientists have found some differences in people’s genes that make them less able to deal with certain chemicals that can cause bladder cancer.
    • Drinking water that contains arsenic is also a risk factor.
  • Prevention Prevention of bladder cancer

    To prevent bladder cancer it’s a good idea, where you can, to avoid anything that has been linked to getting it. For example, if you smoke, stopping can reduce your risk of bladder cancer and a number of other cancers. Likewise, try to keep your contact with chemicals known to cause bladder cancer to a minimum.

    It’s also recommended that you increase the amount of fruit and vegetables that you eat. Having a hearty portion of fruit and vegetables plays a key part in keeping healthy.

    If you have had bladder cancer, preventing it from coming back is really important. It’s thought that eating foods containing vitamins A, B6, C and E can help. There’s less evidence for the benefit of using vitamin supplements. So, next time you’re looking to dish something up, try to incorporate some of the following foods into your meal:

    • vegetables – green leafy ones and peppers are rich in vitamins A and C
    • fruit – those with orange flesh such as apricots and mangos are a good source of vitamin A
    • oily and white fish – for example, salmon, mackerel and cod
    • poultry
    • eggs
    • nuts and seeds
    • wholegrains

    These are all good sources of the vitamins A, B6, C and E. If you would like some more information about what to eat if you’ve had or have cancer, take a look at our topic on having a healthy diet during and after cancer.

  • Urine tests and bladder cancer Can bladder cancer be detected with a urine test?

    Answer

    Bladder cancer is diagnosed by doing a cystoscopy and taking a biopsy (small sample of tissue) from your bladder wall. A urine test may help with your diagnosis.

    More information

    Urine tests can help with your diagnosis. They’re usually done to check for any blood that may not be visible to the naked eye and to look for any signs of infection. Blood in your urine is one of the key symptoms of bladder cancer, so checking for this is important. It’s also important that your urine is tested for infection as it could be this that is causing your symptoms, not bladder cancer.

    Urine tests can also be used to help diagnose bladder cancers that may be hard to see during a cystoscopy. To help diagnose these types of bladder cancer, a sample of your urine is taken and tested by a specialist to see if there are any cancerous cells in it.

    Other urine test kits that can help with your diagnosis are available. They check your urine for things that may suggest that you have bladder cancer. How helpful these tests are and when they should be used to diagnose bladder cancer isn’t well known, so they should not be used instead of cystoscopy. Cystoscopy is essential to diagnose bladder cancer and urinary tests should only be used with cystoscopy to help with your diagnosis.

  • Everyday life and bladder cancer Will treatment for bladder cancer affect my everyday life?

    Answer

    Yes, it’s possible. How you’re affected will depend on which type of treatment you’ve had.

    More information

    Most people with bladder cancer have the non-invasive type and have intravesical chemotherapy. This type of chemotherapy is put inside your bladder and may cause some irritation.

    If you have muscle-invasive bladder cancer, you’ll need whole body chemotherapy. This may cause you to lose your hair. If so, your doctor will warn you of this. Some people find this affects their confidence. You might prefer to cut your hair short or shave your head before you begin to lose your hair. You may choose to wear a wig, head scarf or soft hat. This can help in the summer to protect your head from the sun, and in the winter to keep it warm.

    Both chemotherapy and radiotherapy treatment can also make you feel tired. Try to be as active as possible. Using exercise programmes can be a good way to help you stay active through your treatment.

    If you have a cystectomy as part of your treatment, you will no longer have a bladder. Your surgeon will need to divert your urine so it can leave your body. There are a few different ways to do this. Some mean you will need to wear a bag (urostomy bag) on the outside of your body. Or you might have to drain your urine from a new area inside your abdomen (tummy), using a catheter.

    Regardless of which method is used, you’re going to feel and look a bit different after surgery. Most urostomy bags are very discreet and can’t be seen under clothing, so try not to let this affect you. If you like to swim, there’s no reason why you should stop. There are waterproof dressings available. Getting into a good routine to make emptying your urine a more natural part of your day may also help.

    Treatment for bladder cancer may affect your sex life. You’ll feel tired and if you have a cystectomy, you may have some physical changes after the procedure as well. If you’re a woman, your vagina might be shortened. This could make sex slightly painful. Also, as a result of the procedure, you may have some damage to nerves and blood vessels. This means you may not feel aroused or want to have sex. For men, getting an erection can be difficult after surgery. If you have erectile dysfunction, ask your doctor for advice on the different options available to you.

