This information is intended to provide a general overview of bladder cancer. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health.
Bladder cancer is a disease of the urinary tract that begins in the bladder, a hollow, elastic, and muscular organ in the lower abdomen that stores urine. Urine is produced when the kidneys filter the blood and travels to the bladder through tubes called ureters, before leaving the body through the urethra.
The cancer starts in the innermost lining of the bladder and can grow into the muscular walls, which usually necessitates more aggressive treatment. Although bladder cancer has a high rate of recurrence, estimated at 50% to 80%, the disease is generally treatable, with over 77% of patients surviving at least five years after diagnosis. This high recurrence rate is thought to be due to the fact that the pre-cancerous conditions often impact the entire organ.
Bladder cancer is classified by the type of cell in which it originates. The main types include:
Also known as transitional cell bladder cancer, this is the most common type, accounting for about 90% of cases. It begins in the urothelial cells that line the inside of the bladder.
This type develops in squamous cells, which are thin, flat cells that may form in the bladder after long-term irritation or infection. It is less common than urothelial cell cancer.
This disease develops in the inner lining of the bladder and typically behaves aggressively.
This is technically not a bladder cancer but a cancer of the inner lining of the ureter or kidneys. Because it arises from the same cell type as most bladder cancers, many of the treatments are similar.
These include sarcomas, neuroendocrine tumours of the bladder, and small cell carcinomas.
Bladder cancer is also categorised based on how far it has spread:
This is an early form where the cancer is confined to the inner lining and has not spread to the surrounding muscles. These are often treated in various ways and usually do not require bladder removal.
The cancer has spread into the muscles surrounding the bladder wall. This is a more advanced stage, requiring complex treatments, but it remains treatable.
The cancer has spread beyond the bladder and nearby lymph nodes to distant organs in the body. While less often curable, it can often be managed as a chronic condition.
A risk factor is anything that increases your chance of developing bladder cancer. Key risk factors include:
This is the most significant preventable risk factor. Smokers are two- to three-times more likely to develop bladder cancer. Chemicals from tobacco smoke pass through the kidneys and collect in the urine, damaging the bladder lining.
The risk increases with age, with most diagnoses occurring in people aged 65 or older. It is rare in those under 40.
Men are up to four times more likely than women to develop the disease.
Given the high recurrence rate (50% to 80%), a personal history is a significant risk factor for a return of the disease.
Individuals working with certain chemicals show a higher risk. This includes people in the rubber, chemical, and leather industries, as well as hairdressers, machinists, metal workers, printers, painters, textile workers, truck drivers, and dry cleaning workers.
Infection with certain parasites, more common in tropical climates, increases the risk.
These drugs, used for cancer and other conditions, increase the risk. Arsenic in drinking water may also contribute.
A direct link exists between chronic bladder infections and bladder cancer. Other irritations, such as kidney stones and frequent catheterisation, may be risk factors, though a direct link is not firmly established.
Patients taking immune-suppressing drugs after an organ transplant may experience more frequent bladder infections, a known risk factor.
People with hereditary nonpolyposis colon cancer (HNPCC, or Lynch syndrome) have an increased risk.
Bladder cancer may cause several signs and symptoms, including:
It is important to note that these symptoms can also be caused by other less serious health issues. If you experience any of these, you should discuss them with your doctor immediately for proper evaluation.
If you present with symptoms suggestive of bladder cancer, your doctor will perform a physical examination and take a detailed history regarding your lifestyle (including smoking and drinking habits), overall health, and family medical history.
One or more of the following tests may be used to diagnose bladder cancer, determine its spread, or monitor the effectiveness of treatment:
These help in diagnosing bladder cancer or identifying other underlying conditions that could be causing the symptoms, such as an enlarged prostate, a urinary tract infection, or kidney stones.
This is considered the most reliable and frequent test for bladder cancer. A thin tube with a camera (cystoscope) is passed through the urethra into the bladder. The scope can be used to take a tissue sample (biopsy) and treat superficial tumours without major surgery. Pathologists examine the tissue under a microscope to confirm the diagnosis. In some cases, a more thorough exam is performed under general anaesthesia. SSCHRC also utilises blue light cystoscopy to enhance tumour detection, where a solution is absorbed by cancer cells, making them glow when exposed to blue light.
Cystoscopy is sometimes performed alongside Transurethral Resection (TUR), a procedure to remove cancer cells from the bladder.
Imaging examinations help in visualising the urinary tract and surrounding areas. These may include:
The pathologists at SSCHRC are highly experienced in diagnosing and staging all types of bladder cancer, and the centre welcomes the opportunity to provide second opinions.
Staging is the process of determining how large the primary tumour is and how far the cancer has spread in the body. Knowing the stage is vital for the care team to develop an appropriate treatment plan and estimate the patient's prognosis (chance of successful treatment).
The TNM staging system, used for most cancers, describes the disease based on three key factors, each assigned a numerical score:
The size of the primary tumour and whether it has invaded nearby tissues. Scored between 1 and 4.
The spread of the cancer to nearby lymph nodes. Scored between 1 and 3.
