Bladder cancer

Bladder cancer usually starts in the lining of the bladder and/or urinary tract as a primary cancer. It happens when abnormal cells in the lining of the bladder or urethra (urinary tract) start to multiply in an uncontrolled way to form a tumour.

70% of cases of bladder cancer are non-muscle-invasive (i.e. superficial), which means that the cancerous cells have stayed in the lining. This is the most treatable form and half of people diagnosed with non-muscle-invasive bladder cancer have a good chance of successful treatment.

Other bladder cancer tumours grow into the muscle wall of the bladder, this is called invasive bladder cancer.

Sometimes bladder cancer spreads to other parts of the body – this is called advanced or metastatic bladder cancer and is usually because it was not detected and treated at an early enough stage.

There is no screening programme for bladder cancer, but earlier detection can improve the prognosis and outcome.

Symptoms

The main bladder cancer symptoms are:

  • Blood in your urine which is usually bright red but not painful
  • Pain when urinating
  • Needing to urinate urgently
  • Needing to urinate frequently

You should see your doctor if you have these symptoms, particularly if you have blood in your urine.

Bladder cancer is usually diagnosed in people over 60. It is also more common in men than women.

There are other risk factors that increase the risk of developing bladder cancer. These are:

  • A close relative with bladder or upper urinary tract cancer
  • A history of smoking
  • Exposure to chemicals used in industries including textile, rubber, leather, dye, paint and print industries – usually through previous work
  • A chronic bladder infection or a neurological condition that affects your bladder control (i.e. neurogenic bladder)
  • Previous radiotherapy to the pelvis

Diagnosis

Bladder cancer is usually diagnosed with a procedure called a cystoscopy and commonly involving a biopsy. This is usually carried out with a local or general anaesthetic. Other diagnostic procedures include: intravenous urograms, ultrasound scans, CT scans and MRI scans.

After initial diagnosis and treatment, regular monitoring is needed in case the bladder cancer returns. This is usually carried out with further cystoscopic examinations. However, there are now DNA bladder cancer testing kits available, such as the BCA-1 Test from ArrayGenomics which can be used as an adjunct to procedures mentioned above.

Stages and grades

Bladder cancer is diagnosed according to its type, stage and grade.

Types

There are different types of bladder cancer. About nine out of ten bladder cancers start in the cells of the bladder lining – this is called transitional cell bladder cancer.

It can be:

  • Non-muscle-invasive (superficial or early). This means the bladder cancer hasn’t invaded the deeper layers of the bladder wall.
  • Carcinoma in situ (CIS) or high grade T1 tumours. These are both classed as higher grade bladder cancer and are more likely to grow quickly.

Less common types of bladder cancer are:

  • Squamous cell bladder cancer.
  • Adenocarcinoma.
  • Sarcomas.
  • Small cell cancer of the bladder.

Sometimes, cancer spreads to the bladder from another nearby part of the body. This is called secondary cancer.

Stage

This is a measurement of how far the cancer has spread. It will usually be early, invasive or advanced. Early cancers are easier to treat. The most commonly used staging system is called the TNM (Tumour, Node, Metastasis), which combines information about how far the cancer has spread in the bladder as well as lymph nodes and other parts of the body.

Grade

This is an assessment of how likely it is that the bladder cancer will spread. Grading usually uses a system of 1 to 3, with 3 being high-grade and most likely to spread.

More information can be found at:

Cancer Research UK

Treatment

As with all cancers, the earlier bladder cancer is detected and treated the less invasive and the more effective treatment will be.

  • If bladder cancer is in the non-muscle-invasive stage it can be removed with a surgical procedure called TURBT (transurethral bladder resection). This may be followed by chemotherapy directly to the bladder (intravesicular mitomycin C).
  • Higher risk tumours can be treated with BCG (Bacillus Calmette Guerin).
  • Muscle-invasive cancers may require complete removal of the bladder (cystectomy) and radiotherapy/chemotherapy.

ArrayGenomics, with the BCA-1 Test is committed to helping more patients through effective monitoring of bladder cancer.

More information

If you are affected by bladder cancer, further information and support is available from:

Macmillan Cancer Support

Fight Bladder Cancer

Sources:

Cancer Research UK

NHS

NICE Clinical Knowledge Summary

NICE Guidance

Macmillan Cancer Support

Fight Bladder Cancer