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The bladder is a hollow organ located in the lower abdomen, within the pelvis. The bladder’s main function is to store urine that it receives from the kidney. In order to carry out this function, it has elastic, muscular walls that stretch to hold urine and expel it from the body.
Bladder cancer refers to the abnormal and uncontrollable growth of cancer cells in the bladder. According to the Singapore Urological Association, bladder cancer in Singapore is the 7th most common cancer, and it is more common in men. While bladder cancer can occur at any age, the median age of diagnosis is 69 in men and 71 in women. If the patient presents at an early stage, bladder cancer treatment can be commenced promptly, resulting in a good prognosis.
Symptoms of bladder cancer can often mimic that of a urinary tract infection (UTI) or bladder stone. Some of the bladder cancer symptoms are as follows:
You should visit a doctor if you have any of the bladder cancer symptoms mentioned above, as they may suggest a pathology within your urinary tract. Haematuria could present as an important bladder cancer symptom, and it must be investigated even if it is in small quantities and is not always visible.
There are five stages of bladder cancer – Stages 0 to 4. Staging is essential to denote where the cancer is, the extent of it, and how far it has spread (metastasis).
Once bladder cancer is diagnosed, the doctors will then proceed to stage the tumour. Staging of cancers is important because it helps to ascertain how deep the cancer has invaded the bladder or how far the cancer has spread within the body. This will determine the bladder cancer treatment plan as well as the prognosis of the patient.
Bladder cancer can be divided into two types depending on the depth of cancer invasion.
There are several subtypes of bladder cancers, but the three main ones are as follows:
This refers to a type of thin flat cells that line the inside of the bladder. They typically develop as a result of chronic bladder inflammation or irritation, which can arise from long-term indwelling urinary catheters, bladder stones or certain parasitic infections.
Adenocarcinoma is a very rare type of bladder cancer in Singapore and elsewhere, accounting for 1-2% of all bladder cancers. Adenocarcinoma of the bladder can be classified into two types – primary and secondary adenocarcinoma. Primary adenocarcinoma (arising from the bladder) is typically found at the dome of the bladder and is associated with the urachal remnant (the route where the bladder descends from the umbilicus area to the pelvis during foetal development). Secondary adenocarcinomas, on the other hand, are more common than primary adenocarcinomas and usually occur due to metastasis from a distant organ or as a result of pelvic malignancy e.g., colon cancer.
Sarcoma, micropapillary, plasmacytoid, and small cell carcinoma of the bladder are some of the other less prevalent varieties of bladder cancer. These bladder cancers are uncommon and only affect a small percentage of the population.
There is no specific cause of bladder cancer, but some risk factors include:
No. While holding in your urine does not cause bladder cancer, it can put you at risk of developing urinary tract infections and other issues. Cancer, in itself, results from an overly active and excessive cellular reproduction pathway that is caused by genetic mutations of the cells in the body.
Your urologist will take a detailed medical history and perform a physical examination to look for any masses in your abdomen. Certain diagnostic tests may also be performed, such as:
TURBT is a type of surgery that removes tumours in the bladder and is generally performed under general anaesthesia. It is considered both diagnostic and therapeutic as it is done to diagnose, stage, and treat early-stage bladder cancer.
A rigid endoscopic instrument called a resectoscope will be inserted through the urethra and into the bladder (transurethral). The scope provides visualisation of the bladder, and the surgeon uses an electrocautery loop to remove the tumours from the bladder and to stop bleeding. Following removal, the excised tumours are sent for cancer confirmation as well as to assess the depth and grade of invasion.
Radical cystectomy involves the removal of the entire bladder and some surrounding structures, such as the prostate and seminal vesicles in men, and the uterus, fallopian tubes, ovaries, and part of the vagina in women. This is usually done in very advanced bladder cancers that have invaded the muscle and the structures beyond it.
As the entire bladder is excised, a urinary diversion is then performed to create a new pathway for urine to exit the body. This is done using a portion of the small intestine in either an ileal conduit (a urinary diversion to create a stoma from the small intestine) or a neobladder (reconstructing the bladder using part of the individual’s own small intestine).
While some patients may not show any symptoms at all, there are a few warning clues that may indicate a diagnosis of bladder cancer. Bladder cancer symptoms may mimic those of a urinary tract infection (UTI), and they may include the following:
Some patients may also experience urinary symptoms like frequent urination, nocturia (frequent urination at night), and a weak urine flow. Advanced bladder cancer symptoms can also include fatigue, swelling in the feet, and bone pain.
