Bladder cancer

Bladder cancer is the growth of abnormal tissue (tumour)  in the bladder. It is not contagious. A tumour that grows towards the centre of the bladder without growing into the muscle tissue of the bladder is non–muscle invasive. These tumours are superficial and represent an early stage. This is the most common type of bladder cancer. In most cases, these tumours are benign and rarely spread to other organs, so they are not usually lethal. 

As the cancer grows into the muscle of the bladder and spreads into the surrounding muscles, it becomes muscle- invasive bladder cancer. This type of cancer has a higher chance of spreading to other parts of the body (metastatic) and is harder to treat. 

In some cases, it may be fatal. If bladder cancer spreads to other parts of the body such as the lymph nodes or other organs, it is called locally advanced or metastatic bladder cancer. At this stage, cure is unlikely, and treatment is limited to controlling the spread of the disease and reducing the symptoms.

How can I prevent bladder cancer?

Several biological factors and harmful substances  can increase the risk of developing bladder cancer. A higher risk does not necessarily mean that someone gets cancer. Sometimes bladder cancer develops without any known cause. 

Risk factors for bladder cancer:

Age: Bladder cancer develops slowly and is more common in older people (age 60 and older). 

Tobacco use: Smoking contains many harmful substances and is responsible for almost half of bladder cancer cases. 

Occupational chemical exposure: Chemicals used in the production of paint, dye, metal and petroleum have been associated with bladder 

Infections: Certain viruses, bacteria, or parasites and chronic urinary tract infections increase risk of developing bladder cancer. 

It is important to maintain a healthy lifestyle. If you smoke, try to stop. Follow workplace safety rules and avoid exposure to harmful chemicals. Some evidence suggests that drinking a lot of fluids, mainly water, might lower bladder cancer risk. Eating a balanced diet with lots of fruits and vegetables has health benefits and might protect against cancer. If you have questions or need support to maintain a healthy lifestyle, ask your health care team for assistance or referrals.

What are the symptoms of bladder  cancer? 

Blood in the urine is the most common symptom when  a bladder tumour is present. Tumours in the bladder lining (non–muscle-invasive) do not cause bladder pain and rarely present with lower urinary tract symptoms (need to urinate, irritation). If you have urinary tract symptoms such as blood in 

the urine, painful urination or need to urinate more  often, a malignant tumour might be suspected, particularly if treatment does not reduce the symptoms. Muscle-invasive bladder cancer can cause symptoms as it grows into the muscle of the bladder and spreads into the surrounding muscles. 

If you have a more advanced tumour, you may experience additional symptoms like pelvic pain, pain in the flank, and weight loss, or you might be able to feel a mass in the lower abdomen.

The urinary bladder (referred to as ‘the bladder’) is the organ that collects and stores urine produced by the kidneys. It is a hollow stretchy bag made of muscle  tissue that sits on the pelvic floor muscles. The bladder expands as urine from the kidneys collects before being passed out of the body through the urethra. 

Several biological factors and harmful substances  can increase the risk of developing bladder cancer. A higher risk does not necessarily mean that someone gets cancer. Sometimes bladder cancer develops without any known cause.

Because blood in the urine is the most common  symptom when a bladder tumour is present, your doctor will test your urine to look for cancer cells and to exclude other possibilities like urinary tract infections. Your doctor will take a detailed medical history and ask questions about your symptoms. Physical examination does not reveal non–muscle-invasive bladder cancer, but you might be able to feel a mass if cancer has advanced to the muscle-invasive stage. If muscle-invasive bladder cancer is suspected, your doctor should perform rectal and, for women, vaginal examinations by hand (bimanual palpation). In addition, your doctor will do a series of tests to make the diagnosis. Advanced diagnostic tools include: 

• CT urography

• Intravenous urography

• Transabdominal ultrasound

• Cystoscopy

• Transurethral resection (removal) of bladder tumours (TURBT) 

• Photodynamic diagnosis

• Narrow-band imaging  CT and magnetic resonance imaging (MRI scan) are the techniques used for staging invasive bladder cancer. 

A combination of positron emission tomography (PET scan; uses a radioactive tracer) and CT is increasingly being used at many centres in Europe to enhance the ability of detecting the spread of bladder cancer to the lymph nodes or other organs, mainly in difficult sites like bone. 

Most imaging tests are done from outside the body  (noninvasive) and do not hurt. Some imaging tests use a contrast agent that is injected into a vein and can cause an allergic reaction. Tell your doctor about any allergies that you have. Tests that require the insertion of instruments inside the body (invasive) require local or general anaesthesia and may cause some bleeding and infections. Drinking an additional 500 mL per day (eg, two extra glasses of water) will help dilute the urine and flush out the blood. You might also have painful urination or have to urinate more often or more urgently. These short-term effects will pass. If they persist for more than 2 days, you might have a urinary tract infection and should contact your doctor.

Tumour stage and subtype are based on whether or  not the cancer is limited to the bladder (localisation) and the degree to which the tumour has invaded the bladder wall. This information is important for determining the risk of recurrence of the disease. During examination of tissue under a microscope (histological analysis), the pathologist will grade the tumours according to their potential to grow (aggressiveness). 

High-grade tumours are more aggressive, and tissue is greatly altered in appearance. 

Lowgrade tumours are less aggressive, and tissue is mildly altered in appearance. Based on your personal characteristics, your disease stage and grade, and study-based data from bladder cancer risk tables, you will be assigned to one of three risk groups—low, intermediate, or high risk—based on your risk of recurrence and progression. This risk stratification is used to determine the treatment options that can be offered and the follow-up that will be needed. 

TURBT is the surgical removal of bladder tumours.  It used to take tissue samples for diagnosis and, if appropriate, to treat non–muscle-invasive disease. TURBT is performed by the insertion of a rigid endoscope through the urethra into the bladder, with the patient under general anaesthesia (combination of intravenous drugs and inhaled gasses; you are ‘asleep’). TURBT usually takes no longer than 1 hour and requires a short hospital stay. After the operation, in some cases, a transurethral catheter is placed for a few days. As with any surgical procedure, there are risks of complications. Complications after TURBT include bleeding, infection, perforation of the bladder wall (rare but can happen when the tumour is removed from deep within the bladder), blood in the urine, and blockage of the urethra due to blood clots. 

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