Bladder cancer treatment

Please find more information all about Bladder Cancer. This includes incidence, causes and risk factors, symptoms, how it is diagnosed and the different types of bladder cancer treatments available.

About bladder cancer

Around 10,400 people are diagnosed with bladder cancer each year in the UK. It's the 8th most common cancer in the UK, and the 4th most common cancer in men[i].

The bladder is part of the body's system that filters waste and produces urine, called the urinary system (or urinary tract). This system is made up of the kidneys where waste is processed, the ureter tubes that draw urine from the kidneys, the bladder that stores urine and the urethra that carries urine from the body.

The bladder sits in the lower part of your pelvis, the lower stomach area in between your hip bones, and it is made up of a number of layers. The inside of your bladder has a special type of lining called the transitional epithelium that stretches as the bladder fills up and stops urine being absorbed back into the body.

Just below the transitional epithelium is a thin layer of connective tissue called the lamina propria. Underneath this layer is muscle tissue called the muscularis propria, then around this is a layer of fatty connective tissue that separates the bladder from body organs like the prostate and kidneys.

Bladder cancer is where a growth of abnormal tissue known as a tumour develops in the bladder lining, and in some cases spreads into the surrounding bladder muscles.

The bladder cancer treatment will depend on how far the cancer has grown into these layers.

will depend on how far the cancer has grown into these layers.

Facts:

• Around 10,000 people in the UK are diagnosed with bladder cancer every year[ii]
• Of these, 8 out of 10 (80%) are diagnosed with early bladder cancer[iii]
• Smoking is one of the most common causes of bladder cancer[iv]
• Bladder cancer becomes more common as people get older[v].

[i] Cancer Research UK, Bladder cancer risks and causes
[ii] Macmillan Cancer Support, Bladder cancer
Cancertypes/Bladder/Aboutbladdercancer/Typesofbladdercancer.aspx
[iii] Macmillan Cancer Support, Bladder cancer
[iv] Macmillan Cancer Support, Bladder cancer
[v] Macmillan Cancer Support, Bladder cancer

Types of bladder cancer

There are different types of bladder cancer, divided into non-invasive and invasive stages, dependent on how far it has invaded or what type of cancer cell it comes from.

Some bladder cancers begin at a non-invasive stage that only affects the inner lining of the bladder –called early (superficial) bladder cancer.

Some non-invasive cancers develop into invasive bladder cancer, which is a more advanced stage, where the tumour grows into the bladder's muscle wall.

Transitional cell bladder cancer (TCC)

Also known as urothelial carcinoma, TCC is the most common type of bladder cancer, with about 90% of cancers in the UK being diagnosed as transitional cell[vi].

The cancer starts as transitional cells in the bladder lining (called the urothelium), which are all bunched together when the bladder is empty, and stretched into a single layer when the bladder is full..

Carcinoma in situ (CIS)

This is a non-invasive bladder cancer that appears as a flat, red area in the bladder. CIS can grow quickly –if it's not treated effectively, there's a risk that it will develop into an invasive bladder cancer.

Papillary cancer

Papillary bladder cancer is a form of early bladder cancer, and shows as mushroom-shaped or leaf-shaped growths (fronds). Some people may have papillary and CIS cancers.

Rarer types of bladder cancer

Some rare bladder cancer types include squamous cell cancer, small cell bladder cancer and adenocarcinoma. While squamous cell cancers start a type of cell in the bladder lining, adenocarcinoma starts from glandular cells –but both types of bladder cancer are usually invasive.

It's also possible to have a cancer of the bladder muscle or other tissues around the bladder structure, rather than the bladder lining. Cancers that begin in the bladder muscle are called sarcomas and are very rare.

[vi] Cancer Research UK, Types of bladder cancer

Causes and risk factors

What causes bladder cancer is not fully understood. But there are a few things which can increase your risk.

Smoking

Smoking cigarettes greatly increases risk of bladder cancer. In fact, about 1 in 3 cases of bladder cancer may be caused by smoking. The longer that someone smokes, and the more cigarettes they smoke, the greater the risk of bladder cancer.

Your age

Bladder cancer usually takes a long time to develop and it is more common in older people. Most people with bladder cancer are between 50 and 80 years old, and it's rare in people under 40.

Your sex

More men than women get bladder cancer, which may just be because more men than women have smoked in the past few decades, also possibly because more men have been exposed to chemicals at work[vii].

Your family history

If you have a close relative who has had bladder cancer, your risk of developing bladder cancer is slightly increased.

Your ethnicity

Your ethnic background also relates to your risk of bladder cancer. Black men have about half the risk of bladder cancer compared to white men, while black women have around two thirds the risk compared to white women, and the risk for Asian men and women is even lower[viii].