The first sign is usually haematuria, and in some cases, patients may only present with this symptom. At times, haematuria may even disappear for a period of weeks or months. Haematuria is typically classified into two categories: gross haematuria and microscopic haematuria. The former type is visible to the naked eye, while the latter can only be viewed under the microscope. This is because the red blood cells are too small to be seen with the naked eye.
However, it is important to note that the presence of blood does not necessarily mean that the patient has bladder cancer. But, as it can be a sign of bladder cancer, it is advisable to consult an experienced Senior Consultant Urologist like Dr Terence Lim to carry out a detailed assessment.
Yes, it is highly treatable if detected in the early stages. While there are several management options, the bladder cancer treatment will depend on the type, stage, and grade of the cancer. The primary treatment for bladder cancer is surgery, but this may depend on the health and fitness of the patient. In some patients, surgery alone might be sufficient to treat the cancer, but some may need other treatments (or a combination) like radiation therapy or immunotherapy to treat it successfully.
Here are some of the common surgical treatment approaches:
Transurethral Resection of Bladder Tumours (TURBT): This procedure involves the use of an endoscopic instrument known as a resectoscope that is inserted into the bladder through the urethra to remove the tumour. As this procedure can be used for diagnostic and therapeutic purposes, your urologist may also take a tissue sample for further analysis. This is essential to confirm the diagnosis and to determine the grade of the tumour and the extent of invasion.
Cystectomy: This surgery is useful to remove all or part of the bladder that contains cancer cells. In a partial cystectomy, as the name suggests, only a portion of the bladder is removed with the aim of preserving the bladder. A radical cystectomy, on the other hand, is performed when the entire bladder and the surrounding lymph nodes need to be removed.
In addition, when the bladder is removed, an alternative pathway to pass urine out of the body will be required; this is done with the help of a urinary diversion. For bladder cancers in Singapore, urinary diversions are usually carried out either through an ileal conduit or a neobladder.
This surgery can also be performed by a robotic-assisted procedure that involves robotic technology in treating bladder cancer. Dr Terence Lim has a subspecialty in Uro-oncology and is frequently asked to mentor his colleagues and subordinates for his expertise in robotic surgery. As a veteran robotic urologic surgeon, Dr Lim has been involved in over 700 robotic surgeries.
Bladder cancer is the 7th most common cancer in Singapore, and it is more commonly found in men than women, with a median age of diagnosis of 69 for men and 71 for women. As mentioned before, if detected early, the prognosis is quite good, typically resulting in enhanced survival rates. While the survival rate will depend on a number of factors, including the stage and grade of the cancer, the relative 5-year survival rate is over 90% for early-stage cancers and less than 10% for Stage IV bladder cancers. If the tumour is invasive with no metastasis (localised bladder cancer), the expected 5-year survival rate is around 70%.
The rate of the spread is determined by the type, grade, and stage of the cancer. In general, the later the stage and the higher the grade, the faster it will spread. While bladder cancers like adenocarcinoma and sarcoma are aggressive, the cancer spread can be prevented by bladder cancer treatment if presented early. Low-grade bladder cancers, on the other hand, spread at a much slower pace.
MBBS, MRCSed, MMED(Surgery)
Dr Terence Lim is a Senior Consultant Urologist with a subspecialty in Uro-Oncology. He is also the Medical Director at Assure Urology & Robotic Centre. His clinical interests include Uro-Oncology, Minimally-invasive Urological Surgery, Urinary Stone Disease, Endourology and Prostate Health.
Prior to his private practice, Dr Terence Lim spent almost two decades in public healthcare. He served as the Senior Consultant and Chief of the Department of Urology at Changi General Hospital (CGH). In addition, he is currently a Visiting Consultant at CGH. Dr Lim was also the director of CGH’s Advanced Surgical Centre, a committee dealing with complex surgeries, including robotic surgeries.
Your health is important to us and some conditions require immediate attention. For emergencies, please contact us at 9835 0668.
MBBS, MRCSed, MMED(Surgery)
Dr Terence Lim is a Senior Consultant Urologist with a subspecialty in Uro-Oncology. He is also the Medical Director at Assure Urology & Robotic Centre. His clinical interests include Uro-Oncology, Minimally-invasive Urological Surgery, Urinary Stone Disease, Endourology and Prostate Health.
Prior to his private practice, Dr Terence Lim spent almost two decades in public healthcare. He served as the Senior Consultant and Chief of the Department of Urology at Changi General Hospital (CGH). In addition, he is currently a Visiting Consultant at CGH. Dr Lim was also the director of CGH’s Advanced Surgical Centre, a committee dealing with complex surgeries, including robotic surgeries.
Your health is important to us and some conditions require immediate attention. For emergencies, please contact us at 9835 0668.
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