Bladder cancer develops when abnormal cells in the bladder start to mutate and grow uncontrollably and more rapidly than normal cells. A mass of cancerous cells is called a malignant tumour, or more simply, cancer.
The bladder is a muscular sac in the pelvis, roughly the size of a pear when empty with a capacity somewhere between 400 and 500ml when full. It receives urine from the kidneys and stores it for excretion via the urethra. The bladder is lined with a membrane and the cells of this membrane are called urothelial cells. The membrane lining is called the urothelium.
Nearly all bladder cancers begin in the urothelial cells. This is called a urothelial carcinoma, formally known as transitional cell carcinoma, and constitutes roughly 80-90% of all bladder cancers. In some cases the cancer may grow into deeper layers of the bladder wall.
Other less common types of cancer include squamous cell carcinoma, or an adenocarcinoma.
Treatment for bladder cancer will depend on the progression of the malignant cells and how far they have spread into the layers of the bladder:
Non-muscle invasive tumours – The malignant cells are found only in urothelium or in the next layer of tissue (lamina propria) and haven’t progressed any further into layers of the bladder wall. This accounts for most instances of cancer.
Muscle-invasive tumours – The cancer has spread into layers of the bladder wall.
Like other forms of the disease, we don’t know exactly what causes bladder cancer. However, there are a number of risk factors associated with it developing:
• Age – bladder cancer usually occurs in people over 60
• Smoking is a major risk factor for cancer, particularly prolonged smoking
• Gender – males have a higher risk of bladder cancer
• Prolonged exposure to certain chemicals – usually work-related. For example, chemicals used in dyeing in the textile and rubber industries.
• Chronic inflammation of the bladder or repeat bladder infections
• Family history
• Previous cancer treatments, such as radiotherapy to the pelvic area
Sometimes, bladder cancer doesn’t present any symptoms and it is found during urine tests and routine checkups.
Blood in the urine (haematuria) is the most common symptom of bladder of cancer. Often this comes on suddenly and is not painful, with only a small amount of blood present for a short amount of time.
Although a small amount of blood in the urine may not seem troublesome, it is very important to see your urologist right away. Even if it is not the result of cancer it may be a symptom of another condition such as bladder stones, an infection, or an enlarged prostate.
Other common symptoms of bladder cancer include:
• Trouble urinating
• A burning sensation while urinating
• Frequent need to urine
• Pain in the lower back or abdomen
Surgery – Non-muscle invasive cancers can be removed surgically using a cystoscope. Burning the base of the tumour or using high-energy laser to damage or kill the cells can also be an effective way to treat bladder cancer. A cystectomy – the surgical removal of part or all of the bladder – may be required to treat muscle-invasive tumours.
Immunotherapy – Non-muscle invasive cancers can also be treated with immunotherapy – also known as ‘biological therapy’ – which involves using vaccines to encourage your immune system to fight the cancer. The most common immunotherapy used is a vaccine called Bacillus Calmette-Guérin (BCG).
Intravesical Chemotherapy – Not as effective as immunotherapy but can be used if BCG has failed or if it cannot be tolerated.
Palliative Care – If cancer is diagnosed late and/or if it has spread to far to be treated, palliative care is often the best option. This involves focusing on improving quality of life by alleviating the cancer symptoms and managing pain and discomfort.
Dr Arianayagam is an expert in the field urological cancer surgery, including robotic surgery for the treatment of bladder cancer. He is one of the most experienced robotic surgeons in Sydney and routinely performs robotic bladder removal with intracorporeal diversion (where the urine is diverted using the robot internally).
If you have any further questions about bladder cancer and would like to book an appointment, please feel free to call.