Bladder cancer

Bladder cancer most often occurs out of the blue, but some things put you at higher risk. There are risk factors that you have no control over, such as:

• your family history – you’re more likely to get bladder cancer if a close family member has had it
• bladder disease, usually caused by repeated and prolonged bladder infections, increases your risk
• if you have had a kidney transplant or systemic sclerosis
• exposure to certain chemicals, usually through working in particular industries, such as those involving combustion or handling carbon or crude oil, but also producing dyes, rubber, textiles, chemicals and plastics
• radiotherapy treatment near the bladder, such as for bowel or prostate cancer
• previous chemotherapy treatment such as cisplatin and cyclophosphamide

There are risk factors that you have some control over, of which smoking is number one – it’s the cause of at least one in three cases of bladder cancer and if you smoke you’re up to four times more likely to develop bladder cancer than non-smokers. Obesity is another – you should aim to lose weight if your BMI (body mass index) is over 25.

Blood in the urine (haematuria) is the most common symptom of bladder cancer and it is typically painless. It may come and go but should always be investigated. Other symptoms include passing urine more often, having pain when you pass urine or needing to pass urine urgently, even if only a little comes out.

You may get other non-specific symptoms like weight loss, back pain, loss of appetite and feeling tired and lethargic, but these can point to any number of conditions and cancers.

You should see your doctor if you have any concerning symptoms such as blood in your urine or abdominal lumps and bumps. They will ask about your symptoms and your family history and check any other medical conditions or medications. They will examine your abdomen, looking for any pain or swelling.

They will ask you for a urine sample, looking for any simple signs of bladder disease or damage and also to exclude any urine infection. They may also request some blood tests.

They may then request further investigations such as an ultrasound scan of the kidneys, ureters (the tubes from the kidneys to the bladder) and bladder. If there’s any concern about the possibility of bladder cancer, your doctor will refer you urgently to a bladder specialist called a urologist.

The urologist will perform a cystoscopy, where a thin tube with a camera is passed into your urinary tract to look at your bladder and take samples of the tissue. They may also arrange a CT scan of the bladder area to gain more information.

As with all cancers, treatment of bladder cancer depends on its size, whether it has spread to other areas and how fit you are overall. If the cancer hasn’t invaded the muscle of the bladder wall and it’s viewed as a low-risk cancer, surgery can be done to remove the cancerous area through a technique called Transurethral Resection of Bladder Tumour (TURBT), done under a general anaesthetic. A single dose of chemotherapy treatment is usually given directly into the bladder through a catheter after this surgery in order to reduce the risk of the cancer coming back.

If the cancer hasn’t affected bladder muscle and it’s viewed as an intermediate-risk cancer, you’re likely to be offered at least six doses of chemotherapy. If viewed as high-risk, you’re likely to be offered a second TURBT procedure within six weeks along with a course of BCG vaccine put directly into the bladder.

If the cancer has spread to the muscle, removal of the whole bladder is often undertaken, in a procedure called a cystectomy. Unfortunately the outcome of treatment options can have a significant impact on your life, even if you have been cleared of bladder cancer. After cystectomy, the surgical team needs create a urinary diversion: a new way of collecting and eliminating urine. This may involve reconstructing a new bladder with some of your small bowel, or the bowel may be used to attach to a bad held outside the body (an ileal conduit leading to a stoma), which collects urine and is then emptied by you at intervals.

Radiotherapy is another treatment option and is often used in combination with chemotherapy and/or surgery. Radiotherapy is typically given every day for 5 days a week over four to seven weeks with each session lasting 10-15 minutes. This is given alongside a type of medicine called a radiosensitiser that boosts the radiotherapy effects.

Most people want to know whether they will survive a particular cancer. This is a tricky question, as so much depends on an individual’s risk factors, age and general health, and on the type of tumour, how far advanced it is and whether it has spread.

The general 5-year survival rate with bladder cancer is around 75%, but if it hasn’t spread beyond the inner layer of the bladder wall, it’s almost 96%, and around half of people with bladder cancer are diagnosed at this stage. If the cancer is deeper into the bladder wall but hasn’t spread outside the bladder, the 5-year survival rate is 70%. This falls to 38% if it has spread to surrounding tissue and down to 6% if it has spread to more distant parts of the body.