Bladder cancer: Causes, signs & treatment

May is Bladder Cancer Awareness Month!


About 10,000 people in the UK are diagnosed with bladder cancer every year, making it the 10th most common cancer in the country. It develops when there are abnormal changes to the cells in your bladder; these cells are called urothelial cells. And although they are also found in your kidneys and ureters, cancer rarely every develops there.

What are the causes for bladder cancer?

As with many cancers, the exact cause for bladder cancer is unknown. However, research suggests that there is a link between the development of bladder cancer and exposure to certain harmful substances like chemicals or cigarette smoke. It’s actually estimated that a third of all bladder cancer cases are affecting smokers.

Who is most at risk of developing bladder cancer?

Bladder cancer is generally more common in people over 60 and is also known to affect men more than women. It is believed that this is the case because, historically, men were much more likely to smoke and to be exposed to chemicals at work. But let’s look at some of the most common risk factors for developing bladder cancer.

Smoking

Whether you smoke cigarettes, cigars, or pipes – they will all increase your risk of developing bladder cancer. How? When you smoke your body will process all the harmful chemicals and will get rid of some of them in your urine. This means that at some point, there will be an accumulation of harmful chemicals in your urine which can damage the lining of your bladder and increase your risk of developing bladder cancer.

Exposure to certain chemicals

You might have heard at some point that your kidneys play a key role in filtering any harmful chemicals from your bloodstream and getting rid of them via your urine. Because of this, scientists believe that being exposed to certain chemicals can drastically increase your risk of developing bladder cancer. But which chemicals should you look out for? Arsenic and any chemicals used to manufacture dyes, leather, textiles, rubber, and paints, as well as the already mentioned chemicals in cigarettes, cigars, or pipes have all been associated with developing bladder cancer.

Previous cancer treatment

If you’ve previously had treatment for cancer, especially if the anti-cancer drug cyclophosphamide was used, your risk of bladder cancer will be increased. If you had radiation treatments aimed at your pelvis for a previous cancer you are also at a higher risk of developing bladder cancer.

Chronic bladder inflammation

If you suffer from chronic or repeated urinary tract infections (UTIs) or cystitis your risk of developing bladder cancer will be higher.

Personal or family history of cancer

If you’ve had bladder cancer before, the chances of it coming back are unfortunately high. If one or more of your blood relatives – whether that’s a parent, a sibling, or a grandparent – have a history of bladder cancer, you may also have an increased risk of developing the disease at some point in your life.

What are the symptoms of bladder cancer?

So, how do you know if you’ve got bladder cancer? The most common symptom is blood in your urine. You may notice streaks of blood in your pee, or your urine may turn brown. Be aware that the blood isn’t always noticeable and may come and go. Unfortunately, blood is often the only symptom in the early stages. Other, less common symptoms, can include:

  • Pain when peeing
  • Suddenly having to pee urgently
  • Having to pee more often than usual
  • Burning when peeing
  • Back pain

If your bladder cancer is at an advanced stage and has started to spread, you might experience some of the following symptoms:

  • Losing weight without wanting to
  • Pelvic and bone pain
  • Having swollen legs

When should you seek help?

If you notice blood in your urine, even if it comes and goes, it’s always best to make an appoint with your GP to get it checked out. Having blood in your urine doesn’t automatically mean that you have bladder cancer, though, so there’s no need for immediate panic. What are other reasons for having blood in your urine?

  • Urethritis
  • Kidney infection
  • Urinary tract infections
  • Kidney stones
  • An enlarged prostate gland

How is bladder cancer diagnosed?

As a first step, your GP will likely ask you about the symptoms you’ve been experiencing, your family history, and whether you’ve been exposed to any possible chemicals that are linked to bladder cancer, like cigarette smoke. Your GP will probably also test your urine for blood, bacteria, and abnormal cells and they might also carry out a physical exam of your rectum or vagina. This is because bladder cancer sometimes presents as a noticeable lump that can be felt with an internal exam. If your GP suspects that you have bladder cancer or the tests are inconclusive, they will likely refer you to a hospital where you might have one or more of the following tests:

