Bladder cancer

Bladder Cancer shown in the urinary system diagram

Facts and figures about bladder cancer

Bladder cancer is the 7th most common cancer in the UK, accounting for 3% of all new cancer cases. Higher incidence in men, male to female ratio is 25:10. Age related, approximately 90% are diagnosed in those over 60 years and an average of 53% is in the 75+ years age group.

Risk factors include smoking, occupational exposure related to the production of dyes, rubber, textiles and pesticides, fossil and carbon containing fuels and arsenic.

Medical conditions such as chronic bladder infection, Crohn’s disease, HPV infection and possibly diabetes and also a first degree relative being diagnosed with bladder cancer. 75% are diagnosed in the early stages and consequently have a good prognosis. Over 90% of these tumours are transitional cell carcinomas.

Bladder cancer symptoms

  • Blood in the urine (haematuria) - occurs in 80% of cases.
  • Urinary frequency.
  • Urinary urgency.
  • Pain on passing urine (dysuria).

Some of these symptoms can be caused by other conditions such as infection or an enlarged prostate.

Diagnosis of bladder cancer

Investigation may include:

  • Urine tests (likely to be carried out initially to investigate for possible urinary tract infection).
  • Physical examination.
  • Cystoscopy (may be under a local or general anaesthetic).
  • CT scan –may be a CT urogram (CT scan of the urinary tract).
  • Intravenous urogram (IVU) – x-ray of the urinary system.
  • Ultrasound scan.

Bladder cancer treatment

Depends on several factors:

  • The type of tumour.
  • The grade of the cancer cells.
  • The stage of the cancer.
  • Age and general health.

Surgery

In early stage bladder cancer where the cancer cells are still in the lining of the bladder, the areas affected by the disease can be removed from the bladder lining, which can be done during a cystoscopy.

The tissue that has been removed will be analysed to assess the grade of the tumour cells. This may be adequate treatment but if there is a risk of recurrence, chemotherapy may necessary, which involves putting the chemotherapy drug directly into the bladder or in some cases BCG vaccine.

BCG is a vaccine used to prevent tuberculosis, which has been found to stop or delay the recurrence or spread of high grade early tumours, it is thought to work as a type of immunotherapy.

Radiotherapy

Radiotherapy is used to treat invasive bladder cancer and has the benefit of bladder preservation if it is successful, although the bladder does shrink.

There is also less risk of nerve damage in the genital area and therefore less effect on sexual function compared to surgery. Although in approximately 30% of cases, the disease recurs so removal of the bladder will be necessary.

Radiotherapy may be given in combination with chemotherapy (chemoradiation) which makes the radiotherapy more effective and the recurrence rate for patients receiving chemoradiation is 18-30%.

In cases where the tumour is in the surface layer of the muscle, a transurethral resection of the bladder (TUBRT) is performed followed by chemoradiation.

Radiotherapy may be given in advanced cases to try and control the disease and relieve symptoms such as pain or bleeding.

Chemotherapy

Chemotherapy may be used in early stage bladder and is put directly into the bladder, this is called intravesical therapy, and the chemotherapy drugs frequently used are mitomycin C, epirubicin or doxorubicin.

Chemotherapy may also be used in invasive bladder cancer to shrink the tumour before chemotherapy or radiotherapy (neoadjuvant) or after surgery to reduce the risk of recurrence (adjuvant).

Chemotherapy is also given in combination with radiotherapy (chemoradiation) and this has been shown to reduce the risk of recurrence. Chemotherapy is often a combination of the following drugs gemcitabine, cisplatin, carboplatin, doxorubicin, methotrexate and vinblastine.

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