Overview

What is Bladder Cancer?

The bladder is a hollow muscular organ that lies in the area surrounded by the hipbones, an area called the pelvis. The bladder acts as a reservoir to collect urine from the kidneys. The muscles of the bladder help to pass out urine from the lower urinary passage (urethra). The cells lining the bladder can develop abnormally and result in bladder cancer.

How common is Bladder Cancer?

In Singapore bladder cancer is the tenth most common cancer in men. This cancer usually occurs after the age of 40 years and is seen mostly in the 50 to 70 years age group. It is about 5 times more common in men than in women.  

Causes and Risks

This cancer has been associated with smoking, certain chemicals related to the aniline dye industry and chronic infections with schistosomiasis (a parasite) which is common in the Middle East and Africa.

Symptoms

Symptoms and Signs of Bladder Cancer

The most common symptom is the passing out of bloodstained urine. This is usually not painful. Blood in the urine associated with pain is usually due to infection or stone disease.

Bleeding in bladder cancer is usually more severe and associated with the passing out of blood clots. Occasionally the cancer can cause blockage of the bladder and give rise to difficulty in passing urine.

If there is blood in the urine, especially if a person is above 40 years old, it is important to rule out bladder cancer.

Treatment Options

Treatment of Bladder Cancer

Surgery is recommended for most early bladder cancers. The procedure of removing bladder cancer when it is still very early using a resectoscope is known as transurethral resection of bladder tumour (TURBT). This is done under general anaesthesia. After surgery, the patient may pass bloodstained urine for a while and a temporary urinary catheter (flexible tube passed through the urethra and into the bladder) connected to a drainage bag may be fitted.

When the cancer is fairly advanced the total removal of the bladder is required. A new bladder is then made from a person's own intestines if possible. If not, urine is drained into a segment of small intestine that comes out the side of the abdomen, i.e. ileostomy.

Radiation therapy may be an alternative to surgery for localised disease. This may also be used if the patient has other illnesses that prevent surgery. Alternatively, it may be used after surgery to try to reduce the chance of cancer recurring. Radiation involves concentrating high-energy rays into an area where the cancer was. Side effects, which are temporary, include redness of the skin, pain on passing urine, passing small amounts of urine frequently, and temporary loss of hair at the radiation site.

Chemotherapy is the use of drugs that kill cancers. Some chemotherapy drugs can be injected directly into the bladder for patients with early bladder cancer, to prevent recurrence of cancer. Chemotherapy drugs can also be injected into the veins in the hands to kill bladder cancer cells that have spread throughout the body, to slow down the growth of the cancer. Side effects of chemotherapy injected in the hand veins include temporary nausea and vomiting, mouth ulcers, hair loss, loss of appetite and tiredness.

Immunotherapy can be used to boost the body's immune system. The anti-tuberculosis vaccine, BCG, injected in the bladder, has been effective in treating high risk superficial bladder cancers.

Treatment depends on many factors, including the stage of the cancer, the type of bladder cancer, and the patient's age and general health.

Prognosis of Bladder Cancer

Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of bladder cancer may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with bladder cancer is good.

Frequently Asked Questions

How can I prevent bladder cancer?

If your occupation requires exposure to chemicals that are known to cause bladder cancer such as aniline dye, protective clothing may be beneficial. Smoking doubles the risk of developing bladder cancer. Therefore by not smoking you reduce the risk.

Is there any reliable test that will pick up bladder cancer early?

It is important for a person to seek medical attention early if there is blood in the urine or unexplained or longstanding bladder infection. The confirmatory test for bladder cancer is cystoscopy and biopsy of abnormal areas. People who have high exposure to chemicals that cause bladder cancer may be routinely tested.