  • Biopsy: Your doctor will insert a small tool through your urethra and take a small sample of tissue from your bladder. This piece of tissue will then be sent off and tested for cancerous cells.
  • Cystoscopy: Your doctor will insert a cystoscope – a narrow, flexible tube with a camera on it – through your urethra and into your bladder. This way, they can actually look at your bladder from the inside. The whole procedure is generally over in like 5 minutes, though! Your doctor will likely apply an anaesthetic gel to your urethra before starting the cystoscopy to make it less painful for you and also to make inserting the cystoscope into the urethra easier.
  • Imaging scans: When in hospital, you might be offered a CT or MRI scan for a more detailed picture of your bladder. You might also be offered an intravenous urogram (IVU) which looks at your whole urinary system before any treatment for bladder cancer is started. With an IVU, a special dye will be injected into your bloodstream and then X-rays will be used to study it as it passes through your urinary tract.

Staging and grading of bladder cancer

Once all the tests have been done and it has been confirmed that you have bladder cancer, your doctor will be able to stage it. Staging means that your doctor looks at how far your cancer has spread. The stages usually rank from 0 to 4 and mean the following:

  • Stage 3: The cancer has spread into the tissue that surrounds your bladder.
  • Stage 1: The cancer has spread past the lining of your bladder but hasn’t reached the muscle layer of your bladder yet.
  • Stage 0: The cancer is still only in the lining of your bladder and hasn’t spread past it.
  • Stage 2: The cancer has spread into the muscle layer of your bladder.
  • Stage 4: The cancer has spread past the bladder and has reached neighbouring areas in the body.

Your doctor will also check if the cancer has spread into any lymph nodes or into any other organs like your lungs or liver. The whole staging process can be a bit complicated and feel overwhelming, so don’t hesitate asking questions if you feel unsure about anything.

How is bladder cancer treated?

How your bladder cancer is treated will largely depend on how advanced it is. Treatments are usually different for early stage, non-muscle-invasive bladder cancer and advanced, muscle-invasive bladder cancer. But let’s look at it in a bit more detail.

Non-muscle-invasive bladder cancer

If your cancer is stage 0 or 1, your treatment will likely depend on the risk of the cancer returning or spreading beyond the lining of your bladder. This risk is calculated looking at the following factors:

  • Whether you’ve had bladder cancer before
  • How many tumours are currently in your bladder
  • How big those tumours are (your doctor will likely check whether they are more or less than an inch)
  • The grade of your cancer cells

Treatment for low-risk early-stage bladder cancer

Generally, the treatment for low-risk non-muscle invasive bladder cancer is a transurethral resection of the bladder tumour, also called TURBT. Once the tumour has been resectioned, the wounds will be sealed with a mild electric current and you might get a catheter inserted for a short period of time to drain any blood and debris from your bladder. After your surgery, you might also be given a single dose of chemotherapy straight into your bladder. The solution is kept in there for around an hour before being drained. If everything goes to plan, you’ll be able to leave hospital in less than 48 hours after your TURBT surgery. You’ll likely have to take it slow for a couple of weeks afterwards, though, and you’ll usually have a follow-up appointment at 3 and 9 months to check your bladder via a cystoscopy.

Treatment for intermediate-risk early-stage bladder cancer

If it turns out that your bladder cancer is intermediate risk, you might be treated with 6 doses of chemotherapy liquid directly into your bladder. The liquid is placed in the bladder using a catheter and is kept in there for around an hour before being drained. After the treatment, you’ll likely be offered follow-up appointments, most commonly around 3, 9, and 18 months after your initial treatment. After your 18-month check up you should be invited for a check up every 12 months. At these follow-up appointments, your bladder will be checked via a cystoscopy.

Treatment for high-risk early-stage bladder cancer

If your cancer is high-risk, you will probably have a second investigation about 6 weeks after your initial TURBT. If any abnormalities are found then, you might be offered another TURBT. After this second surgery, you will usually be offered follow-up appointments, most commonly every 3 months for the first 2 years, then every 6 months for another 2 years, and then once a year. During these check-ups, your bladder will be checked via a cystoscopy. If your bladder cancer keeps coming back, a cystectomy – or removal of the bladder – is an option. This will mean that your urine will need an alternative way to leave your body, also called a urinary diversion.

