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What is bladder cancer?

Bladder cancer begins when abnormal cells in the bladder’s inner lining grow and divide in an uncontrolled way.

There are different types of bladder cancer:

  • urothelial carcinoma, formally known as transitional cell carcinoma, is the most common form of bladder cancer (80-90%) and starts in the urothelial cells in the bladder wall's innermost layer
  • squamous cell carcinoma (1-2%) begins in the thin, flat cells that line the bladder
  • adenocarcinoma is a rare form (1%) which starts in mucus-producing cells in the bladder and is likely to be invasive.

In 2016, 2790 new cases of bladder cancer were diagnosed in Australia. Bladder cancer is common in people aged over 60 and is significantly more common in men than in women.  

In 2018, there were 1015 deaths caused by bladder cancer in Australia. 

The chances of surviving bladder cancer for five years is 54%. 



Bladder cancer symptoms

The most common symptom of bladder cancer is blood in the urine (haematuria), which usually occurs suddenly and is generally not painful.

Other less common symptoms include:

  • problems emptying the bladder

  • a burning feeling when passing urine

  • need to pass urine often

  • pain while urinating

  • lower abdominal or back pain (less common).



Causes of bladder cancer

Some factors that can increase your risk of bladder cancer include:

  • smoking

  • older age

  • workplace exposure to certain chemicals used in dyeing in the textile, petrochemical and rubber industries

  • use of the chemotherapy drug cyclophosphamide

  • diabetes treatment using the drug pioglitazone

  • family history

  • chronic urinary tract infections.



Diagnosis of bladder cancer

Tests to diagnose bladder cancer may include:

Internal examination

Your doctor may do an internal examination by inserting a gloved finger into the vagina or rectum to feel for anything unusual.

Blood tests

Blood tests can be taken to check your general health.

Urine test

Urine tests (urinalysis) check for blood or bacteria. If there is blood in your urine you may be asked to give more tests over several days (urine cytology) – these will be sent to a laboratory to check for cancer cells.

CT scan

CT scans produce three-dimensional pictures of several organs at the same including the bladder which can help in the detection of any tumours.

Ultrasound

Ultrasound scans produce pictures of the organ, and can show the presence and size of cancer. Small tumours may be difficult to detect by ultrasound.

Cystoscopy and biopsy

A cystoscopy is a common procedure used to diagnose bladder cancer by examining the inside of the bladder using a thin tube with a light and camera on the end called a cystoscope. If abnormal tissues are detected, a tissue sample (biopsy) will then be taken. 

After a diagnosis of bladder cancer 

After a diagnosis of bladder cancer you may feel upset, confused and anxious. These are normal reactions. Talk to your doctor, family and friends about your treatment options and seek as much information as you need.  

To ensure you receive the best care, your specialist will arrange for a team of health professionals to plan your treatment based on your overall health, how far the cancer has spread and your preferences and needs.  



Treatment for bladder cancer

Staging

Staging describes the extent of the cancer in your body.

The most common staging system used for bladder cancer is the TNM system, which describes the stage of the cancer from stage 1 to stage 4. Determining the stage of your cancer helps your doctors plan the best treatment for you.

Types of treatment

Superficial bladder cancers are treated with surgery and/or immunotherapy, or sometimes chemotherapy instilled into the bladder.

Surgery

Surgery (transurethral resection) is done using a cystoscope which has a wire loop which the doctor uses to remove any tumours. Other ways to kill the cancer cells can include burning the base of the tumour or high-energy laser to damage or kill the cells

Immunotherapy

Non-invasive bladder cancers an also be treated with immunotherapy. A vaccine called Bacillus Calmetter-Guerin, developed to prevent tuberculosis, can be used to stimulate your immune system in order to stop or delay bladder cancer.

Chemotherapy

Chemotherapy drugs are used to destroy or damage cancer cells. For non-invasive bladder cancers, chemotherapy drugs are instilled into the bladder (intravesical chemotherapy).

Invasive bladder cancers are most commonly treated with surgery, although radiation therapy (radiotherapy) is an alternative treatment. In some cases chemotherapy may be added.

If surgery is not an option, the cancer may be treated with radiation therapy, with or without chemotherapy, or chemotherapy alone (platinum and gemcitabine).

Palliative care

In some cases of bladder cancer, your medical team may talk to you about palliative care.

Palliative care aims to improve your quality of life by alleviating symptoms of cancer without trying to cure the disease.

As well as slowing the spread of bladder cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Urologist- specialises in the treatment of diseases of the urinary system (male and female) and the male reproductive system.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Cancer care coordinators- coordinate your care, liaise with the multidisciplinary team and support you and your family throughout treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.


Screening for bladder cancer

There is currently no national screening program for bladder cancer available in Australia.



Preventing bladder cancer

While it is not possible to prevent bladder cancer, it is possible to reduce your risks such as by not smoking or quitting smoking and avoiding exposure to chemicals listed above.



Prognosis for bladder cancer

It is not possible for a doctor to predict the exact course of a disease as it will depend on the person's individual circumstances. However, your doctor may give you a prognosis, the likely outcome of your disease, based on the type of cancer you have, your test results, the rate of tumour growth, as well as your age, fitness and medical history.

Bladder cancer can be effectively treated if it is found early, before it spreads outside the bladder.



Sources

Understanding Bladder Cancer, Cancer Council Australia © 2020. Last medical review of source booklet: February 2020. 

Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW. 

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