Bladder

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Reviewed Jan 2016

The basics

Guidelines for treating this type of cancer have been developed by the Genitourinary Tumour Group.
For health professional information on treating this cancer, please see our Cancer Management Guidelines.
The bladder is a hollow organ that stores urine (pee).
The bladder has many layers lining it. The deeper the cancer has penetrated these layers, the harder the cancer is to treat and the greater the chance it can spread.
Urothelial cells (otherwise known as the urothelium, or also called transitional cells) line the inner surface of the bladder. This lining begins in the kidneys and goes through the ureters towards the bladder - this is the connection between the kidney and the bladder. In men, the lining of the urethra that goes through the prostate gland is also covered with urothelium.
Urothelial cancer is the most common type of bladder cancer (over 90%).

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

Cigarette and tobacco smoking are linked to bladder cancer. The risk for smokers is more than three times that of non-smokers.
Bladder cancer is quite common for those in their 50s, 60s and older.
It affects men three times more than women.
Caucasians are far more likely to get bladder cancer than any other race.
Chemical risks - the bladder is sensitive to chemicals because they are absorbed by the blood and then are filtered out through the urine. The lining of the bladder is damaged by these chemicals.
Occupational risks - these workers are more likely to get bladder cancer: companies producing aluminum (pot room workers), paint companies and painters, leather goods, rubber compounds, the printing industry, hairdressers, truck drivers, petroleum and machinists.

If you work in these industries and you are also a smoker, your risk increases even further.

You are more likely to get bladder cancer if you have had chronic bladder infections. Changes can occur in the bladder as a result of repeated or persistent infections.
If you are from the Middle East, schistosomiasis has been associated with bladder cancer. The parasitic worm called 'schistosoma haematobium', which lodges in the bladder, has been found in 97% of Egyptian patients with bladder cancer. This is not a problem for B.C and Yukon residents unless you are an immigrant from the Middle East.
Excessive use of drugs containing phenacetin. The use of phenacetin in prescription or over-the-counter drugs was discontinued in Canada in 1973, so this risk factor is diminishing in the general population. However, illegal drug dealers are known to sometimes cut cocaine with phenacetin.
Statistics

Can I help to prevent it?

To reduce your risk, don’t smoke, and avoid exposure to tobacco and cigarette smoke. Even if you have been using tobacco for many years, quitting will reduce your cancer risk. Support is available to help you successfully quit. Visit the BC Cancer Agency’s Prevention page on Tobacco for information and resources.
Try to minimize or eliminate your exposure to environmental and occupational risk factors.

Screening for this cancer

No effective screening program exists for this cancer yet.

Signs and Symptoms

The first and most common sign is usually visible blood in the urine (even one time may be significant). But this symptom may not occur, or the blood may be visible only under a microscope.
Colour of urine can range from smoky to rusty to bright or deep red: this is known as hematuria.
Bladder cancer can show up suddenly and without pain.
In some patients, bladder irritability, frequency, urgency and pain do occur. However, these are also symptoms of bladder infection and can confuse diagnosis.
Symptoms of advanced disease include weight loss, loss of appetite, weakness and general discomfort.

Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

Vaginal or rectal examination will be performed.
Urinalysis – a lab technician looks at your urine sample with a microscope to see if bladder cancer is there. This test is also used to see if bladder cancer has come back, since these tumours tend to recur. They check the urine for microscopic amounts of blood (urinalysis) and check for cancer cells (urine cytology).
The urine cytology test examines cells that the bladder wall or the tumour have shed into the urine.
Cystoscopy: A cystoscope is used to examine the bladder. This is a camera which goes up the urethra into the bladder. The doctor can use the cystoscope to snip off small samples of tissue, which are sent to the pathologist. Some cancers can be partially or totally removed using the cystoscope.
IVP (intravenous pyelogram)

A special dye is injected into the bloodstream passing into the urine, outlining the urinary system.

CT scan:

Cross section view of the organ; pinpoints the size and location of the tumour. This is used primarily to look for enlarged lymph glands.

For more information on tests used to diagnose cancer , see our Recommended Websites, Diagnostic Tests section.

