Bladder Cancer

Bladder cancer is a complex and serious condition affecting the urinary system, which can lead to substantial morbidity and mortality if not detected and treated in a timely manner. Discover the causes and symptoms of bladder cancer and how this condition can be diagnosed and treated.

What is Bladder Cancer?

Bladder cancer is a type of cancer that begins in the cells of the bladder, the hollow organ in the lower abdomen that stores urine. Bladder cancer typically starts in the urothelial cells lining the inner surface of the bladder but can also develop in other types of cells in the bladder, such as squamous cells or glandular cells. Bladder cancer is more common in men than in women.

Causes

The exact cause of bladder cancer is not fully understood, but several factors may increase the risk of developing the disease:

• Tobacco Smoke: Tobacco smoke, including cigarette smoke, cigar smoke, and pipe smoke, is the leading cause of bladder cancer. Smoking tobacco is responsible for the majority of bladder cancer cases worldwide, and long-term smokers are at significantly higher risk of developing the disease than nonsmokers.
• Occupational Exposure: Exposure to carcinogens and hazardous substances in the workplace, such as aromatic amines, polycyclic aromatic hydrocarbons (PAHs), aniline dyes, benzene, or certain chemicals used in the rubber, textile, leather, or chemical industries, may increase the risk of bladder cancer.
• Chemical Exposure: Exposure to certain chemicals or toxins in the environment, such as arsenic, chlorinated drinking water, diesel exhaust, or industrial pollutants, may increase the risk of bladder cancer, particularly among individuals with prolonged or high levels of exposure.
• Age: The risk of bladder cancer increases with age, with the majority of cases diagnosed in adults over the age of 55. However, bladder cancer can occur at any age, including in younger adults and adolescents.
• Gender: Bladder cancer is more common in men than in women, although the incidence rates are increasing in both sexes. The reasons for the gender disparity in bladder cancer are not fully understood but may be related to differences in smoking habits, occupational exposures, hormonal factors, or genetic predisposition.
• Chronic Bladder Inflammation: Chronic inflammation of the bladder, such as from recurrent urinary tract infections (UTIs), bladder stones, urinary catheterization, or chronic bladder irritation, may increase the risk of bladder cancer.
• Bladder Birth Defects: Certain congenital or developmental abnormalities of the bladder, such as bladder diverticula, bladder exstrophy, or ureteral reflux, may increase the risk of bladder cancer later in life.
• Personal History: Individuals who have had bladder cancer in the past are at increased risk of developing a new cancer in the bladder or a recurrence of the original cancer, particularly if they have a history of non-muscle invasive bladder cancer (NMIBC) or certain types of bladder cancer.
• Family History: A family history of bladder cancer may increase the risk of developing the disease, particularly among first-degree relatives (such as parents, siblings, or children) of individuals with bladder cancer.
• Genetic Factors: Certain genetic factors or inherited predispositions may increase the risk of bladder cancer, although the specific genes involved and their exact roles are still being studied.

Symptoms

Bladder cancer may cause symptoms, but they are often nonspecific and may be similar to symptoms of other urinary tract conditions. Common symptoms of bladder cancer may include:

• Blood in Urine: Haematuria, or blood in the urine, is the most common symptom of bladder cancer and may cause urine to appear pink, red, or cola-coloured. Blood in the urine may be intermittent or persistent and may be accompanied by pain, discomfort, or urgency.
• Urinary Symptoms: Changes in urinary habits, such as increased frequency of urination, urgency to urinate, pain or burning during urination (dysuria), or difficulty emptying the bladder, may occur with bladder cancer.
• Pelvic Pain: Pelvic pain or discomfort, which may be dull, achy, or sharp in nature, and may be felt in the lower abdomen, pelvis, or back.
• Urinary Tract Infections: Recurrent urinary tract infections (UTIs) or bladder infections that do not respond to treatment or occur in the absence of known risk factors may be a sign of underlying bladder cancer.
• Urinary Retention: Difficulty urinating or incomplete emptying of the bladder, which may lead to urinary retention, urinary urgency, or urinary incontinence.
• Pelvic Mass: Palpable mass or swelling in the lower abdomen or pelvis, particularly if it is firm, irregular, or fixed in location.
• Bone Pain: Bone pain, particularly in the pelvis, hips, spine, or ribs, may occur if bladder cancer spreads to the bones (bone metastases).
• Lymph Node Enlargement: Enlarged lymph nodes in the groin, pelvis, or abdomen, which may be felt as firm, swollen, or tender, if bladder cancer spreads to nearby lymph nodes.
• Systemic Symptoms: Systemic symptoms such as unexplained weight loss, loss of appetite, fatigue, weakness, or fever may occur in advanced or metastatic bladder cancer.

It is important to note that these symptoms can also be caused by other conditions, such as urinary tract infections, kidney stones, benign prostatic hyperplasia (BPH), or bladder inflammation, and experiencing one or more of these symptoms does not necessarily mean that a person has bladder cancer. However, if symptoms persist or worsen over time, it is important to see a doctor for evaluation and diagnosis.

Diagnosis and Evaluation

If bladder cancer is suspected based on symptoms, physical examination, or imaging findings, diagnostic tests and evaluations may be performed, which may include:

• Urinalysis: Urinalysis involves analysing a urine sample for the presence of blood, protein, bacteria, or abnormal cells that may indicate the presence of bladder cancer.
• Urine Cytology: Urine cytology involves examining a urine sample under a microscope to detect abnormal cells shed from the bladder lining that may indicate the presence of bladder cancer.
• Cystoscopy: Cystoscopy is a procedure that uses a flexible tube with a camera (cystoscope) to visualize the inside of the bladder and collect tissue samples (biopsy) from suspicious areas for microscopic examination. Cystoscopy is the gold standard for diagnosing bladder cancer and determining the location, size, and extent of the tumour.
• Imaging Studies: Imaging studies such as ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan may be performed to evaluate for the presence of tumours, detect metastases, or assess treatment response.
• Biopsy and Pathologic Evaluation: If bladder cancer is suspected based on imaging studies or cystoscopic findings, a biopsy may be performed to obtain tissue samples from the bladder for microscopic examination. Pathologic examination helps determine the type, stage, grade, and molecular characteristics of the cancer, which are important factors for treatment planning and prognosis.

Staging and Evaluation

Once a diagnosis of bladder cancer is confirmed, further staging and evaluation may be performed to determine the extent of the disease and guide treatment decisions. Staging may include:

• Transurethral Resection of Bladder Tumour (TURBT): TURBT is a surgical procedure that involves removing the bladder tumour or tumours using a cystoscope inserted through the urethra. TURBT may be performed for both diagnostic and therapeutic purposes and allows for the examination of the tumour under a microscope to determine its characteristics and extent.
• Imaging Studies: Additional imaging studies such as CT scan, MRI, PET scan, or bone scan may be ordered to evaluate for metastases, detect involvement of adjacent organs or lymph nodes, or assess treatment response.
• Lymph Node Evaluation: Assessment of lymph node involvement is an important part of bladder cancer staging. Lymph nodes in the pelvis, abdomen, or groin may be evaluated using imaging studies, cystoscopic examination, or surgical lymph node dissection to determine if cancer has spread to nearby lymph nodes.

