Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour invades deeper into the muscle of the bladder and can spread to surrounding organs.
Once diagnosed, bladder cancer can be classified by how deep it has spread.
If the cancerous cells are contained inside the lining of the bladder, doctors describe it as ‘non-muscle-invasive’ bladder cancer (NMIBC). This is the most common type of bladder cancer, accounting for 7 out of 10 cases. This stage of cancer is usually manageable with regular checks of the bladder and removing any regrowth of cancer.
When the cancerous cells spread beyond the lining, into the surrounding muscles of the bladder, it is referred to as ‘muscle-invasive’ bladder cancer (MIBC). This is less common but has a higher chance of spreading to other parts of the body and can be fatal.
If bladder cancer has spread to other parts of the body, it is known as locally advanced or metastatic bladder cancer.
Bladder cancer symptoms include:
- Blood in the urine (haematuria) – This is the most common symptom
- Frequency – You may pass urine more often than normal
- Urgency – You may have to get to the toilet quickly
- Pain during urination or pain in the pelvis/lower back
It is important to note that here are a number of conditions that may cause these symptoms, not just bladder cancer.
Some commonly used tests to rule out or diagnose bladder cancer include specialized urine tests looking for cancer cells, imaging studies (CT or MRI scans), cystoscopy to physically look into the bladder and biopsy of abnormal tissue.
Treatment of bladder cancer requires different doctors working together to create an overall treatment plan and manage the cancer. This is the multi-disciplinary team (MDT) approach to treatment which is essential for the best management of any cancer. The team generally consists of a surgical oncologist (Dr. Goolam), medical and radiation oncology specialists, pathologists, radiologists and nuclear medicine specialists, oncology nurses, physiotherapists, dieticians, social workers and many other supporting staff.
Specific treatment depends on the stage the cancer has reached (NMIBC vs. MIBC).
For NMIBC, the treatment options include:
- Surgery – Cystoscopy to monitor regrowth of cancer in the bladder
- Chemotherapy & Immunotherapy (Intravesical) – This involves instilling the medication into the bladder via a urethral catheter and allowing it to coat the surface of the bladder. The bladder is then emptied and medication is then passed into the toilet.
For MIBC, the treatment options include:
- Surgery – Complete removal of the bladder and surrounding tissue (Radical Cystectomy) is considered the best option for cure and control of cancer. For specific cancer types, removal of only part of the bladder may be an option.
- Radiotherapy – Radiotherapy may be used to treat bladder cancer when combined with systemic chemotherapy. It is sometimes reserved for those patients who are unable to undergo surgery.
- Chemotherapy – These are medications used to destroy cancer cells. Chemotherapy may be used in various scenarios in bladder cancer including in preparation for surgery to remove the bladder, in conjunction with radiotherapy, following surgery or as an attempt to manage widespread or recurrent cancer.
- Multi-modal therapy – For some patients, a combination or all the above treatments are needed to manage their cancer.
Following the removal of the bladder, urine is redirected to leave the body in a new way. This is known as a urinary diversion.
For some patients, a small segment of intestine is used to direct urine out to the surface of the abdomen via an opening called a stoma. This may be referred to as an ileal conduit. A small drainage bag is placed over the opening to collect the urine which needs to be emptied as needed.
Another method is to refashion a segment of intestine to collect urine inside the body. This reservoir when connected to the urethra is known as a neobladder. It allows urine to be passed naturally, however the usual sensation of a full bladder is no longer present and patients need to learn to pass urine based on a timed schedule. Some patients may not be able to empty out the neobladder with urination alone and may need to pass a catheter through the urethra into the new bladder to empty the bladder completely.