    If you’re diagnosed with bladder cancer and have been told that you’ll need treatment, it’s normal that you’ll feel worried or anxious. There will be lots for you to think about and decisions you’ll need to make. Coping with cancer can be hard, but there are specialist cancer doctors and nurses who are experts in providing the care and support you need. See our Other helpful websites section for links to organisations that can offer more advice.

  • Other helpful websites Other helpful websites

    Sources

    • Bladder Cancer. Patient Plus. www.patient.info/patientplus, reviewed July 2015.
    • Bladder cancer: Diagnosis and management. National Institute for Health and Care Excellence (NICE), February 2015. www.nice.org.uk
    • Bladder cancer. BMJ Best Practice. www.bestpractice.bmj.com, reviewed February 2015
    • Bladder anatomy. Medscape. www.emedicine.medscape.com, reviewed November 2013
    • Urinary bladder. Stedman's Medical Dictionary. www.medicinescomplete.com, accessed August 2015
    • Known and probable human carcinogens. American Cancer Society. www.cancer.org, reviewed February 2014
    • Bladder cancer. Medscape. www.emedicine.medscape.com, reviewed April 2014
    • Tumour grade. National Cancer Institute. www.cancer.gov, reviewed May 2013
    • Bladder cancer clinical presentation. Medscape. www.emedicine.medscape.com, reviewed October 2015
    • Urinary tract infection in males. Medscape. www.emedicine.medscape.com, reviewed October 2015
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), June 2015. www.nice.org.uk
    • Cystoscopy in bladder carcinoma. Medscape. www.emedicine.medscape.com, reviewed October 2013
    • Map of Medicine. Bladder cancer. International View. London: Map of Medicine; 2013 (Issue 4)
    • Sullivan P, Chan J, Levin M, et al. Urine cytology and adjunct markers for detection and surveillance of bladder cancer. Am J Transl Res 2010; 2(4):412–40
    • Bladder tumour resection. The British Association of Urological Surgeons. www.baus.org.uk, reviewed March 2014
    • Transurethral resection of bladder tumours: Overview of TURBT. Medscape. www.emedicine.medscape.com, reviewed July 2013
    • Cystoscopy in bladder carcinoma. Medscape. www.emedicine.medscape.com, reviewed October 2013
    • Bladder cancer treatment protocols. Medscape. www.emedicine.medscape.com, reviewed September 2013
    • Treatment of bladder cancer by stage. American cancer society. www.cancer.org, reviewed February 2015
    • General aspects of chemotherapy. PatientPlus. www.patient.info/patientplus, reviewed June 2014
    • Intravesical chemotherapy with mitomycin C. The British Association of Urological Surgeons. www.baus.org.uk, reviewed March 2014
    • Bacillus Calmette–Guerin immunotherapy for bladder cancer. Medscape. www.emedicine.medscape.com, reviewed may 2014
    • Bladder Cancer. The Merck Manuals. www.merckmanuals.com, reviewed November 2013
    • Bladder cancer. Royal College of Radiologists. www.rcr.ac.uk, published June 2006
    • Radiotherapy. PatientPlus. www.patient.info/doctor, reviewed January 2013
    • Genitourinary cancers. Oxford handbook of Oncology (online). Oxford Medicine Online. www.oxfordmedicine.com, published August 2015
    • Synopsis of causation: cancer of the bladder. UK Government. www.gov.uk, published September 2008.
    • Jian Gu and Xifeng Wu. Genetic susceptibility to bladder cancer risk and outcomes. Personalized Medicine 2011; 8(3):365–74
    • Hotaling J, Wright J, Pocobelli G, et al. Long-term use of supplemental vitamins and minerals does not reduce the risk of urothelial cell carcinoma of the bladder in vitamin and lifestyle study. J Urol 2011; 185(4):1210–215. doi:10.1016/j.juro.2010.11.081
    • Vitamins. British Nutrition Foundation. www.nutrition.org.uk, accessed September 2015
    • Coping with hair loss. Cancer Research UK. www.cancerresearchuk.org, reviewed March 2014
    • Coping with hair loss. Macmillan. www.macmillan.org.uk, reviewed February 2015
    • Fletcher L. Catheterization and urostomy for the community pharmacist. US Pharmacist. 2013; 38(8):27–30
    • Living with a urostomy. Urostomy Association. www.urostomyassociation.org.uk, reviewed May 2014
    • Miranda–Sousa A, Davila H, Lockhart J, et al. Sexual function after surgery for prostate or bladder cancer. Cancer Control 2006; 13(3):179–87
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