Bladder Cancer

How common is it?

Bladder cancer is more common than people realise. Over 10,000 cases are diagnosed each year in the UK with nearly 100 per year in the Grampian Region. The majority of these (about 7,500) are diagnosed in men, meaning that, on average, one man in thirty will get bladder cancer at some time in his life.

What can increase my risk?

Bladder cancer affects the inner lining of the bladder. As it grows, it may spread to other organs near the bladder or metastasize (spread) to the lymph nodes, lungs or bones. The risk of developing bladder cancer increases with age, and two-thirds of all cases occur in people over 70. It affects twice as many men as women.

Is smoking linked to bladder cancer?

Smokers are two to five times more likely to get bladder cancer than normal. The more they smoke, or the longer they smoke, the higher the risk. It is estimated that half of all bladder cancers in men, and one third in women, are the result of smoking.

Smoking increases the risk of bladder cancer. Chronic bladder infections, or bladder stones, slightly increase the risk. Contact the NHS Grampian Smoking Advice Service for help to give up smoking.

What are the symptoms?

Symptoms include:

  • blood in the urine
  • the need to pass urine very often or very urgently.

The most common symptom is blood in the urine, although there are many other conditions (such as bladder infections) which can cause this. The other less common symptoms (frequency of urination and pain when urinating) can also have other causes.

None of these symptoms are necessarily due to bladder cancer because infections can also cause these signs. However, anyone noticing these signs should report them to a doctor.

How dangerous is bladder cancer?

Over 3000 people die from bladder cancer each year in the UK. However, the vast majority of patients will have superficial bladder disease and will not require radiotherapy or bladder removal (see below). These patients will come back to hospital for check cystoscopys( bladder inspections) on a regular basis for a significant number of years. The death rate amongst women has remained the same for a long time, the death rate amongst men is slowly dropping.

Who is at risk from bladder cancer?

There are very few cases of bladder cancer in people under 40 and the vast majority of cases are diagnosed after the age of 55. Caucasian (ie white) people are more at risk than others. Significantly lower levels of this cancer are found in people of African or Asian origin. There is a very high rate of bladder cancer in countries such as Iraq and Egypt, where it is associated with an infection of the bladder called schistomiasis, which is endemic in those countries. Some industrial chemicals used in dying are known to be linked with a high risk of bladder cancer. These chemicals are no longer in use.

How is bladder cancer diagnosed?

First, a urine sample is taken and sent for analysis, too see if any abnormal cells can be found in it. The next test is usually cytoscopy under local anaesthetic, a thin flexible tube is passed up the urethra (the tube that carries the urine out) and into the bladder. Fibre-optics in the tube allows the doctor to inspect the inside of the bladder. In some cases, X-rays and blood tests may also be required.

How will my doctor test for cancer?

Initially, a doctor will carry out an examination and a urine test and refer you to a specialist. The specialist may want to examine the inside of the bladder. This procedure is called cystoscopy, and means inserting a tube into the bladder under local or general anaesthetic. Optic fibres inside the tube allow the doctor to view the inside of the bladder in order to find out whether anything looks abnormal. When the doctor or specialist finds a tumour he will arrange for the patient to come and get an operation on the bladder done through the water passage, called a trans urethral resection of bladder tumour (TURBT) to remove the growth and send it for analysis. This allows the doctor to plan whether any other treatment will be necessary once the tumour has been analysed. If an invasive cancer is present, the specialist will want to find out if it has spread to other parts of the body, and may want to carry out some scans. These might include a body scan and a bone scan.

How is bladder cancer treated?

This depends on how advanced the cancer is. Some cases of early bladder cancer can be treated by adding either cancer drugs, or the BCG vaccine, directly to the contents of the bladder. For early cancer, a simple operation, using a similar thin flexible tube inserted via the urethra, is followed by drug or vaccine treatment. More advanced cancers require either radiotherapy or an operation to remove the bladder. This type of operation has a number of repercussions. The patient does not urinate in the conventional way afterwards and usually has a bag on the side of the abdomen collecting urine from a stoma (an opening that the surgeon has created). Sometimes a reconstruction of the bladder is possible, but this may require the patient to use a catheter ( a tube to pass into the new bladder). Radiotherapy (Xray treatment to kill the cancer cells where they are) leaves the bladder where it is so the patient passes urine in the normal way, but it may not be as effective at curing the cancer. Increasingly patients are offered chemotherapy(drug treatment) before surgical removal or radiotherapy as this has been shown to increase the chance of curing bladder cancer, however not everybody is suitable for this.

How effective are these treatments?

This depends on how advanced the cancer is and the age of the patient.