Bladder Cancer

written by Dr Thomas Dean MBBS (UNSW), FRCS (Edin) FRACS (Urol)

Bladder cancer is a common and in some cases a rapidly spreading cancer that may present in a number of ways. The most common symptom is seeing blood in the urine, but occasionally the blood is invisible and only picked up on a urine test. Other symptoms include frequency of passing urine in the day and night, urgency with passing urine and pain. It is important that any patient who has the onset of unexplained urinary symptoms with or without blood in the urine should be investigated to ensure that they are not suffering from bladder cancer. In the past, exposure to toxic chemicals (known as carcinogens) in a number of industries was commonly the cause of bladder cancer. This is now rare, the most common carcinogens now are a result of cigarette smoking. It is important to understand however that the majority of patients diagnosed with bladder cancer have never smoked.

Superficial bladder cancer – 80% of tumours at diagnosis

These tumours at diagnosis are confined to the lining of the bladder. The less active tumours can simply be treated with regular endoscopic examinations. More aggressive superficial cancers will need other treatments such as instillation of chemotherapy or immunotherapy into the bladder via a catheter to reduce the chance of recurrence of the disease. Some patients despite adequate treatment do progress to invasive bladder cancer.

Invasive bladder cancer – 20% of tumours at diagnosis

These tumours have invaded into the muscle and are therefore not considered curable without radical treatment such as radiotherapy or surgery.

If your urologist suspects that you may suffer from bladder cancer a number of investigations will be required. These include a CAT scan of the entire urinary tract, as similar tumours can occur, albeit rarely in the lining of the kidney or ureters. Other investigations include urine tests to look for abnormal cells (known as urine cytology) and a cystoscopy to confirm the diagnosis. Cystoscopy involves the passage of an instrument through the urethra into the bladder. If a tumour is detected a biopsy is performed to determine the appropriate treatment.

Because bladder cancer can be an aggressive cancer it is essential that any symptoms that could be related to bladder cancer are investigated thoroughly and promptly to ensure that there is the best chance of a successful outcome.