Exposure to chemicals at work

Chemicals used in dye factories (many of which are now banned), and other processing industries have been attributed to causing some bladder cancers.

However, it can take up to 25 years following exposure to these chemicals for bladder cancers to develop[ix].

Infection

Repeated urinary infections and untreated bladder stones are linked with cases of some rarer types of bladder cancer called squamous cell cancer. Also people who are paralysed have more bladder infections and a higher risk of bladder cancer.

Previous cancer treatment

If you've had radiotherapy to the pelvis to treat another cancer, or treatment with a chemotherapy drug called cyclophosphamide, this can increase your risk of bladder cancer[x].

[vii] Macmillan Cancer Support UK, Bladder cancer causes and risk factors. 
[viii] Macmillan Cancer Support UK, Bladder cancer causes and risk factors.
[ix] Macmillan Cancer Support UK, Bladder cancer causes and risk factors
[x] Macmillan Cancer Support UK, Bladder cancer causes and risk factors

Bladder cancer symptoms and diagnosis

The common symptoms of bladder cancer are blood in your urine, burning sensations when you pass urine, and pain in the lower part of your stomach or back.

Whatever pain, discomfort or symptom you feel, it is always best to get things checked out by your GP.

Blood in the urine (haematuria)

Finding blood in your urine is the most common symptom of bladder cancer. It can happen suddenly and may come and go. Your urine may look pink, red or even brown, or you may see threads or clumps of blood in it.

However, sometimes blood in the urine can't be seen and may be picked up through a simple urine test called a non-visible or microscopic haematuria. This test for non-visible blood is often performed if you have urinary symptoms –for example, pains when you pass urine.

If you see blood in your urine, it's important to get it checked by your GP straight away.

Urinary symptoms

Sometimes, people with a bladder cancer may feel a burning sensation when they urinate, or the need to urinate more often. These symptoms can be caused by an infection rather than cancer, and some people may need tests so a proper diagnosis can be made.

Pain in the lower stomach or back

Lower abdominal and back pain can be a symptom of many different conditions. But, if you experience these or any other symptoms, it's important to get them checked by your GP. The earlier the cancer is diagnosed, the more likely it is for the bladder cancer treatment to succeed. 

GP tests

Based on your symptoms, your GP can use one of the following tests to reach the right diagnosis, and is likely to begin by asking you about your general health and then examining you. You might be asked to give a urine sample to be sent away for analysis to see if you have a urine infection –if you have a bladder cancer, the urine may reveal some cancer cells.

Your GP may also want to examine you internally. And, because the bladder is close to the prostate in men and the womb in women, your doctor may need to put a gloved finger into the rectum (back passage) or vagina to see if everything feels normal.

Hospital tests

If the doctor thinks your symptoms could be due to a cancer, they will refer you to a hospital where you will see a consultant urologist, a specialist in diseases of the urinary tract.

Further hospital tests might require a blood or urine test, and may include advanced tests such as a cystoscopy, intravenous urogram, MRI, CT or ultrasound scans.

Cystoscopy

The main test used to diagnose bladder cancer, where a consultant or specialist nurse uses a cystoscope (a thin tube with a camera and light at the end) to examine inside your bladder. This is usually done under local anaesthetic using a flexible cystoscope.

You may be asked to drink plenty of fluids before your cystoscopy and also asked to provide a sample of urine, which is checked for infection.

The consultant specialist gently passes the cystoscope into your urethra and inside the bladder to examine the whole entire lining of the bladder and urethra. This only takes a few minutes.

After this test, you may notice some burning or mild pain as you pass urine for the first couple of days or notice blood in your urine. This should clear up after a day or so, and you should drink lots of fluids to help flush out your bladder.

After the cystoscopy, the doctor will be able to tell you if they have seen a bladder tumour. They will then arrange for you to come into hospital to have a procedure under general anaesthetic. This will involve having another cystoscopy, but the doctor will pass instruments through the cystoscope under a general anaesthetic to take a small piece of tissue taken (biopsy), or to remove the tumour.

Intravenous urogram (IVU)

An intravenous urogram (IVU) is also sometimes called an intravenous pyelogram (IVP) and is an X-ray to examine your entire urinary system. The IVU can show what is causing your symptoms, and check the health of your urinary tract.

CT scan

A CT urogram is a scan to examine the whole of your urinary tract and see if any blood is coming from the bladder or anywhere else.

Ultrasound scan

An ultrasound test bounces sound waves off the inside of your body to create a picture of your organs, and can be used to check for blockages in the tubes (the ureters) that pass urine between the kidney and bladder.

MRI scan

An MRI scan uses magnets to create a picture inside the body, and can be used to see if a cancer has spread.

Stages of bladder cancer [xi]

The stage of a bladder cancer gives an idea of how quickly it might grow, and can be determined after the biopsy is examined under a microscope. This will influence the type of treatment you're offered after surgery.