Types and Stages

‎Types

Urothelial cancer (transitional cell) is the most common type.
Bladder cancer can be described as either superficial or invasive. Superficial cancers are easier to treat and cure.
Occasionally bladder cancers are squamous cell carcinomas, or adenocarcinomas or mixed cell.
Superficial papillary tumours involve only the inner lining of the bladder (stages Ta and T1). They are usually low grade, which means they are less likely to grow and they spread more slowly.
One type of superficial high grade disease is called carcinoma-in-situ. It is much more likely to behave aggressively, and may require cystectomy (removal of the bladder by surgery) if other treatments are not successful.
More advanced tumours may go:

into the superficial or deep bladder muscle (stages T2 and T3a).
through the muscle (stage T3b).
into other areas or organs (stage T4). These are usually high grade cancers and require radical treatment.

Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

T describes the site and size of the main tumour (primary)

N describes involvement of lymph nodes

M relates to whether the cancer has spread (presence or absence of distant metastases).

Treatment

‎Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Surgery

Removal of the tumour can often lead to cure.
The extent and type of surgery depends on individual cases.
Superficial papillary tumours are generally treated by transurethral resection (TUR surgery). A thin tube is inserted up the urethra. It has a camera and a wire loop on the end. The wire loop can be used to grab the cancerous tissue, or to burn the cancer with electricity through the wire.

This procedure can be repeated as often as necessary. Periodic follow up is essential to detect any new cancers, as papillary tumours tend to keep coming back in different places in the bladder.
Your urologist may give you some chemotherapy which will be placed in the bladder right after surgery. This will be removed before you leave the recovery room. This treatment prevents new tumours from forming by killing any free floating cells that may occur after surgery.

More aggressive superficial tumours are treated by transurethral surgery (TUR), with postoperative chemotherapy instilled into the bladder plus a treatment called BCG.
Once the bladder has healed from the surgery, your urologist may give you a treatment called BCG that is placed in your bladder once a week for six weeks. This is usually given 4-6 weeks after the TUR.
Invasive or high grade tumours are usually treated by removal of the bladder (cystectomy). When this happens, the surgeon will divert the flow of urine.

Urinary diversion involves attaching the ureters to a segment of small intestine which has been isolated to form a pouch for urine collection. One end of the pouch is brought through the abdominal wall to form a small opening or stoma. An external bag holds the urine until it is emptied manually.
Newer methods of urinary diversion have been developed which allow intermittent release of urine from the stoma by catheter, or reconstruction of an internal bladder made from the bowel, which is connected to the urethra.

In men, the prostate is removed with the bladder. A long term complication of bladder surgery may be erectile dysfunction.
In women, the uterus, cervix, fallopian tubes and ovaries are usually removed as well as a top of the vagina. These organs are removed in order to ensure that all of the cancer is removed and maximizes the chance of cure in women.

Chemotherapy

Chemotherapy shows some results, but the improvements are usually not dramatic or long-lasting.
Chemotherapy can be done two ways:

Intravesical – the drug(s) are injected into the bladder.
Intravenous or systemic – this type of chemotherapy uses a needle in a vein to give the drugs to the patient.

Intravenous chemotherapy may be administered along with surgery and radiation in the management of deep or metastatic cancer.
There is evidence that some patients with invasive bladder cancers may benefit from chemotherapy given prior to their cystectomy.
Chemotherapy is the standard treatment for patients in which the cancer has already spread (ie, to the lymph nodes or other organs).

Radiation

Radiation therapy can be an effective curative treatment. This can be a different option than removal of the bladder for some patients. Radiotherapy may be associated with significant bladder and bowel toxicity.
Radiation interferes with male potency less often.
In bladder cancer where cure is not possible, radiotherapy is done in some cases to relieve symptoms, discomfort or pain. Tumours can sometimes be effectively controlled in this manner.
Radiotherapy does not prevent the development of new cancers in the bladder.
Radiotherapy is not suitable for all patients..

Immunotherapy

BCG is sometimes used. It is a drug that is considered a type of immunotherapy. Immunotherapies start your immune system fighting the cancer.
Interferon is another type of immunotherapy that is sometimes useful in bladder cancer.

Follow-up after Treatment

You will be returned to the care of your family doctor or specialist for regular followup. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
Followup testing is based on your type of cancer and your individual circumstances.
Life after Cancer focuses on the issues that cancer survivors can face.

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