Bladder cancer is when abnormal cells in the bladder 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 begins in the thin, flat cells that line the bladder
- adenocarcinoma is a rare form which starts in mucus-producing cells in the bladder.
In 2013, 2555 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 2014, there were 1040 deaths caused by bladder cancer in Australia. The five-year survival rate for Australians with bladder cancer is 53%.
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
- blood in urine
- lower abdominal or back pain.
Some factors that can increase your risk of bladder cancer include:
- workplace exposure to certain chemicals used in dyeing in the textile, petrochemical and rubber industries
- use of the chemotherapy drug cyclophosphamide
- family history
- chronic inflammation of the bladder.
Tests to diagnose bladder cancer may include:
Blood tests can check you general health.
Urine tests check for blood, bacteria and any cancer or pre-cancer cells.
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 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 the main procedure used to diagnose bladder cancer by examining the inside of the bladder. If abnormal tissues are detected, a tissue sample (biopsy) will then be taken.
A CT scan, bone (radioisotope) scan and chest X-ray are done to determine the extent of the cancer (its stage).
The most common staging system used for bladder cancer is the TNM system, which describes the stage of the cancer from stage I to stage IV. 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 (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
Non-invasive bladder cancers an also be treated with immunotherapy. A vaccine called Bacillus Calmetter-Guérin, developed to prevent tuberculosis, can be used to stimulate your immune system in order to stop or delay bladder cancer.
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 radiotherapy is an alternative treatment. In some cases chemotherapy may be added.
If surgery is not an option, the cancer may be treated with radiotherapy, with or without chemotherapy, or chemotherapy alone (platinum and gemcitabine).
Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
- a GP who works with other specialists to coordinate treatment
- urologist, who specialises in surgery of the urinary system
- radiation oncologist, who prescribes and coordinates radiotherapy treatment
- medical oncologist, who prescribes and coordinates the chemotherapy
- cancer care coordinators and nurses
- other allied health professionals such as a dietician, social worker and counsellor.
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.
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.
There is currently no screening for bladder cancer available in Australia.
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.
While it is not possible to prevent bladder cancer, it is possible to reduce your risks such as not smoking or quitting smoking, and avoiding exposure to chemicals listed above.
Understanding Bladder Cancer, Cancer Council Australia © 2016. Last medical review of this booklet: February 2016.
Australian Institute of Health and Welfare. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.
Australian Institute of Health and Welfare (AIHW) 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW.