Home

Bladder cancer

Bladder cancer can occur in men and women. However, in the UK, there are more men with bladder cancer than women. It is also a disease that affects the older person.

Article by Ian Peate

First published: Last updated:
Expand all
Collapse all
Key Points
  • In the UK there are approximately 10,300 new bladder cancer cases annually, with a higher incidence in men than in females.
  • Bladder cancer begins when the cells that make up the urinary bladder start to grow out of control.
  • As more cancer cells develop, they can form a tumour and with time, spread to other parts of the body.
  • The key risk factors are tobacco smoking and exposure to certain chemicals in working and general environments.
  • Ongoing research aims to identify and reduce risk factors, as well as to understand the impact that genetics may have on bladder cancer risk.

To view the rest of this content login below or request a demo

Log in
Overview

There are three main types of bladder cancer (Kaufman et al, 2009). The type of bladder cancer depends on how the tumour's cells appear under the microscope. 

  1. Urothelial carcinoma (or UCC) accounts for about 90% of all bladder cancers. This type begins in the urothelial cells located in the urinary tract. Urothelial carcinoma also called transitional cell carcinoma or TCC.
  2. Squamous cell carcinoma develops in the bladder lining in response to irritation and inflammation, as time passes these cells can become cancerous. Squamous cell carcinoma accounts for around 4% of all bladder cancers.
  3. Adenocarcinoma accounts for about 2% of all bladder cancers developing from glandular cells. 

Other, less common types of bladder cancer, includes sarcoma and small cell anaplastic cancer. Sarcoma begins in the fat or muscle layers of the bladder. Small cell anaplastic cancer, a rare type of bladder cancer, is likely to spread to other parts of the

To view the rest of this content login below or request a demo

Log in
Risk factors

There are several risk factors for bladder cancer (Box 1). The main risk factor is increasing age. However, smoking and exposure to some industrial chemicals also increase the risk (National Institute for Health and Care Excellence, NICE, 2015a). The risk of developing bladder cancer is 2-6 times greater in smokers compared to non-smokers (Freedman et al, 2011). 

Box 1. Bladder cancer risk factors 

  • Age
  • Smoking
  • Chemicals in the work place
  • Treatment for other cancers (e.g. pelvic radiation)
  • Some medical conditions (e.g. diabetes, spinal cord injury, Crohn's disease)
  • Infection (e.g. cystitis, gonorrhoea)
  • Bladder calculi (NICE, 2011; Cancer Research UK. 2018a)

To view the rest of this content login below or request a demo

Log in
Symptoms

Bladder cancer may present as a number of signs and symptoms (Box 2). It is frequently identified on the basis of painless haematuria. Gross haematuria refers to enough blood present in the urine that can be seen. It is also possible that there are small amounts of blood in the urine that cannot be seen, this is termed microscopic haematuria and can only be found with a urine test.

Bladder cancer often presents for the first time as an emergency admission and this late presentation is commonly associated with a poor prognosis. Advanced disease may cause the person to present with voiding symptoms. 

Box 2. Signs and symptoms of bladder cancer 

  • Frequency of micturition
  • Urgency
  • Dysuria
  • Nocturia
  • Weight loss
  • Back pain
  • Lower abdominal pain
  • Bone pain
  • Malaise (Domino et al, 2014; Tobias and Hochhauser, 2015)

It should be noted that the symptoms may be caused by other conditions that may

To view the rest of this content login below or request a demo

Log in
Diagnosis

A physical examination (this may include an internal vaginal or rectal examination) should be undertaken. In early stage bladder cancer, the physical examination may be normal, in advanced disease there may be abdominal or pelvic masses. A detailed patient history should also be obtained.

When a physical examination and history have been gathered, this provides the opportunity for further tests and investigations to be considered so as to make a diagnosis or to make a differential diagnosis (for example, urinary tract infection). NICE (2015b) recommends evidence based approaches that are used to make a diagnosis of bladder cancer.

A urine specimen is obtained to ascertain if the symptoms could be a urinary tract infection (urinalysis). If there is bladder cancer then the patient's urine could contain cancer cells, this is called urine cytology. The urine specimen is examined under a microscope for the presence of cancer or pre-cancer cells. Different

To view the rest of this content login below or request a demo

Log in
Treatment

There are several factors that will determine the type of treatment, for example, the size of the cancer and if it has metastasised, the type of bladder cancer, the grade and the person's general health. 

Surgery

This treatment mode is undertaken for most bladder cancers. The type of surgery undertaken depends on the stage of the cancer. Transurethral resection of bladder tumour (TURBT) removes the tumour in the bladder through the urethra—usually the first-line treatment for early bladder cancer.

Cystectomy, when bladder cancer is invasive, all or part of the bladder may need to be removed (cystectomy). Generally, chemotherapy is given before cystectomy is performed.

  • Partial cystectomy: If the cancer has invaded the muscle layer of the bladder wall, but is not very large and is in one place only, occasionally it can be removed, along with part of the bladder wall, without taking out the whole bladder

To view the rest of this content login below or request a demo

Log in
Resources

I would like to thank Mrs Frances Cohen for her help and support. 

Glossary

Anterior 

Near to the front

Bifurcation 

The point or area at which something divides into two branches or parts

Calculi 

Also known as stones

Contrast medium 

A special kind of dye injected into a vein or given as a liquid to swallow

Cystectomy 

Removal of the bladder

Cystitis 

Inflammation of the urinary bladder

Distal 

Situated away from the centre of the body

Fluoresce 

To glow

Haematuria 

The presence of blood in the urine

Intravesical 

Situated or occurring within the bladder

Peritoneum 

The serous membrane that lies in the cavity of the abdomen and covering the abdominal organs

Posterior 

Near to the back

Proximal 

Next to or nearest to the point of attachment or origin, located toward the centre of the body
References

Bellmunt J, Orsola A, Leow JJ et al. Bladder cancer: ESMO practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:iii40–48.

To view the rest of this content login below or request a demo

Log in