Bladder Cancer

T he bladder is the organ in the urinary system that stores and expels urine.

Bladder cancer is a relatively common malignancy in the urinary tract. It is known to have a high recurrence rate after treatment.

Bladder cancer mostly occurs in individuals aged 50 to 70 years. It can be caused by exposure to certain chemicals. Cigarette smoking is the most common cause of bladder cancer. The more an individual smokes, the more they increase their long-term risk of getting bladder cancer. Specific infections like Bilharzia also increase the risk of certain types of bladder cancer.

1What are the symptoms of bladder cancer?

Passing blood in the urine is usually the first symptom. The blood in the urine can be obvious to the eye (ie red- or pink coloured urine) or may only be detected on routine urine tests done for other purposes such as medical insurance. The presence of blood in your urine does not mean that you definitely have bladder cancer. Other causes of blood in your urine include urinary tract infection and kidney stones.

2How is bladder cancer diagnosed?

Any of the following tests may be performed to confirm the diagnosis of bladder cancer and assess the severity:

  • Urine tests: To detect cancer cells in the urine and check for infection.
  • Blood tests: To check your kidney function.
  • Cystoscopy: A look inside your urinary bladder with a special camera to assess for any abnormal growths within the bladder. A sample / biopsy may also be taken during cystoscopy to confirm the presence of cancer.
  • Sonar / ultrasound: The bladder and kidneys are checked for the presence of cancer.
  • CT scan: To give more detailed information about the urinary system and possible cancer spread.
3What are the treatment options for bladder cancer?

When an abnormal growth is found inside the bladder, it needs to be cut out / resected. This surgical procedure is called "Trans-urethral Resection of Bladder Tumor (TURBT)". Surgically removing the mass will not only clear the bladder of this growth, but the resected tissue will be sent to the pathology laboratory for analysis and identification. This will give essential information regarding the type of cancerous growth, its aggressiveness, and how far it has grown. For each individual patient, this information will determine the further management.

The initial surgical removal of the growth inside the bladder is done with special cameras and resecting equipment and no incision on the skin is made – ie minimally invasive endoscopic surgery via the urethra / bladder pipe.

4What to expect during surgery for bladder cancer?

The initial treatment of bladder cancer is called Trans-urethral Resection of Bladder Tumor (TURBT). Although this is not major surgery, you will likely still need to spend time in hospital afterwards. Resection is done using a camera system that allows for the tumor to be carefully cut from the inner lining of your bladder.

TURBT is performed under general- or spinal anaesthesia. After the procedure you will usually have to stay in hospital for 1 or 2 nights. During this time your bladder will continuously be rinsed with water via a bladder catheter, until the urine is clear from blood. The catheter is removed as soon as your urine becomes clear, after which you will be allowed to go home.

5What happens after the initial surgery / resection / TURBT?

The definite treatment of bladder cancer depends on the results obtained from the pathology laboratory. The pathologist's report will indicate the aggressiveness of the bladder cancer and also how far it had spread at the time of diagnosis. Depending on these variables, further treatment may include:

  • Follow up only with camera checks of the bladder every 3 to 6 months.
  • Further resection (TURBT) of growths inside the bladder.
  • Chemotherapy placed inside the bladder.
  • Surgical removal of the entire bladder (called “radical cystectomy”) - this is a major surgical procedure.
  • Radiation treatment.
  • Systemic chemotherapy through an IV line.