The most commonly used staging system is the TNM system, where each letter (T, N and M) describes a feature of the cancer:

• T is the size of the tumour (cancer).
• N is whether it has spread to the nearby lymph nodes (sometimes called glands).
• M is whether the cancer has spread to other parts of the body (metastases).

Stages of non-invasive bladder cancer

Non-invasive bladder cancer is labelled under three stages –CIS, Ta or T1:

• Carcinoma in situ (CIS) - Sometimes described as a flat tumour, where cancer cells are only in the inner layer of the bladder lining.
• Ta - Cancer appears as a mushroom-shaped growth (papillary cancer) growing within the inner layer of the bladder lining.
• T1 - Cancer growing into the layer of connective tissue beneath the bladder lining.
• T2a - Cancer has grown into the superficial muscle.
• T2b - Cancer has grown into the deeper muscle
• T3 - Cancer has grown through the muscle into the fat layer.
• T3a - Cancer in the fat layer can only be seen under a microscope (called a microscopic invasion).
• T3b - Cancer in the fat layer can be seen on tests, or felt by your doctor during an examination under anaesthetic (macroscopic invasion).
• T4 - Cancer has spread outside the bladder.
• T4a - Cancer has spread to the prostate, womb (uterus) or vagina.
• T4b - Cancer has spread to the wall of the pelvis or abdomen.

N stages of bladder cancer [xii]

The N stages describe whether cancer has spread to the nearby lymph nodes, and there are four of these stages in bladder cancer. The N stages are

• N0 - No cancer in any lymph nodes
• N1 - Cancer is present in one lymph node in the pelvis (your lower stomach, between the hip bones)
• N2 - Cancer is in more than one lymph node in the pelvis.
• N3 - Cancer is in one or more lymph nodes in the groin.

Lymph nodes can be examined and staged using a CT scan or MRI scan, or may be found if you need surgery to remove your bladder.

Grades of bladder cancer

Your consultant specialist may also talk to you about the grade of your cancer. This means how well developed the cells look under the microscope:

• Grade 1 or low-grade: Cancer cells look like normal bladder cells, are usually slow-growing and less likely to spread.
• Grade 2 or intermediate-grade: Cancer cells look more abnormal and grow slightly more quickly than grade 1 cancers.
• Grade 3 or high-grade: Cancer cells look very abnormal and are likely to grow more quickly. Carcinoma in situ (CIS) is always classed as high-grade.

[xi] Cancer Research UK, Bladder cancer stage and grade
[xii] Cancer Research UK, Bladder cancer stage and grade

Bladder cancer treatment

If you've been diagnosed with bladder cancer, there are several treatments for you to consider. Your consultant urologist and cancer care nurse will be able to talk through your options with you.

Treatment for early (superficial) bladder cancer

The main bladder cancer treatment is surgery. There may be one or more bladder cancers, which can be removed with surgery using a cystoscope.

Some people may only require surgery to cure their cancer, but non-invasive bladder cancer can return to the bladder lining and may start to grow into the muscle (invasive bladder cancer). Because of this, you may be given treatment after surgery to reduce the risk of this happening.

Treatment after surgery

Depending on your risk of the cancer returning, you may have the inside of your bladder treated with chemotherapy.

During and after treatment, you'll have regular cystoscopies to check the lining of your bladder, and any new tumours can usually be successfully removed with further surgery.

Occasionally, people with a very high risk of the cancer becoming invasive may be advised to have an operation to remove the bladder (cystectomy), but this is usually only suggested after other treatments have already been tried.

Treatment for invasive and advanced bladder cancer

The treatment for invasive and advanced bladder cancer will depend on the stage of the cancer, its size and your health.

Treatment might be given with the aim of curing the cancer. But if a cure isn't possible, treatment can help to control the cancer and relieve the symptoms.

People with bladder cancer at invasive and advanced stages are usually given treatment with the aim to cure the cancer or control it over a long time.

Surgery, radiotherapy and/or chemotherapy are the main treatments used for invasive and advanced bladder cancer.

Surgery usually involves removing the bladder (cystectomy), so you will pass urine in a different way. Alternately, radiotherapy uses high-energy rays to destroy the cancer cells, and means you will keep your bladder. Radiotherapy causes side effects, and some people may have long-term side effects.

Your consultant specialist can suggest the best treatment for you, based upon your general health and the size and spread of the tumour.

Paying for your treatment

You have two options to pay for your bladder cancer treatment – your costs may be covered by your private medical insurance, or you can pay for yourself.

Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy.

If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes the consultants'fees and the hospital charge for your procedure.

Want to know more?

If you'd like to read more about bladder cancer, treatment or living with bladder cancer, please visit cancerresearchuk.org.