Cancer is the growth of abnormal cells that may progress and grow locally and sometimes may spread to other parts of the body (metastasize). These are also called malignant tumours. Lumps which grow but aren’t cancer and don’t spread are called benign lumps.
The bladder is a hollow muscular organ that functions to store and empty urine. Its internal lining is formed by cells called transitional cells and as whole, this is known as Urothelium.
Almost all types of bladder cancer begin in the urothelium and are known as transitional or urothelial cancers. These cancers can be low grade or high grade. High grade cancers may be superficial (confined to the lining of the bladder or muscle invasive, that is, into the muscle layers of the bladder.
Less common bladder cancers include adenocarcinomas and squamous cell carcinomas. These type are likely to spread to deeper layers of the bladder.
Risk factors of bladder cancer:
- Cigarette smoking
- Exposure to chemicals used in the textile, petrochemical and rubber industries
- Drugs such as chemotherapy agents
- Inflammation of the bladder
The most common sign is painless haematuria. This should not be ignored and further tests to determine the cause of bleeding is required.
Your specialist may order the following tests: urine test, bloods tests, renal ultrasound and CT scan.
You will also be scheduled for theatre for a cystoscopy and biopsy of the area. A fine telescopic tube is inserted in your bladder to visualise the cancer and take a biopsy. The biopsy will be sent to pathology to determine the extent and grade of the cancer. The doctor may use a laser to cauterise the area and stop any bleeding. In some cases, a chemotherapy drug, such a doxorubicin or mitomocin is given straight after theatre.
Treatment will depend whether the cancer is superficial or invasive as well as your general health. Your doctor will determine the best treatment and will discuss this with you.
- Regular cystoscopies are recommended if the cancer is superficial. The frequency of these will be determined by your doctor.
- Immunotherapy BCG: This is a substance used to encourage the immune system to fight the cancer cells in the bladder. This is effective for superficial cancers with carcinoma in situ (CIS). This treatment is given weekly for 6 weeks and is administered via a catheter (thin tube inserted in the bladder at time of treatment). The catheter is removed following insertion of treatment. Further information on BCG will be provided from the hospital where your treatment is arranged. Following completion of your treatment, you will be scheduled for another cystoscopy 6-8 weeks later to determine the effectiveness of this treatment. For some persons monthly instillations may be required for the next 12 months. Your doctor will determine whether this is the right management for you.
If your bladder cancer has been diagnosis as muscle invasive or your treatment with intravesical treatment has failed, then other treatments are recommended and include:
- Radical cystectomy (removal of the bladder) – In men this includes the prostate and in women it includes the uterus and a small part of the vagina). This is major surgery and requires reconstruction of the urinary tract. This reconstruction surgery can be done in 3 ways. Your doctor will discuss with you the best option.
- Ileal conduit – An ileal conduit is the redirection of the urine so that it drains into a bag located on the right side of your abdomen. This diversion is created by removing a small section of the small bowel (ileum) which is used as a conduit to allow urine to flow out. The ureters will be surgically sewn to the wall of the conduit. The surgeon will close one end of the conduit and will bring the open end through the abdominal wall creating a stoma. A water tight bag will be placed over the opening of stoma to collect the urine.
- Neo bladder – A new bladder is made by taking a piece of bowel and making into a balloon like sac. The left and right ureters are implanted into the Neobladder allowing urine to drain into the Neobladder directly from the kidneys. The urethra is then anastomosed onto the base of the neobladder to allow normal passage of urine. You will learn new ways to empty your bladder and sometimes this can take a few months. For some, incomplete bladder emptying can occur and you are required to pass a disposable catheter to ensure bladder emptying
- Radiotherapy – Radiotherapy therapy treats cancer by destroying cancer cells and stop them from growing. If this is determined to be best management for you then a referral to a Radiation Oncologist is made.
- Chemotherapy – Chemotherapy treats cancer by destroying all cancer cells whilst doing the least possible damage to normal cells. The drugs work by killing the cells or stop them growing and reproducing themselves. If this is determined to be best management for you then a referral to a Medical Oncologist is made. Chemotherapy is often considered before surgery but may also be recommended if the cancer has spread to the lymph nodes.
The management strategies for patients with bladder are not always straightforward and may sometimes require input from medical disciplines outside urology. At NEU, we have fortnightly Multi- disciplinary meetings in our rooms and have specialist medical oncologists, radiation oncologists and other urologists present. Also, through our association with Austin Health, our Urologists also attend their weekly Multidisciplinary meetings. This ensures that all our patients have access to all the latest therapies and clinical trials being run as well as the collective opinion of a team of specialists dedicated to the management of bladder cancer.