Cancer of the Bladder

The bladder is a muscular sac that stores and empties urine which has been carried down the two tubes (called ureters) from the kidneys. The urine is emptied by the bladder through another tube (called the urethra). In women this is very short and runs in front of the vagina; in males it is much longer, passing through the prostate and along the under-surface of the penis. One of the main contributory causes of bladder cancer is smoking, since some of the breakdown products of tobacco are excreted in the urine.

Symptoms

The prime symptom of bladder cancer is blood in the urine (haematuna). It mostly appears quite suddenly and without pain. Depending on the amount of blood, the urine may vary from a smoky- or rusty-shade to deep red in colour but the amount of blood is not related to the stage of advancement of the disease. Sometimes haematuria may be due to a stone or to bladder-infection. It is important to realise that the urine may often remain clear for weeks or months after the initial bleeding, but with bladder cancer it will reappear sooner or later. If blood clots form they may block the urethral opening and cause painful bladder muscle spasms.

Diagnosis

The diagnosis is established by means of a cystoscope, a slender rod fitted with a lens and a light that works in a similar way to a periscope. The cystoscope is inserted through the urethra into the bladder where tissue from suspicious-looking areas can be removed for examination under a microscope.

Treatment

The treatment of established bladder cancer is tailored to the individual needs of the patient; the most important points being the type, location and advancement of the disease, as well as the patient’s general condition. A solitary mushroom-type tumour (called papillary) can be removed by a wire loop and the base cauterised; this procedure can be carried out through a cystoscope. Such patients have to have regular cystoscopies, as further papillary tumours may appear in other parts of the bladder. When several such tumours are found they are usually treated by surgical removal of the affected section.

When the tumour has spread over most of the inner surface or when it has grown right through the bladder wall, the entire bladder may require removal by surgery (cystectomy). A number of methods have been developed to provide a substitute store for the urine. The most common one is for the surgeon to shape a new bladder from a segment of small intestine. Both ureters are attached at one end and the other end is brought out through the wall of the abdomen near the navel where it forms an opening, called a stoma. A flat bag attached to the skin with a special type of glue is placed over the stoma and serves to collect the urine.

At first many patients are apprehensive, and embarrassed at having to wear a bag. It does take some getting used to, but within a few months, except when having to empty the bag, most patients are scarcely aware of it. The bag is not visible under casual clothing and does not prevent a person from returning to work, taking part in sports or even swimming.

The alternative treatment for advanced bladder cancer is radiotherapy, usually a daily treatment for about six weeks. Although the radiation is carefully beamed (by pin-pointing the target with the help of the CAT scanner) to include the bladder only, a side-effect in the form of troublesome diarrhoea is almost inevitable as the rectum lies immediately behind the bladder. The radiation-induced inflammation of the bladder-lining also adds to the patient’s discomfort when urinating. As at other sites, results of the treatment of bladder cancer, whether by cystectomy or radiotherapy, depend on the advancement of the disease. Chemotherapy is not used in the treatment of bladder cancer as, so far, no sufficiently effective drugs have been discovered.