Bladder cancer is a common condition, with about 10,000 new cases in the UK every year. Like all cancers it is most easily treated when picked up early, so making sure you are seen by a specialist if you are concerned is very important.
There are various risks for bladder cancer including:
- Smoking (smokers are at least 3 times more likely to develop bladder cancer)
- Chronic infection/inflammation
- Exposure to certain chemicals and dyes
- Prior radiotherapy to the pelvis
Bladder cancer can present in a variety of ways. Often it is diagnosed after a patient is found to have blood in their urine (haematuria). This blood can either be visible or detected on urine tests carried out by a GP.
Bladder cancer can also occasionally cause a change in urinary symptoms including:
- Passing urine more frequently
- Urinary urgency (a sudden need to pass urine)
- Occasionally pain in the lower abdomen
- Rarely, generalised fatigue and weight loss.
Bladder cancer can range from very superficial, easily treated disease through to very serious muscle-invasive cancer that requires urgent intervention. If you are suspected of having a bladder cancer you will be offered an operation called a Transurethral Resection of Bladder Tumour (TURBT) to remove the tumour and, just as importantly, assess its appearance under a microscope and how deep into the bladder wall it has grown.
Subsequent treatment for bladder cancer depends on certain factors:
- The Grade of the tumour (high or low grade)
- The depth of tumour invasion (superficial or deep)
- Any evidence the tumour has spread elsewhere
Depending on the situation your consultant will discuss your treatment options, based on your individual circumstances. Not all treatments are appropriate for all patients or types of tumour, but available options include:
- Camera surveillance (for low grade and superficial tumours)
- A course of bladder chemotherapy (mitomycin) or immunotherapy (BCG) with camera surveillance (high grade, superficial tumours)
- Radical cystectomy (surgical removal of the bladder for high grade and muscle invasive bladder tumours)
- Radiotherapy (for muscle invasive bladder tumours)
Nottingham Urology Group are able to offer a complete range of diagnostic tests and treatments for bladder cancer at every stage.
Bladder cancer patients require camera surveillance, often for many years, as bladder cancer has high rates of recurrence. Regular surveillance allows early detection and prompt treatment if a recurrence is ever found. Most surveillance is done with a narrow, flexible camera called a flexible cystoscope and can be performed with local anaesthetic.
If the bladder cancer is thought to be at a higher than average risk of recurrence then a course of chemicals can be washed into the bladder to reduce this risk. Mitomicin C is a chemotherapy drug washed into the bladder once a week for 6 weeks and is used for ‘intermediate risk’ cancer. BCG is an immunotherapy drug that can be washed into the bladder at intervals over 1-2 years and is used for ‘high risk’ cancer.
Radical cystectomy is an operation to remove the bladder in its entirety, along with local lymph nodes (areas of tissue that ‘filter’ the immune system). Urine is diverted through a conduit into a bag on the skin. The conduit is constructed from small bowel. To reduce the risk of recurrence the prostate is removed at the same time in male patients, and in women the uterus is usually removed.
Mr Will Green, who leads the bladder cancer service at Nottingham University Hospitals, is able to offer this procedure and can advise whether this operation is right for you.
Radical radiotherapy to the bladder is carried out by external beam. It can be an option in muscle invasive disease in those patients who are at high risk of surgery (for example if they have lots of other medical conditions), or they do not wish to undergo cystectomy. Nottingham urology group collaborates closely with oncology colleagues and can refer you to discuss radiology if it is appropriate
Bladder Cancer FAQs
I have been told I may have bladder cancer after a camera inspection (cystoscopy) – what will happen next?
You are likely to need an operation called a transurethral resection of bladder tumour (TURBT). This procedure involves passing an instrument into the bladder (under anaesthetic) to scrape away the growth that has been found. A catheter will be left in the bladder for 24 to 48 hours to allow it to drain and the growth will be sent to the lab for analysis.
I have been diagnosed with a bladder cancer elsewhere – do you offer surveillance and follow up?
Yes, Nottingham Urology Group would be happy to take over your care.
I have been told that I may need a cystectomy or radiotherapy to treat my bladder cancer. Do you offer these services?
Yes, we are able to offer all surgical treatments for bladder cancer, including initial TURBT, laser treatment of small recurrences, through to partial and total cystectomy. We also work closely with our oncology colleagues and are able to discuss referral for radiotherapy if this is appropriate.
Do you offer any non-surgical treatments for bladder cancer?
Yes, in certain circumstances after removal of the initial growth in the bladder medical treatments can be used to try and prevent it coming back. The most common medications are mitomycin C and BCG, both of which are instilled into the bladder using a catheter.