Definition Bladder cancer is a form of cancer affecting the internal lining of the bladder. Bladder cancer can be superficial or invasive.
What is going on in the body? Cancer occurs when a cell undergoes changes that cause it to grow and multiply uncontrollably. Eventually a tumour will form. The damage that leads to cancer in the bladder often affects more than one place in the bladder. More than one tumour in the bladder may develop at the same time. If not treated, a tumour will grow through the bladder. It will then spread to structures around the bladder in the abdomen. Cells from the tumour can also enter the blood stream and spread to distant parts of the body, a process known as metastasis.
What are the signs and symptoms of the disease? Blood in the urine without any other symptom may be the only sign. Sometimes the blood is not visible. It can only be seen when a urine sample is tested. Some people will have symptoms similar to a urinary tract infection, such as painful urination and an urgent need to urinate frequently. If the cancer has spread, or metastasised, then the symptoms will be related to the area affected.
What are the causes and risks of the disease? Use of tobacco products, smoking in particular, may lead to many cancers including bladder cancer. The cancer-causing chemicals are absorbed in the lungs and then excreted into the urine. While the urine is held in the bladder until voided, the lining of the bladder is exposed to concentrated amounts of these poisons for long periods. This is why more than one area of the bladder can be affected. Other chemicals such as aniline dyes and other industrial chemicals are known to cause similar damage.
Known risk factors include:
occupational exposure to chemicals. Occupations associated with an increased risk of bladder cancer:
consuming drinking water contaminated with pesticides
consuming highly chlorinated drinking water
What can be done to prevent the disease? Avoiding exposure to tobacco products will help prevent this and other cancers. When working with chemicals at work or at home, a person should take precautions to avoid contamination.
How is the disease diagnosed? Often a person who sees blood in the urine will see a doctor. A urine sample will be checked for cancer cells. An x-ray of the bladder, called intravenous urogram (IVU), is routinely part of the diagnostic work-up. The doctor may also do a cystoscopy, looking at the inside of the bladder with a small telescope (cystoscope). If a tumour is seen, the doctor will do a biopsy to take a piece of it for examination. If the cancer is confirmed, more surgery may be necessary to investigate how deep the cancer has grown into the bladder wall. Other studies such as CT scans may be done to determine the extent of the problem, which is known as staging.
What are the long-term effects of the disease? Five-year survival rates for early superficial bladder cancer are as high as 90%. Early detection saves lives. Bladder cancer is fatal if not successfully treated.
What are the risks to others? There is no risk to others.
What are the treatments for the disease? With superficial tumours endoscopic surgery with the cystoscope to remove as much of the bladder cancer as possible is the primary treatment. Removing the entire bladder is not always necessary if the tumours are superficial and have not penetrated through the bladder wall.
After diagnosis, medications such as certain chemotherapy drugs or a biological response modifier called BCG can be instilled into the bladder. The entire surface of the bladder will be treated. Any remaining cancers will be bathed in the medications. Often this treatment is successful, and no further surgery is necessary.
Sometimes the entire bladder must be removed particularly if the tumour has invaded the bladder muscle. When this happens, urine will be diverted to an external collection pouch in a surgical procedure known as a urostomy. Sometimes a new bladder can be reconstructed with bowel to avoid a urostomy. If the cancer has spread to other parts of the body, then chemotherapy or radiation therapy will be given to control the growth of the cancer. Advanced bladder cancer is not curable.
What are the side effects of the treatments? Surgery to remove superficial tumours followed by instillation of medications can be uncomfortable. The person will be tired. The discomfort will resolve when the treatments are completed. Other side effects can be easily managed and will be specific to the medications used. If the bladder is removed, the person will need to adjust to the appliance. This can be psychologically distressing. With support and understanding, the person can return to a normal life. For persons with advanced disease, the chemotherapy may be rigorous but the side effects manageable. Specific side effects depend on the medications chosen.
What happens after treatment for the disease? A person who has early stage bladder cancer will have the inside of the bladder examined at regular intervals along with urine testing. Over time, the frequency of examinations will decrease if the cancer does not return. People with advanced cancer will be followed with CT scans and other x-rays to determine the response of the cancer to the treatment.
How is the disease monitored? In the early stages, examining the inside of the bladder is the most effective way to monitor response. Urine samples can indicate if cancer cells have shed from tumours not visible in the examination. For later stage disease, diagnostic studies such as x-rays are the most helpful.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 19/05/2005 Contributors Potential conflict of interest information for reviewers available on request