Treatment and Management

Treatment for bladder cancer depends on various factors, including the type, stage, grade, histologic subtype, molecular characteristics, extent of the disease, and the patient’s age, overall health, and preferences. Treatment options may include:

• Transurethral Resection: Transurethral resection of bladder tumour (TURBT) is the primary treatment for non-muscle invasive bladder cancer (NMIBC) and involves removing the tumour or tumours from the bladder lining using a cystoscope inserted through the urethra. TURBT may be combined with other treatments such as intravesical therapy or immunotherapy to reduce the risk of recurrence.
• Intravesical Therapy: Intravesical therapy involves instilling medications directly into the bladder through a catheter to treat or prevent recurrence of non-muscle invasive bladder cancer (NMIBC). Intravesical therapy may include chemotherapy drugs (such as mitomycin C or gemcitabine) or immunotherapy agents (such as Bacillus Calmette-Guérin [BCG]).
• Partial Cystectomy: Partial cystectomy is a surgical procedure that involves removing a portion of the bladder containing the tumour while preserving the rest of the bladder. Partial cystectomy may be considered for selected patients with localized bladder cancer or tumours located in the bladder dome or anterior wall.
• Radical Cystectomy: Radical cystectomy is a surgical procedure that involves removing the entire bladder, nearby lymph nodes, and surrounding tissues (such as the prostate, seminal vesicles, uterus, ovaries, or part of the urethra) for invasive or advanced bladder cancer. Radical cystectomy may be followed by urinary diversion surgery to create a new way for urine to be stored and eliminated from the body.
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells or inhibit their growth and may be used alone or in combination with surgery or radiation therapy for both non-muscle invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). Chemotherapy may be administered intravesically (directly into the bladder) or systemically (by mouth or intravenously) and may be given before or after surgery or radiation therapy.
• Radiation Therapy: Radiation therapy uses high-energy beams of radiation to destroy cancer cells or shrink tumours and may be used as a primary treatment for muscle-invasive bladder cancer (MIBC), as adjuvant therapy (after surgery) to reduce the risk of recurrence, or as palliative therapy to relieve symptoms or control advanced disease.
• Immunotherapy: Immunotherapy drugs such as immune checkpoint inhibitors or Bacillus Calmette-Guérin (BCG) may be used to stimulate the immune system to recognize and attack cancer cells in the bladder. Immunotherapy may be used in certain cases of non-muscle invasive bladder cancer (NMIBC) to prevent recurrence or progression to invasive disease.
• Targeted Therapy: Targeted therapy drugs that target specific molecular pathways or genetic mutations involved in bladder cancer growth and progression may be used to block tumour growth, prevent angiogenesis (formation of new blood vessels), or overcome resistance to chemotherapy. Targeted therapy drugs may include FGFR inhibitors, EGFR inhibitors, or other molecularly targeted agents.
• Palliative Care: Palliative care focuses on providing relief from symptoms, pain, and stress associated with cancer and its treatment, and may be provided concurrently with curative or life-prolonging therapies. Palliative care aims to improve quality of life, relieve suffering, and support patients and their families throughout the cancer journey.
• Clinical Trials: Participation in clinical trials may offer access to novel treatments, experimental therapies, or investigational drugs that are being evaluated for safety and efficacy in the treatment of bladder cancer. Clinical trials help advance scientific knowledge and may provide potential benefits to participants.

Follow-Up and Monitoring

After treatment for bladder cancer, regular follow-up visits with your doctor, urologist, medical oncologist, or radiation oncologist are essential to monitor treatment response, assess disease recurrence, and address any complications or side effects. Monitoring may include:

• Cystoscopy: Regular cystoscopic examinations may be performed to evaluate for recurrence, detect new bladder tumours, or assess treatment response.
• Imaging Studies: Follow-up imaging studies such as CT scan, MRI, PET scan, or bone scan may be ordered to evaluate for recurrence, detect metastases, or assess treatment response.
• Urinalysis and Urine Cytology: Periodic urinalysis and urine cytology tests may be performed to monitor for the presence of blood, abnormal cells, or signs of recurrence.
• Lymph Node Evaluation: Assessment of lymph node involvement may be performed using imaging studies, cystoscopic examination, or surgical lymph node dissection to evaluate for metastases or lymph node recurrence.
• Symptom Assessment: Your doctor will ask about any changes in symptoms, such as urinary habits, pelvic pain, blood in the urine, or systemic symptoms, during follow-up visits.
• Blood Tests: Periodic blood tests may be monitored to assess for signs of disease recurrence, evaluate treatment response, or detect any treatment-related side effects.
• Supportive Care: Supportive care services, such as nutritional counseling, pain management, bladder rehabilitation, or psychosocial support, may be offered to help manage symptoms, improve quality of life, and address the physical, emotional, and social needs of patients and their families.

