All About Bladder Cancer: Symptoms and Treatment

We’re all fairly familiar with the bladder and the function it serves in our urinary system. As a storage organ for urine, the bladder has very stretchy muscles that allow it to expand and hold urine before it is expelled from the body.

Sometimes, the tissues in the bladder can turn malignant and result in bladder cancer.

The 3 most common types of bladder cancer are:

Transitional cell carcinoma/urothelial carcinoma — this is the most common type of bladder cancer and makes up more than 90% of all bladder cancers.
Squamous cell carcinoma — cancer that arises from squamous cells, which may form after chronic bladder inflammation and long standing bladder stones.
Adenocarcinoma — cancer that arises from glandular cells in the bladder, commonly at the dome (top) of the bladder.

In Singapore, bladder cancer is more common among older men. It is the 7th most common cancer in Singapore. Most patients are aged 50 years and older.

What causes bladder cancer?

Bladder cancer is closely associated with risk factors such as:

Chemicals such as aniline dyes used in rubber, paint, leather, metals, and hair dye (commonly found in occupational contact)
Chemotherapy agent cyclophosphamide
Smoking
Previous pelvic radiation therapy
Chronic bladder inflammation

Contrary to popular belief, holding your bladder does not cause bladder cancer. It can, however, cause other urinary issues. Smoking remains the biggest risk factor for bladder cancer, making someone 3 times more likely to get bladder cancer than someone who doesn’t.

How do I know if I have bladder cancer?

The most common symptom of bladder cancer is blood in the urine (haematuria), and this symptom is often present in other urinary issues, like kidney stones or an infection. This makes a thorough diagnosis important. Other symptoms to take note of include:

Urinary urgency and / or frequency
Difficulties in passing urine
Lower abdominal pain or mass
Loss of weight
Loss of appetite

If you experience any of the above, please seek medical attention immediately.

Can bladder cancer be cured?

Bladder cancer can certainly be cured is diganosed early. Treatment for bladder cancer depends on the stage of the cancer, location, and the patient’s general medical background and fitness for surgery.

It is important to note that the earlier the cancer is detected (in its early stages), the more options there are for minimally invasive treatment and possibly, better outcomes.

Some modalities for treatment include:

1. Transurethral resection of bladder tumour (TURBT)

TURBT can be used to diagnose, stage and treat bladder cancer in its early stages. The procedure involves the use of an endoscope, which is inserted through the urethra and into the bladder.

The surgeon uses a special wire loop to then remove the tumour tissue one piece at a time. Electrocautery helps remove the tumour and stop the bleeding.

After TURBT, patients may also receive chemotherapy / immunotherapy via a catheter inserted directly into the bladder. Therapeutic agents include mitomycin C and BCG (Bacille Calmette Guerin) immunotherapy.

2. Surgical removal of whole or part of bladder

Surgery can involve partial (partial cystectomy) or complete (radical cystectomy) removal of the bladder.

Radical cystectomy — this surgical procedure involves the removal of the entire bladder and some surrounding structures such as prostate in men and uterus in women. This is usually done in very advanced bladder cancers, where the cancer has spread deeper into the bladder muscles and/or the structures around it.

Urinary diversion will also have to be carried out, which entails the creation of a new way for urine to exit the body. This could be done via an ileal conduit or a neobladder.
Partial cystectomy — in some rare circumstances, a partial cystectomy can be carried out to preserve part of the bladder by removing only the affected area in the bladder wall, and closing it up with stitches. This is done for adenocarcinoma of the bladder or if the cancer is small and located in a bladder diverticulum.

3. Radiation therapy is another treatment modality used to treat bladder cancer. It uses high energy x-ray beams to kill cancer cells, or to halt their growth. It is often given together with chemotherapy. Chemotherapy is a systemic treatment used in treating muscle-invasive muscle cancer or bladder cancer that has spread to other parts of the body. It serves to kill off cancer cells and may be given before or after the surgery.

Summary

Seeking medical attention promptly and getting an early diagnosis (and treatment) lead to the best outcomes. As such, it is important to keep a mindful watch of your urinary habits and seek medical attention if any unusual symptoms arise.