What is Bladder Cancer? It’s Causes, Treatment & Diagnosis

An Informative Guide To Diagnosis of Bladder Cancer

Facing a bladder cancer diagnosis is tough. Receiving a cancer diagnosis is likely to leave you dealing with a complex state of emotions. But you definitely would not be alone.

In 2015, 2747 new cases of bladder cancer were diagnosed in Australia. Bladder cancer is common in people over 60, and is significantly more common in men than in women.

At Katelaris Urology, (we deal with a number of different treatment methods for bladder cancer.) Whilst we can’t wave a magic wand and make it disappear, we can help you through this difficult experience by giving you the right information to understand your situation and get you through to the next steps.

Bladder Cancer Symptoms

The most common symptom of Bladder cancer is blood in the urine, which occurs suddenly and is not generally painful. Other symptoms may be;

  • A burning sensation during urination
  • A need to urinate frequently/urgently
  • Problems emptying the bladder
  • Lower abdominal or back pain.

What is bladder cancer?

Bladder cancer occurs when a tumour develops in the bladder lining or muscle. A tumour in the bladder occurs when abnormal cells grow and divide in an uncontrolled way. Generally speaking, there are three types of bladder cancer.

Superficial Bladder Cancer

Formally known as transitional cell carcinoma (TCC), this is the most common form of bladder cancer (80-90%) and starts in the urothelial cells in the bladder wall’s innermost layer. Essentially, this means the cancerous cells are contained inside the bladder lining.
There are three types of non-muscle invasive or superficial bladder cancer;

  1. Non-invasive
    These cancers grow from the cavity of the bladder like coral growing on a reef. They vary in size and can grow quite large, but the risk of them turning into invasive cancers is only around 5%.

    These tumours’ are shaved off under a general anesthetic. Unfortunately, they do have a tendency to recur after removal in around 50-70% of patients, and occasionally can be difficult to control.

    For patients with large tumours, frequent recurrences or adjacent areas of carcinoma, further treatment by the flushing of drugs into the bladder is required.
  2. Superficially invasive
    This cancer begins in the thin, flat cells that line the bladder. The cancerous cells have begun to invade into the deeper layers of the bladder wall lining and pose a risk of spreading elsewhere in the body.

    Around 30-50% of these tumours will progress to muscle-invasive tumours and following a Trans-Urethral Resection of the Bladder Tumour (TURBT) with the flushing of drugs or immunotherapy into the bladder.
  3. Carcinoma in situ (CIS)
    CIS is when the lining of the bladder transforms into flat areas of cancer cells that have not begun to invade through the bladder wall or formed a growth. It appears as flat, red, inflamed areas or may not be visible to the naked eye at all.

    CIS is when the lining of the bladder transforms into flat areas of cancer cells that have not begun to invade through the bladder wall or formed a growth. It appears as flat, red, inflamed areas or may not be visible to the naked eye at all.

    This is also why CIS cannot be surgically removed, as it is not possible to see where it starts and stops and attempting removal may affect other areas of the bladder.

Most diagnoses of this form of bladder cancer don’t change the patient’s life expectancy, allowing them a relatively normal lifestyle with the appropriate treatment methods.

Muscle-invasive Bladder Cancer

This is when the cancerous cells spread beyond the lining and into the surrounding muscle.

Whilst less common, unfortunately muscle-invasive bladder cancer is a life-threatening cancer as it has invaded into the muscle of the bladder and is at risk of spreading to lymph nodes and other distant organs via the bloodstream.

To surgically remove these tumours requires complete removal of the bladder, this procedure is called a radical cystectomy. Another treatment method for muscle-invasive bladder cancer is a combination of chemotherapy and radiotherapy.

What causes bladder cancer?

Like many forms of cancer, the cause of bladder cancer isn’t always known. There are however factors that increase the chances of developing bladder cancer.

  • Smoking
    This is the most common risk factor for bladder cancer. Smoking over long periods of time exposes the bladder to harmful chemicals. Chemicals inhaled are excreted by the kidneys and expose the lining of the urinary tract to an increased cancer risk.
  • Exposure to Chemicals
    Exposure to certain industrial chemicals such as aniline dyes, 2-Naphthylamine, 4-Aminobiphenyl, xenylamine, benzidine and o-toluidine can cause cancer. Many manufacturing workers have been known to develop bladder cancer as a result of continuous exposure to such chemicals and fumes.
  • Drugs
    Old fashioned headache tablets (phenacetin), certain chemotherapy agents (e.g. cyclophosphamide) ·
  • Radiotherapy to the pelvis
  • Longstanding inflammation within the bladder
    e.g. from a long-term catheter
  • Other rare conditions
    eg. schistosomiasis (disease endemic in parts of Africa and the Middle East which can infect the urinary tract)
  • Diabetes
  • Family history
  • Chronic inflammation of the bladder.

 What happens after a bladder cancer diagnosis?

Once you have been diagnosed, your doctors will investigate further to determine the extent (stage and grade) of cancer.

In most cases, you will have a cystoscopy. This is a five-minute procedure which involves passing a thin tube and camera through your urethra to examine the bladder.

Any or all of these procedures will help your doctors to identify the extent of the cancer and determine the best course of action.

Bladder Cancer Treatment Methods

Like most cancers, bladder cancer treatment comes in various forms. Which treatment you receive will depend on the type, stage and grade of cancer. There are a number of Treatment methods for Bladder cancer;

Trans-Urethra, Resection of the Bladder Tumour (TURBT)

TURBT is the first step for treatment of all bladder cancers. It involves the removal of the tumour using a resectoscope passed through the urethra. The cancer is removed by shaving away as much of the tumour as possible.

The shavings of tumour are washed out of the bladder for analysis and any bleeding is controlled with cautery.

Intravesical Therapy

Only suitable for superficial bladder cancers, Intravesical therapy treatment is the flushing of the bladder with a drug to kill any remaining cancer cells and prevent the recurrence of treated bladder tumours.

Intravesical treatments is given by inserting a urethral catheter and flushing dissolved medication into the bladder. This treatment runs a course that is performed weekly as a procedure in hospital usually for 6 weeks.

There are two main types of intravesical treatments, namely Bacille Calmette- Guerin (BCG) and Intravesical Chemotherapy.

Other treatment methods for the less common, more invasive strains of bladder cancer include radical cystectomy removal of the bladder), radiotherapy or immunotherapy.

What to do next?

Once you have been diagnosed, your doctor will most schedule another appointment where they will discuss your various options. Take someone with you and ask them to take notes as the information can be overwhelming.

Although hearing you, or a loved one may have cancer is a frightening experience, try not to panic. There are a number of treatment methods at your disposal. Listen to your doctor and don’t be afraid to ask plenty of questions.

For more answers about Bladder Cancer, or other urological issues, contact Dr Katelaris at Katelarisurology.com.au.