Whether the cancer has spread to distant parts of the body (metastasised). Scored 0 or 1.
Your doctor will determine the TNM stage after all diagnostic procedures are complete and will explain how this impacts your treatment and prognosis.
The detailed TNM staging can often be simplified into five main stages (0 to IV), where larger numbers indicate a more advanced and generally more difficult-to-treat cancer.
Noninvasive bladder cancer, where cancer cells are found only in the tissue lining the inside of the bladder and have not invaded the wall. This stage is considered pre-cancerous and is also called in-situ ("in its original place"). It is divided into Stage 0a (noninvasive papillary carcinoma) and Stage 0is (carcinoma in situ), which is always high grade.
A form of non-muscle-invasive bladder cancer that has spread into the connective tissue but has not reached the muscle layers of the bladder wall.
Also known as muscle-invasive bladder cancer, the cancer has spread through the connective tissue into the muscle layers of the bladder.
Also described as locally advanced bladder cancer, it is divided into:
The most advanced stage, divided into:
At SSCHRC, patients receive personalised care from a dedicated team of specialists, which includes urologic surgeons, medical oncologists, and radiation oncologists, all working together to plan treatment and recovery. Your treatment will be customised based on several factors, including the cancer type and stage, and your general health.
For cancer that has not spread to distant parts of the body and has not yet moved into the muscle wall, treatment typically involves surgery and may include intravesical therapy (washing the bladder's inside with chemotherapy or immunotherapy drugs).
There are two main treatment options:
Patients usually receive systemic therapies like chemotherapy, immunotherapy, or targeted therapy, and may be eligible for clinical trials.
Surgery is a core component of most bladder cancer treatment plans, often combined with other therapies. SSCHRC surgeons use minimally invasive techniques, such as robotic reconstruction and robotic cystectomy, which may lead to shorter hospital stays, less blood loss, and faster recovery times.
This procedure involves scraping the tumour from the bladder wall using a resectoscope (a thin instrument with a wire loop) passed through the urethra. TUR is used for diagnosis, treating superficial cancer on its own, or as the first step in the bladder-sparing trimodality approach for muscle-invasive cancer.
Used for more advanced bladder cancer. This typically involves removing the entire bladder and nearby lymph nodes. In men, the prostate is also usually removed, and in women, part of the vagina, uterus, ovaries, and fallopian tubes may be removed, though this is often not necessary.
When the bladder is removed, a urinary diversion is performed concurrently to create a new way to store and eliminate urine.
The most common diversion. A piece of the small intestine is used to create a tube connecting the ureters to a skin opening called a stoma. Urine drains continuously into a urostomy bag worn externally.
Part of the small intestine (ileum) is used to create a new bladder, allowing the patient to urinate naturally through the urethra. It provides good daytime urinary control, though some patients may experience nighttime incontinence or require occasional catheterisation.
Intestinal tissue forms an internal pouch connected to the navel or nearby area. The patient uses a catheter to drain the pouch every few hours. This is an option when a neobladder is not suitable, avoiding an external stoma.
Chemotherapy drugs kill cancer cells, control their growth, or relieve symptoms. A single drug or a combination may be used. It is often used with surgery for bladder tumours that have invaded the muscle wall and have a high risk of spreading, typically given before the procedure to shrink the tumour.
These drugs link a chemotherapy agent with laboratory-designed antibodies that recognise cancer cells. This delivers a powerful dose of medication while limiting negative side effects. ADCs are currently approved for patients with metastatic bladder cancer, but research is ongoing to expand their use.
These drugs prevent the immune system from prematurely turning off, allowing it to eliminate cancer. For bladder cancer, they are currently used only for Stage IV cancer, with clinical trials exploring their use in earlier stages.
These drugs interfere with the specific molecules (often proteins) that cancer cells need to multiply, survive, and spread. Targeted therapy is currently only approved to treat Stage IV cancers with specific genetic mutations.
Radiation therapy uses powerful, focused energy beams to kill cancer cells, with techniques like Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy used to accurately target the tumour while sparing healthy tissue. For bladder cancer, it is used in combination with chemotherapy and Transurethral Resection surgery as part of the bladder-sparing approach.
Used for superficial bladder cancer which has a high rate of recurrence. After surgical scraping to remove superficial tumour cells, a catheter is used to fill the bladder with medication to prevent recurrence and progression. The medication is either Bacillus Calmette-Guérin (BCG), an immunotherapy that stimulates the immune system, or a chemotherapy drug.
This treatment modifies a patient's DNA to help fight cancer by inserting a healthy gene copy, removing or replacing abnormal gene parts, or inhibiting the growth of disease cells. For bladder cancer, gene therapy is used to treat patients whose non-muscle-invasive disease has not responded to intravesical therapy.
SSCHRC is committed to finding better ways to prevent, diagnose, and treat cancer through clinical trials. Trials for bladder cancer often focus on expanding the use of immunotherapy, targeted therapy, and antibody drug conjugates, as well as new combinations of treatments. Your doctor may offer a clinical trial as a treatment option.