Bladder Cancer

  • Is the tenth most common cancer worldwide
  • Is more common in Men than in Women
  • At first diagnosis, 75% of bladder cancers are not immediately life threatening, though if left untreated may become so
Bladder Cancer
Risk Factors
  • Smoking
  • Occupational exposure – industrial plants that process paint, dye, metal and petroleum products
    • Aromatic amines
    • Hydrocarbons
  • Chronic irritation to bladder
    • Long-term foreign body
  • Schistosomiasis
  • Cyclophosphamide exposure
Type of Cancer
  • 90% of bladder cancers are urothelial carcinomas
    • high-risk variant histology does exist
  • The remaining 10% could be any of squamous cell carcinoma, small cell carcinoma, adenocarcinoma or other even rarer types
Stage of Cancer: How Far Has it Gone?
  • The largest deciding factor in the treatment and prognosis of bladder cancer is whether the cancer has reached the muscle layer of the bladder or not
  • 75% of bladder cancers have not reached the muscle of the bladder at diagnosis
    • this is often referred to as non-muscle invasive bladder cancer (NMIBC)
    • the 25% that have reached the muscle of the bladder are referred to as muscle invasive bladder cancer (MIBC)
  • Whether the cancer has reached the muscle of the bladder is usually determined by an endoscopic procedure called a TURBT (transurethral resection of bladder tumour)
    • This is when, under a general anaesthetic, a camera is inserted into the bladder (through the urethra) and the growth inside the bladder is shaved off.
  • CT scanning and sometimes a PET scan and/or MRI are used to determine if the cancer has spread to the lymph nodes or other organs of the body
What will my treatment involve?

The treatment of bladder cancer is largely dependant on its stage.

  • NMIBC
    • Treatment is largely endoscopic with regular camera checks being done to remove any re-growths of the cancer inside the bladder. Bladder cancer tends to recur frequently inside the bladder.
    • Immunotherapy (BCG) and chemotherapy instillations into the bladder are also commonly used
    • Sometimes, NMIBC can have features that increases its risk of progressing onto muscle invasive disease (MIBC) and as such may require a cystectomy (operation to remove the bladder)
  • MIBC
    • Is a life threatening cancer
    • Requires a cystectomy (removal of bladder) and urinary diversion procedure (ileal conduit or neobladder); the pelvic lymph nodes are also removed.
      • An ileal conduit is the formation of a stoma and urine bag
      • A neobladder is when a segment of small bowel is used to form a ‘new bladder’. This is not always a feasible option
    • Chemotherapy is often administered either before or after the surgery
  • Other treatment options would only be recommended in very specific cases
    • Trimodality treatment – maximal TURBT, chemotherapy and radiotherapy
    • Partial cystectomy
  • Cancer that is metastatic (has spread to other places in the body)
    • Chemotherapy and Immunotherapy
      • Administered by Medical Oncologist
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