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Bladder cancer

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Fast facts

What is bladder cancer?

The bladder is an organ in the pelvis. Our kidneys filter our blood and produce urine (pee), which then travels to the bladder and collects there. When the bladder is full, we feel the need to urinate, and the bladder empties out of the body through a tube called the urethra.

Bladder cancer occurs when abnormal cells grow uncontrollably in the bladder.

Causes

The cause of bladder cancer is damage to the DNA in the bladder cells. In bladder cancer, it is not always clear what causes this damage.

Risk factors

Risk factors for bladder cancer include:

  • Cigarette smoking;
  • Age: most people with bladder cancer are over 70 years old;
  • A family history of bladder cancer;
  • Exposure to certain chemicals that are used in the dyeing and textile industries;
  • Chronic and recurring bladder infections, and;
  • Treatment for other cancers: radiotherapy in the pelvic area for other types of cancer increases your risk of developing bladder cancer.

Types

There are several different types of bladder cancer. The most common type is transitional cell cancer, which arises from the cells that line the inside of the bladder. Other types of bladder cancer, which are much rarer, are adenocarcinoma and squamous cell carcinoma. These tend to be more aggressive and spread into the deeper layers of the bladder.

Signs and symptoms

The following symptoms of bladder cancer are also associated with less serious conditions such as urinary tract infections, but you should still see your doctor if you have any of these symptoms:

Methods for diagnosis

Physical examination

Your doctor may perform a pelvic examination (for women), or a digital rectal examination (for women and men), to feel for any masses or growths on the bladder.

Urine test

Your doctor may ask you to give a urine sample. Your urine will then be checked for the presence of cancerous cells and/or blood. This is known as urinary cytology.

Scans

Scans that can be used to identify the site, size and stage of the bladder cancer:

Procedures

Cystoscopy and biopsy

A thin, flexible tube with a camera at the tip will be inserted into the urethra to view the lining of the urethra and the bladder. This procedure, known as cystoscopy, is performed under anesthetic in a hospital.

If cancer is suspected, your doctor may want to take a tissue sample from that area and check it for cancerous cells.

Stages of bladder cancer

Stages of bladder cancer depend on size, location and whether or not it has spread. Broadly, bladder cancer can be superficial or invasive.

Superficial or non-invasive bladder cancer

This category of bladder cancer describes cancers that have not spread beyond the inner lining of the bladder. They are staged as:

Superficial bladder cancers tend to grow back even after treatment. Therefore, it is important to have regular check-ups to keep the cancer well-controlled.

Stages of invasive bladder cancer

Stage I

The cancer has penetrated deeper into a layer of tissue next to the bladder's inner lining.

Stage II

The cancer has spread into the muscle layers of the bladder.

Stage III

The cancer has spread into the layer of fat around the bladder, and may also have spread to the uterus or vagina in women, or to the prostate gland or seminal vesicles in men.

Stage IV

The cancer has spread beyond the pelvis and/or throughout the body to other organs, such as the lungs or liver.

Stages of invasive bladder cancer. 

Bladder cancers can vary in how aggressive they are based upon their grading:

Treatment and outcomes vary depending on the stage and grade of bladder cancer.

Types of treatment

Superficial bladder cancer

Surgery

Superficial cancers can be surgically removed using cystoscopy. They are shaved off from the inner lining of the bladder. Due to the fact that superficial bladder cancer often comes back, you may need to have follow-up cystoscopies to remove new cancers.

Additional therapies

One form of medication, which uses the Bacillus Calmette-Guérin (BCG) vaccine (which is also used for tuberculosis prevention) helps the body's immune system to fight off bladder cancer cells. This is known as immunotherapy or biological therapy.

Chemotherapy can also be directly injected into the bladder using a catheter, to help damage the bladder cancer cells. This is known as intravesical chemotherapy.

Invasive bladder cancer

Surgery

The first line of treatment is often removing part of the bladder (partial cystectomy), or the whole bladder (radical cystectomy).

Additional therapies

Other therapies, such as chemotherapy and radiotherapy, can be used together with surgery. They may be given before surgery (neoadjuvant therapy) and/or after surgery (adjuvant therapy). When given before surgery, they aim to reduce the size of the cancer. When given after surgery, they aim to help prevent the cancer returning.

Occasionally, chemotherapy and radiotherapy may be the only treatments used if individuals are not suitable for surgical treatment. Often, in these situations, the aim of treatment is to control symptoms, and not necessarily for cure. The treatment options and aims can differ, based on the individual, the stage and type of cancer. Your doctor can help explain this information in more detail.

More information on cancer treatments can be found here.

Complementary and alternative therapies

Some people diagnosed with cancer seek out complementary and alternative therapies. None of these therapies are proven to cure cancer, but some can help people feel better when used together with conventional medical treatment. It is important to discuss any complementary treatments with your doctor before starting them.

