What is bladder cancer?
Cancer is an abnormal growth of cells in part of the body. Bladder cancer is a tumour that grows from the inside lining of the bladder. The lining of the bladder has a layer of transitional epithelium cells, which change shape and stretch so that your bladder can hold urine. Almost all bladder cancers grow from this layer of cells on the surface inside the bladder and therefore are called transitional cell cancers.
When considering bladder cancer, we are most interested in whether the cancer is just growing on the surface of the bladder, or if it has started growing deeper into the wall of the bladder - this gives us an idea about how bad the cancer might be and can help determine if the cancer will spread to other parts of the body or if it may come back in the future.
Like most cancers, the exact cause is unknown. Bladder cancers can occur when the chemicals found in the urine cause damage to lining of the bladder over many years. Generally, even if the whole lining of the bladder is damaged, only a small area will grow a cancer. Because the most concentrated urine sits at the bottom of the bladder, most initial cancers are on the floor or sides of the bladder. Also, sometimes when we remove a cancer, some of the cancer cells can spread around the bladder. These can stick to the bladder lining and grow into a new cancer. Thankfully these grow like the first cancer - only on the surface of the bladder - and eventually all the cells can be eradicated.
You are more likely to have a bladder cancer if you are over 40 years old, male, smoke and have had pelvic radiotherapy - in fact, smoking is the most common preventable cause of bladder cancer.
Most bladder cancers do not cause any symptoms. They are often found when a person is investigated because of microscopic (non-visible) blood in their urine. Sometimes, bladder cancers are discovered in people who have visible blood in the urine (visible haematuria), and occasionally, they are found in people who complain of needing to urinate urgently and frequently. That said, most people with frequent urgent passage of urine do not have bladder cancer.
Diagnosis and treatment
Bladder cancers are diagnosed through x-rays, urine tests and an operation where we look into the bladder (cystoscopy) and cut out the bladder tumour.
The x-rays used can be an ultrasound or a CAT scan, though, unfortunately, these x-rays are not able to detect all bladder tumours. Urine tests can sometimes be helpful, but usually only work in more nasty cancers. Because of the problems with detecting bladder cancers, all patients will eventually need an operation to look into their bladder. This is done under local anaesthetic with a flexible telescope called a cystoscope. If a bladder cancer is found on flexible cystoscopy or seen on an x-ray, then an operation is needed to remove it. This operation is called a TURBT or TransUrethral Resection of Bladder Tumour. Under general anaesthetic, the surgeon looks inside the bladder with a telescope and then cuts the cancer out from inside the bladder. After removing the cancer, patients will need follow-up consultations for their bladder for at least 5 years.