Bladder cancer and how it is treated

THE earliest symptom of bladder cancer is blood in the urine. In most cases, the cancer is confined to the inside lining of the bladder. Treatment of these superficial bladder cancers is relatively easy and often curative. If the cancer has spread into or through the muscle layer of the bladder wall then treatment is less likely to be curative. Treatment can, however, often slow the progress of the cancer.

The bladder is part of the urinary system. It is a hollow, muscular and elastic organ found in the lower part of your belly (abdomen). The bladder collects and stores urine. Urine is made in the kidneys and passes through tubes called ureters to the bladder. When the bladder is full, urine is passed from the body through a tube called the urethra. The bladder has a number of layers. The innermost layer has a special lining that prevents urine being reabsorbed into the body. It also allows the bladder to stretch. This lining has cells called transitional cells. The other layers are made up of connective tissue, muscle and fat.

Bladder cancer is a common cancer and can occur in both men and women. In 2007, there were over 400 cases of bladder cancer diagnosed in Ireland. In most cases, bladder cancer develops from the transitional cells which line the inside of the bladder (as mentioned above). This type of cancer is called transitional cell bladder cancer. Other types of bladder cancer are rare.

How is it caused? A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and it then multiplies out of control. In many cases, the reason why a bladder cancer develops is not known. However, there are factors which are known to increase the risk of bladder cancer developing. These include increasing age, smoking, various chemicals in some workplaces, gender (it is about three times more common in men than in women), ethnic background (bladder cancer is more common in white people than in black people) or the schistosomiasis infection.

Repeated bouts of other types of bladder infection may also slightly increase the risk in some people.

In most cases, the first symptom noticed is the presence of blood in your urine (haematuria). Haematuria caused by an early bladder tumour is usually painless. You should always see your doctor if you pass blood in your urine. The blood in your urine may come and go as the tumour bleeds from time to time.

Some tumours may cause irritation of the bladder and cause symptoms similar to a urine infection. For example, passing urine frequently or pain on passing urine. If the cancer is a muscle-invasive type, and grows through the wall of the bladder, other symptoms may develop over time. For example, pain in the lower tummy (abdomen). If the cancer spreads to other parts of the body, various other symptoms can develop.

If initial tests confirm that the cancer is a superficial tumour then no further tests may be necessary. Superficial bladder tumours have a low risk of spread to other parts of the body.

However, if you have a muscle-invasive tumour, further tests may be advised in order to assess if the cancer has spread or not. For example, a CT scan, a magnetic resonance imaging (MRI) scan or other tests. This assessment is called staging of the cancer.

Treatment options depend on whether or not the cancer is contained within the bladder. Most superficial cancers are removed with a cystoscope via transurethral resection (TUR). Following this it is usual for patients to have at least one dose of chemotherapy which is delivered directly into the bladder (intravesical) and removed after a few hours. The aim is to kill any cancer cells that have been left behind following the TUR. The tumour that is removed during TUR is examined under the microscope. This enables the exact stage and type of the tumour to be determined. Depending on the stage and type of the cancer, further intravesical chemotherapy may be advised.

After a superficial tumour is removed, you will need a cystoscopy every so often. A return of a tumour occurs in some cases, and routine check cystoscopies will detect these at an early stage.

For muscle invasive tumours, or tumours which have spread outside the bladder wall, treatment options that may be considered include surgery, chemotherapy and radiotherapy.

With superficial bladder tumours. there is a good chance of cure with treatment.

With muscle-invasive bladder tumours. a cure is less likely than with a superficial tumour. As a rule, the earlier the stage of the tumour, the better the chance of a cure with the treatments listed above. However, even if it is not cured, treatment can often slow down the progression of the cancer.

For further information visit cancer.ie.