Bladder cancer – also called urothelial carcinoma (UC) or transitional cell carcinoma (TCC) – is a “forgotten cancer” due to its lack of profile in the community, with many patients and family knowing nothing about it, despite it being the 9th most common cancer. It affects both men and women, however is three times more common in men. It is one of the few cancers to show a significant decrease in 5 year survival between the 1982-1987 and 2006-2010 periods to ~50% (in high grade muscle invasive disease).
Bladder cancer may have no symptoms other than blood in the urine, and this blood could be visible (macroscopic hematuria) or invisible (microscopic hematuria). Blood in the urine is never normal and always requires investigation to rule out bladder cancer.
Some other symptoms can include frequency of urination, pain on urination and in the advanced setting weight loss and pain in the bones or other parts of the body. Many of these symptoms are vague and similar to other conditions. We therefore investigate many patients who do not turn out to have bladder cancer.
Diagnosis and Testing
All patients with blood in their urine and/or risk factors and symptoms require investigation by a urologist to rule out bladder cancer. Standard tests used include urine cytology (microscopic assessment of cells in the urine) on three separate occasions, imaging of the urinary tract (either ultrasound or CT as determined as appropriate by the urologist), and flexible cystoscopy – a visual assessment of the lining of the bladder – by inserting a fine, flexible telescope down the urethra (wee pipe) into the bladder.
If any suspicious lesions are identified through the above investigations, the patient must undergo biopsy or resection in the operating theatre. Under a general anaesthetic, a telescope is inserted down the urethra into the bladder and, using electrocautery, tissue is resected and sent to the pathologist for review.
There are several risk factors for bladder cancer. The most common cause is smoking, even if a patient had stopped smoking years previously. Other environmental exposures with certain chemicals or in certain professions also increase the risk (e.g. leather workers, hairdressers, exposure to petrochemicals and others).
Treatment of Bladder Cancer
Bladder cancer is not just one disease, but rather a spectrum. It is defined in terms of the grade of cancer (high or low grade) and whether the tumour is sitting on the surface of the bladder (superficial or non-muscle invasive disease) or invading the deeper structures of the bladder (superficially invasive and muscle invasive).
These factors, which are defined by pathologic analysis of tumour specimens under the microscope, entirely determine the appropriate management of the individual patient. Management can range from simple surveillance of the bladder with intermittent cystoscopy to major operations including removal of the bladder.
Prof Vela will discuss in detail your individual type of cancer, the options for treatment, and what is the best management approach for you. In some settings treatments in addition to surgery may be recommended, including systemic chemotherapy and/or treatments in the bladder such as chemotherapy or immunotherapy or clinical trials.
Regardless of the type of cancer, all bladder cancer patients are followed up with varying frequency and procedures; some for several years, some for the rest of their life. Stopping smoking will be strongly advised as the priority for any bladder cancer patient.