Muscle-invasive bladder cancer

If your bladder cancer is stage 2 to 4 your treatment will depend on how far it has spread and will either aim to cure your cancer or keep it at bay for as long as possible. But let’s look at the possible treatment options.

Radiotherapy with a radiosensitiser

Radiotherapy means that a machine beams radiation at your bladder; this is also called external radiotherapy. If you have advanced bladder cancer, you might have a 10-to-15-minute session daily, 5 days a week over the course of 4 to 7 weeks. You’re possibly also given a radiosensitiser alongside your radiotherapy. This is a medicine that affects the cells of the tumour in order to make the treatment more effective. The biggest downside of radiotherapy is that it’ll also damage healthy cells, which can cause a number of side effects like diarrhoea, an inflammation of your bladder, erectile dysfunction, tiredness, or difficulty going for a pee. Most of these side effects will go away a few weeks after the treatment has finished but there is a slim chance that some of them will be permanent. Once your radiotherapy has finished, you’ll usually be offered follow-up appointments, most commonly every 3 months for the first 2 years, then every 6 months for another 2 years, and then every year after that.

Surgery

If your symptoms are impacting your daily life severely or if your bladder cancer keeps coming back, getting your bladder removed might be an option for you. A radical cystectomy means that your bladder will be removed in one surgery and won’t need any regular cystoscopies afterwards. Here are some things to bear in mind when thinking about a cystectomy:

  • There’s a 90% chance of developing erectile dysfunction as a result of nerve damage.
  • There’s a risk of complications from general anaesthesia.
  • It can take up to 3 months for you to fully recover.
  • There’s a risk of general surgical complications such as pain, infection, and bleeding.
  • You’ll need an alternative way for urine to leave your body can involve wearing an external bag.
  • Some women may find sex uncomfortable or even painful after a cystectomy as your vagina might be tightened.

Chemotherapy

In some cases, chemotherapy may be used for muscle-invasive bladder cancer. Instead of the solution being put directly into your bladder, however, it’ll likely be put straight into a vein in your arm. Chemotherapy is usually used in the following ways:

  • In combination with radiotherapy before your surgery; this is called chemoradiation.
  • Before radiotherapy & surgery to shrink the size of your tumours.
  • To slow the spread of an incurable advanced bladder cancer; this is called palliative chemotherapy.

Chemotherapy is usually given once a week for 2 weeks followed by a week off; this cycle will generally repeat for a few months. As the chemotherapy will be given directly into your bloodstream, you’ll likely experience a more side effects than if you were getting your chemotherapy solution straight into your bladder. But what are possible side effects? Chemotherapy weakens your immune system and makes you more prone to infections. Other side effects include a loss of appetite, nausea, vomiting, hair loss, and tiredness.

Advanced or metastatic bladder cancer

Which treatment you will receive depends on how far your cancer has spread. Your doctor will discuss treatment options with you which can include chemotherapy, immunotherapy, and other medication to relieve your symptoms.

  • Chemotherapy: You may be given a course or multiple courses of chemotherapy and some medication to relieve side effects. If the chemotherapy isn’t working, the treatment can either be stopped or further courses of chemotherapy can be considered.
  • Immunotherapy: Immunotherapy helps the immune system to recognise and attack any cancerous cells in your body.
Palliative or supportive care

If your cancer has advanced to a stage where it can no longer be cured your doctor and nurses will likely discuss with you which treatments can be used to make your end of life care as comfortable as possible. This can be pain relief, medication to relieve symptoms, psychological support, or practical help.

Can you prevent bladder cancer?

Unfortunately, there’s no sure-fire way to prevent bladder cancer but you can take certain steps to reduce the risk of developing it. Here are some things you can do:

  • Be careful if you’re around harmful chemicals: If you work with any harmful chemicals, make sure you follow all the necessary safety instructions and guidelines to avoid any exposure.
  • Don’t smoke: If you don’t smoke, don’t start! If you’re a smoker and struggle with quitting, speak to your doctor about a plan that will help you to quit. There are different support groups, medications, or other methods that may help you make stopping easier.
  • Eat a variety of fruit and veg: Make sure your diet is rich in fruit and veg as a well-balanced diet is a crucial for a healthy life and there’s evidence that suggests that the antioxidants in these foods may reduce the risk of bladder cancer.