Prevention and Risk Reduction

While the exact cause of bladder cancer is not fully understood, several strategies may help reduce the risk of developing the disease:

• Tobacco Cessation: Quitting smoking and avoiding exposure to second-hand smoke are the most important steps to reduce the risk of bladder cancer. Smoking cessation programs, nicotine replacement therapy, medications, counselling, or support groups may be helpful for individuals trying to quit smoking.
• Occupational Safety: Minimizing exposure to carcinogens and hazardous substances in the workplace, such as aromatic amines, polycyclic aromatic hydrocarbons (PAHs), or certain chemicals used in the rubber, textile, leather, or chemical industries, can help reduce the risk of bladder cancer. Employers should implement workplace safety measures to protect workers from occupational exposures.
• Chemical Safety: Using protective equipment, following safety guidelines, and practicing proper hygiene when handling chemicals or toxins in the environment can help reduce the risk of bladder cancer from chemical exposure.
• Hydration: Drinking plenty of fluids and maintaining good hydration may help dilute urine and reduce the concentration of carcinogens or toxins in the bladder, thereby reducing the risk of bladder cancer.
• Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, and limiting intake of processed foods, red meat, saturated fats, and added sugars may help reduce the risk of bladder cancer and improve overall health.
• Hygiene Practices: Practicing good hygiene, such as emptying the bladder regularly, avoiding prolonged bladder retention, and maintaining urinary tract health, may help reduce the risk of bladder infections or chronic bladder inflammation, which are associated with bladder cancer.
• Regular Screening: Regular screening and surveillance for individuals at high risk of bladder cancer, such as current or former smokers, may help detect bladder cancer at an early stage when it is most treatable. Screening tests may include urine cytology, cystoscopy, imaging studies, or molecular markers.

Conclusion

Bladder cancer is a complex and challenging disease that affects the urinary system and may cause significant morbidity and mortality if not diagnosed and treated promptly.

While the exact cause of bladder cancer is not fully understood, several factors such as tobacco smoke, occupational exposure, age, gender, and genetic predisposition may increase the risk of developing the disease.

Bladder cancer often presents with nonspecific symptoms such as blood in the urine, urinary symptoms, pelvic pain, or systemic symptoms, which may lead to delayed diagnosis or misdiagnosis. If bladder cancer is suspected based on symptoms, imaging findings, or diagnostic tests, prompt evaluation, diagnosis, and treatment are essential to improve outcomes and prevent disease progression. T

reatment options for bladder cancer depend on various factors, including the type, stage, grade, and molecular characteristics of the cancer, and may include surgery, chemotherapy, radiation therapy, immunotherapy, or targeted therapy. Prevention strategies such as tobacco cessation, occupational safety measures, chemical hygiene practices, hydration, healthy diet, regular screening, and surveillance can help reduce the risk of bladder cancer and improve overall health.

Arranging To Visit A Private GP

To discuss any worrying symptoms that could be an indication of bladder cancer make an appointment with one of our private GPs. Appointments are available to everyone and can often be booked for the same day. There is no need to be registered with our Buckinghamshire hospital, or live locally.

If you have insurance which covers a GP visit, we can in most cases invoice the insurer directly. Where you are paying directly, the cost for a 30 minute consultation is £125.

Any additional costs will always be discussed. They could apply if you are referred for an MRI scan, or to a consultant, or for other agreed decisions to support your health.

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