The bladder is the bag of muscle in the lower abdomen that collects urine produced by the kidneys. Bladder cancer is the most frequently occurring tumour of the urinary system. It is a common cancer that accounts for 1 in 30 new cases of cancer in the UK every year, being the 4th most common cancer in men and the 11th most common in women. The average age at diagnosis is 68 with men outnumbering women threefold, although women have a poorer prognosis. Although bladder cancer is the sixth most common cancer in the UK, with over 10,000 cases diagnosed annually, it has one of the highest survival rates of any cancer. Five years after being diagnosed over half the patients are still alive.
The majority of bladder cancers start in the cells that line the bladder and are transitional cell carcinomas (tumour tissues). Some remain undetected until they have spread through the bladder lining into the adjacent muscle.
- The appearance of blood in the urine is the most common clue to bladder cancer and occurs in up to 80 per cent of those affected. As the blood is often in microscopic amounts, it may only picked up during urine tests.
Other symptoms may not appear until the cancer has developed further and include:
- The need to pass urine suddenly and often
- Pain when passing urine.
All these symptoms are typical of urinary tract infections, which are considerably more common than bladder cancer, so there is no need to panic if you develop these problems. However, it is important that you see your GP for further investigations. Even if there is a tumour present, it may be benign rather than a malignant cancer.
The National Institute for Health and Clinical Excellence (NICE) recommends GPs to refer their patients to a specialist within two weeks should they have blood in their urine and:
- there are no symptoms to suggest a urine infection
- a urinary tract infection has been ruled out
- the patient is over 40 and has recurring or persistent infections of the urine
Bladder cancer was one of the first cancers to be linked to a specific cause and many other risk factors have been identified, including:
- Exposure to certain dyes increased the risk.
- Ethnic background – Caucasians are most at risk
- Smoking – the body filters cigarette smoke chemicals into the urine and when passed to the bladder they are in contact with the wall lining. Smokers are two to three times more likely to develop bladder cancer than non-smokers.
- Radiotherapy and chemotherapy used to treat other cancers
- Exposure to different chemicals, such as arylamines, polycyclic hydrocarbons, paint and printing inks. Workers in the rubber, chemical and leather industries appear to be at increased risk
- Repeated bladder infections increase the risk of a type of cancer called squamous cell carcinoma [a type of skin cancer], especially when patients have bladder stones or smoke
- Parasitic infections such as bilharzias, also known as schistosomiasis, is a tropical disease caused by parasitic worms called Schistosomes. There are over a billion sufferers in the developing world
Despite these discoveries, researchers are still unsure precisely why and how the disease first develops.
T (Tumour) describes the size of the tumour. Doctors find the T stage by taking tissue samples (biopsies) to look at the grade of the cancer cells. They also look at your bladder using a cystoscopy and a CT or MRI scan.
There are several T stages:
- CIS or Tis means very early, high grade cancer cells are only in the innermost layer of the bladder lining
- Ta means the cancer is just in the innermost layer of the bladder lining
- T1 means the cancer has started to grow into the connective tissue beneath the bladder lining
- T2 means the cancer has grown through the connective tissue into the muscle
- T2a means the cancer has grown into the superficial muscle
- T2b means the cancer has grown into the deeper muscle
- T3 means the cancer has grown through the muscle into the fat layer
- T3a means the cancer in the fat layer can only be seen under a microscope (microscopic invasion)
- T3b means the cancer in the fat layer can be seen on tests, or felt by your doctor during an examination under anaesthetic (macroscopic invasion)
- T4 means the cancer has spread outside the bladder
- T4a means the cancer has spread to the prostate, womb (uterus) or vagina
- T4b means the cancer has spread to the wall of the pelvis or abdomen
The primary source for some of the content of this updated article is Cancer Research UK. To read their latest detailed research findings, we strongly recommend that you access their web site page, just click on the link below:
then click on Bladder Cancer.