WHAT IS BLADDER CANCER?
Bladder cancer starts as an abnormal growth of the cells lining the bladder wall. If allowed to grow unchecked, the cancer cells can invade deeper into the bladder muscle, fat and to distant sites.
Smoking is the most common cause of bladder cancer. Exposure to certain fumes and workplace chemicals, radiation and infections are also risk factors.
Most bladder cancers can grow for many years undetected. However, symptoms such as pain, blood in the urine (haematuria) or urinary tract infections (UTI) can be the first signs of bladder cancer.
If discovered early, most cancers remain confined to the bladder. However, larger tumours, higher grade disease and invasion into deeper layers of the bladder can be lead to spread of cancer cells.
The survival rate at 5 years is 54% and therefore early detection is vital.
Suspicious cases should be investigated initially with urine tests for the presence of blood and abnormal cells.
Further imaging such as ultrasound or Computer Tomography Intravenous Pyelography (CTIVP) help localise lesions within the urinary tract.
Finally, a camera examination (cystoscopy) is needed to directly visualise the bladder and a biopsy may be also needed for confirmation. This can be performed under local or general anaesthetic
For superficial bladder cancers, surgical resection of the tumour (TURBT) is often the first step. This is performed under general anaesthetic via a camera into the bladder and may involve an overnight stay in hospital.
Due to the common rate of recurrence, however, vigilant follow up cystoscopy is often needed to ensure clearance and early detection of new cancers.
Chemotherapy or immunotherapy agents may also be instilled into the bladder to reduce the risk of recurrence of cancer and progression to invasive disease.
For bladder cancer that has invaded into the muscle wall, complete removal of the bladder may be necessary in addition to chemotherapy. In such cases, the urine may be diverted into a wearable "bag" or a "neobladder" using reconstructed portions of a patient's bowel.
This may be performed via an open cut or robotically assisted keyhole surgery.