The bladder is part of the urinary tract. It is at the bottom of the tummy (abdomen). It fills with urine and we pass urine out from time to time through a tube called the urethra. The urethra passes through the prostate gland and penis in men. The urethra is shorter in women and opens just above the vagina.
Urine is made in the kidneys and contains water and waste materials. A tube called a ureter comes from each kidney and drains the urine into the bladder.
The cells that line the inside of the bladder are called transitional cells or urothelial cells. There is a thin layer of cells beneath the lining, called the lamina propria.
The outer part of the bladder wall contains a thick layer of muscle tissue which contracts from time to time to push out the urine.
Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age.
The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up tests to look for bladder cancer recurrence for years after treatment.
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply out of control.
In many cases, the reason why a bladder cancer develops is not known. However, there are factors which are known to alter the risk of bladder cancer developing. These include:
In most cases, the first symptom is to pass blood in your urine (haematuria). Haematuria caused by an early bladder tumour is usually painless. You should always see your doctor if you pass blood in your urine. The blood in your urine may come and go as the tumour bleeds from time to time.
Some tumours may cause irritation of the bladder and cause symptoms similar to a urine infection. For example, passing urine frequently or pain on passing urine. If the cancer is a muscle-invasive type, and grows through the wall of the bladder, other symptoms may develop over time. For example, pain in the lower tummy (abdomen).
If the cancer spreads to other parts of the body, various other symptoms can develop.
A sample of urine can be sent to the laboratory to look for cancerous cells under the microscope. This test may detect cancer cells. However, if no cancer cells are seen it does not rule out bladder cancer. Further tests are done to confirm or rule out the diagnosis if symptoms suggest bladder cancer.
This test is commonly done to confirm a bladder tumour. Having a cystoscopy entails a doctor or nurse looking into your bladder with a special thin telescope called a cystoscope. The cystoscope is passed into your bladder via your water pipe (urethra). A cystoscopy which is done just to look into your bladder is normally carried out under local anaesthetic. If a procedure is done, such as removing a tumour via a cystoscope, a general anaesthetic is usually used.
During cystoscopy a doctor or nurse can:
Special urine tests
Urine tests have been developed which can detect bladder cancer. For example, urine tests called the BTA test, the NMP22 test and the MCM5 test. These tests detect chemicals and proteins in urine that are made by bladder cancer cells. However, these tests not routinely used.
Treatment options that may be considered include surgery, chemotherapy and radiotherapy. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and if it has spread), and your general health.
You should have a full discussion with a specialist who knows your case. He or she will be able to give the pros and cons, the likely success rate, the possible side-effects and other details about the possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
An operation to remove your bladder (a cystectomy) is the most common treatment. This is a major operation. Before surgery you need a full discussion with a surgeon to understand the implications of the operation planned. For example, you will need an alternative way of passing urine if you have your bladder removed. One way for this is by a urostomy. This involves a surgeon using a technique to arrange a system for urine to drain into a bag which you wear on the outside of your tummy (abdomen). An alternative operation may be possible where the surgeon creates an artificial type of bladder from a part of the gut.
A cystectomy can be undertaken by an open operation where you will have a scar on your abdominal wall or by keyhole surgery. Your surgeon will be able to discuss with you in detail which type of operation is most suitable for you.
Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, if the passage of urine is blocked by a tumour then placing a tube (catheter) or other techniques may be appropriate.
Radiotherapy is sometimes used instead of surgery. It can also be used for some people who have symptoms of pain or bleeding that are not improving. Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells or stops cancer cells from multiplying.
Chemotherapy is a treatment of cancer by using anti-cancer medicines which kill cancer cells or stop them from multiplying. Prior to surgery or radiotherapy, a course of chemotherapy may be advised. This is called neoadjuvant chemotherapy. Chemotherapy used before surgery may improve the outlook (prognosis). In some cases a course of chemotherapy is given following surgery.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information above about outlook is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.