Potential complications

Treatment side effects

Stoma and surgical complications

A partial cystectomy results in a smaller bladder that holds less urine, so you will need to urinate more often. A radical cystectomy results in complete removal of the bladder, so most commonly an artificial opening, called a stoma, is needed. This allows urine to pass through the abdomen into a watertight bag, bypassing the need for a bladder. Your doctor will discuss the stoma and other options with you if it is required.

Surgical removal of the lymph nodes can result in a build-up of fluid, leading to swelling of the legs (known as lymphoedema). Massage and compression clothing can help relieve swelling.

Chemotherapy and radiotherapy complications

There are a range of side effects related to chemotherapy and/or radiotherapy treatment, which include:

Advanced bladder cancer

In cases of advanced cancer, the cancer can metastasize to other parts of the body through the bloodstream and lymphatic system. The growth of cancer in the organs and other body parts has a destructive effect on their function.

Recurrence of bladder cancer

Occasionally, bladder cancers may return (recur) even after treatment. If this occurs, additional therapies may be needed. Because the success of curing recurrent cancers is lower, your doctor will generally advise regular and frequent follow up to detect any early recurrences so your chances of a successful cure are much greater.

Prognosis

The prognosis for bladder cancer depends on the type and stage of the disease, but the overall five-year survival rate from the point of diagnosis is 58% - more than one of every two will survive. For those who survive the first year, this rate increases to 73%, and for those who survive five years, the survival rate for the next five years increases to 88%. [1]

It is important to remember that survival rates are only an indication, and are based upon the averages of previously-treated patients. It is not an absolute prognosis for an individual. It is often difficult to accurately predict an individual's cure or survival rate. Constant advances in treatment are continually improving these statistics.

Prevention

Bladder cancer cannot be prevented, but one way to reduce the risk of developing the cancer is by quitting smoking.

References

  1. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Australian Government – Australian Institute of Health and Welfare. Accessed 22 September 2014 from link here

10 Most frequently asked questions (FAQs)

What is bladder cancer?
Bladder cancer occurs when DNA in cells in the bladder is damaged. As a result, the bladder cells replicate uncontrollably. In many cases of bladder cancer, it is not known exactly what causes this DNA damage. Factors such as cigarette smoking are known to increase the risk of bladder cancer.
What are the symptoms of bladder cancer?
The symptoms of bladder cancer include blood in the urine and frequent urination, as well as pain and a burning sensation during urination. These can be symptoms of less serious problems, such as urinary tract infections. If you have these symptoms, you should see a doctor.
What causes bladder cancer?
Bladder cancer is caused by DNA damage to cells that causes them to replicate uncontrollably and form cancers.
How is bladder cancer diagnosed?
A definitive diagnosis of bladder cancer is made by your doctor taking a tissue sample, called a biopsy, and having it examined under a microscope.
What increases the chances of developing bladder cancer?
Your risk of bladder cancer increases with age. It also increases if you have recurring bladder infections, experience long-term exposure to chemicals such as aromatic amines (common in the dyeing and textile industries), smoke cigarettes, or have a family history of the disease.
What is the outcome for bladder cancer?
The prognosis for bladder cancer depends on the type and stage of the disease. Your doctor will discuss your likely treatment outcomes with you if you have bladder cancer.
Are there different types of bladder cancer?
Yes. There are different types of bladder cancer and they are defined by the cells they originate in. By far the most common are transitional cell carcinomas.
Can bladder cancer be cured?
Bladder cancer cannot be cured, because there is always a chance that it will return. It can, however, go into remission, meaning that no trace of cancer is found when you go for a periodic check-ups.
How is bladder cancer treated?
Treatment for bladder cancer varies according to the type and stage of the cancer. Your doctor will discuss your treatment options with you. In general, a combination of surgery, radiotherapy and chemotherapy is used.
Can bladder cancer be prevented?
Although bladder cancer cannot be prevented, you can reduce your risk by not smoking cigarettes.

Related topics

Urinary tract infections (UTI)

Urinary tract infections, or UTIs, are caused by bacteria entering the urinary tract. This can cause problems with urination including increased frequency and burning sensations. While the condition can be frustrating, symptoms will typically subside with proper treatment.

Prostate cancer

Prostate cancer is the name for cancers that form in the prostate gland, which is part of the male reproductive system. Abnormal cells can form a tumour in the prostate gland and spread throughout the body, commonly to the bones.

Breast cancer

Breast cancer is the name for cancers that develop in breast tissue. Abnormal cells can form a tumour (lump) in the breast and spread throughout the body. Breast cancer is the most common form of cancer among women, but can also develop in men.

Cervical cancer

Cervical cancer is the name for cancers that form in the cervix, the lower part of the uterus where it meets the vagina. Most cases arise from human papillomavirus infection. Abnormal cells can form a tumour and spread to other parts of the body.

About this article

Title: Bladder cancer

Author: Jonathan Meddings BMedLabSc (Hons)

First Published: 17 Nov 2014

Last reviewed: 17 Jan 2022

Category: Information on Bladder cancer

Average rating: 4.7 out of 5 (1554 votes)

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