BLADDER CANCER

GENERAL INFORMATION

The bladder is a hollow muscular organ located in the lower part of the abdomen behind the pubic bone.

Bladder cancer is the 5th most common cancer in men. The lifetime risk of bladder cancer in Australia is 1 in 44 men and 1 in 154 women (Cancer Council of Australia). In 2007, there were 2217 new cases diagnosed in Australia and 925 deaths.

Invisible blood or asymptomatic microscopic haematuria is common. Approximately 1-15% of the people are affected by this condition, and it is often transient. About one-third of people will have a cause found when a urological assessment is undertaken, and up to one-tenth of people may have a serious condition, especially if they have voiding symptoms or risk factors that predispose to a diagnosis of kidney disease or urinary tract cancers. However, in the majority of patients, no cause or serious condition is found.

Visible blood or macroscopic is more alarming, and may be the first sign of a serious urological problem. People should seek medical advice as soon as possible if they notice a change in the colour of the urine or pass clots (blood may cause urine to look bright red, dark red, brown, wine-coloured or rusty).

SYMPTOMS

The following symptoms may be present if you have a bladder tumour:

Blood in the urine – pink, red or brown discolouration +/- clots
Urgency (difficulty holding on)
Frequency (urinating every 2 hours or less)
Nocturia (waking up more than once at night to urinate)
Dull pain in the lower pelvic area

CAUSES

Scientists still do not know what triggers the start of a cancer, and why some people get cancer whilst others don't. However research shows that patients who develop cancer may have certain common characteristics (risk factors) that may or may not directly cause, but increase the chance of getting the disease.

The following risk factors have been associated with bladder cancer:

Smoking
Increasing age
Male gender (incidence in females is higher after 80 years of age)
Radiation exposure or therapy
Occupational exposure to chemicals – hairdressers, pest controllers, textile or rubber manufacturers, heavy metal workers, petroleum industry
Cyclophosphamide (chemotherapy for lymphoma)
Chronic bladder irritation from infections or cathethers
Schistosomiasis (parasite in Middle Eastern or African lakes and rivers)

DIAGNOSIS

Urine test – positive for blood
Urine cytology – positive for cancer cells
Ultrasound scan – bladder mass or polyp seen
CT scan of the chest, abdomen and pelvis – to evaluate extent of cancer and possible spread to lymph nodes, liver, lungs or bone
Cystoscopy – minimally invasive test to visualise the bladder tumour internally

TREATMENT

Tumours or polyps in the bladder are almost always malignant (cancerous). Once a bladder tumour is suspected or confirmed, your urologist will remove the tumour under general or spinal anaesthetic. A transurethral resection of bladder tumour (TURBT) is performed through the natural opening of the bladder (urethra) through which you urinate. There are no incisions externally.

Once the pathologist has examined the tissue, they will classify the tumour into one of two major groups, NMIBC or MIBC (see below). Other details such as the type (transitional cell, squamous cell or adenocarcinoma) and appearance of the cancer cells will influence further treatment.

NON-MUSCLE INVASIVE BLADDER CANCER (NMIBC)

NMIBC involves the superficial lining of the bladder only, and does not penetrate deep into the bladder layers. A second TURBT may be required to confirm that absence of muscle involvement.

Your urologist will assess the following features:

Stage - Ta / T1
Grade – low or high
Presence of carcinoma-in-situ (CIS)
Tumour size
Number of tumours

These features are used to decide whether you will require:

Surveillance only with regular check cystoscopies
Instillation of chemotherapy drug into the bladder (Mitomycin, Epirubicin)
Instillation of immunotherapy drug into the bladder (BCG)

Once diagnosed with bladder cancer, there is high risk of recurrence, and surveillance will be required lifelong.

MUSCLE-INVASIVE BLADDER CANCER (MIBC)

MIBC is diagnosed when the cancer cells are found in the muscle layer of the bladder. In this situation, the cancer cannot be removed completely with a TURBT. This is a potentially fatal disease, with a danger of becoming incurable if it spreads outside the bladder. MIBC can be cured by surgery or radiation therapy, often combined with several cycles of chemotherapy.

Surgery will involve complete removal of the bladder (and prostate for a man) through an incision in the lower abdomen. The urine will need to be diverted into a neobladder (artificial bladder constructed by small bowel within the abdomen) or external bag (through a loop of bowel or ileal conduit, brought to the skin surface as a stoma). This treatment provides the best chance of cure and is standard therapy.

Radiation and chemotherapy is an alternative to surgery, and may be recommended if the patient has been counselled and chooses this option, or the risks of surgery are very high due to other medical problems.

RESOURCES

NCI Bladder Cancer information and online booklet

Better Heatlh Channel Bladder Cancer information sheet
betterhealth.vic.gov.au is the official Web site for the Better Health Channel. The BHC provides health and medical information, and is part of the Digital Strategy and Services Unit managed by the Department of Health, Victoria, Australia. This site is fully funded by the State Government and has no commercial advertising or corporate sponsorship.

Urology Care Foundation Bladder Cancer fact sheet
urologyhealth.org is the official Web site of the Urology Care Foundation, the official foundation of the American Urological Association. This site provides patients, health care professionals and caregivers with accurate and up-to-date educational materials about urologic problems.

Cancer Council Australia Coping with a Cancer Diagnosis information sheet and Helpline
cancer.org.au is the official Web site of Cancer Council Australia, a national non-government cancer control organisation that advises the Australian Government and other bodies on practices and policies to prevent, detect and treat cancer, and advocate for the rights of cancer patients for best treatment and supportive care.

UpToDate Blood in the Urine Overview
uptodate.com is the official Web site for UpToDate, a physician-authored clinical decision support resource that provides evidence-based recommendations to improve patient care and quality. This site does not accept funding from pharmaceutical companies, medical device manufacturers or other commercial entities.

Radiotherapy for Invasive Bladder Cancer
www.cancerresearchuk.org is the official Web site of Cancer Research UK, a cancer research charity organisation.

NKUDIC Haematuria fact sheet

Useful Information

NCI Booklet

BHC Fact Sheet

AUA Fact Sheet

Cancer Council

Haematuria

Radiotherapy

NKUDIC Fact Sheet

BCG Protocol

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