Bladder Cancer


Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.

Bladder cancer or transitional cell cancer of the bladder is relatively common.1

It is usually caused by smoking, that’s the commonest reason. 

There are a few other causes but smoking is the most important factor that causes bladder cancer.2
So it’s imperative to patients when they’re diagnosed with bladder cancer to stop smoking. 

Usually present, patients present with hematuria (blood in the urine) and we look inside the bladder and we usually find a tumour which is usually polypoid frond like. 

Sometimes it can be sessile or more solid and that’s a bit more concerning, it can be a bit more invasive.3

So we would investigate patients with a CT scan, a chest x-ray and blood tests. 

The next step is to resect this tumour and what we do is we put a telescope through the eye of the penis or the urethra in females and we look at the bladder tumour and we resect it, we remove it piecemeal, we remove little chips of, of the bladder tumour until we’re flat with the bladder wall. 

We then get a sample of the bladder wall in the deeper area to check that there’s no invasion into a deeper area.4

The management then depends on the pathology. 

If the pathology shows the tumour is superficial and not into deeper layers then these patients just need to have regular checks or we do CYSTOSCOPIES initially every three to four months for the first year and then maybe four to six monthly then one yearly. 

It’s really important for patients to have ongoing checks because once you have a bladder tumour your chance of getting a recurrent tumour is about 80%.5

It’s because the whole mucosa is susceptible to getting a tumour.

If the tumour involves a deeper layer such as lamina propria or the supporting tissue or tumours keep on coming back we sometimes give additional treatment. 

The additional treatment is called BCG treatment.6

It’s basically like a tuberculosis virus that’s been altered, we instil this via catheter into the bladder usually once a week for six weeks and what happens is the body reacts to this medicine and fights it as it kills these abnormal, this abnormal material, it also kills cancer cells that are in the bladder. 
It decreases the chance of tumour coming back and decreases the recurrence of tumours.7

There are some side effects however, you can have frequency, wanting to rush to go, urgency, rushing to go.7

Occasionally you can have joint pains, arthralgia and very rarely you can have BCG sepsis where this medicine can, the BCG can spread into the bloodstream and that can be quite serious.8

That occurs in a very low percentage of patients hence we only reserve this for selective patients. 
Sometimes we also use intravesical chemotherapy where we put a little catheter and put some chemotherapeutic agents. 

But that has been show to decrease recurrence but probably not progression of these progressing.9
So usually my favourite treatment is the BCG treatment.

Now for bladder cancers that are more invasive, that is they go into the bladder muscle wall layer. 

They need more aggressive treatment and usually they need to have a cystectomy10, the bladder removed and we can either remove the bladder completely and form a new bladder out of bowel and join it on to the urethra which is called a neobladder or we remove the bladder, join the ureters, the tubes that come from the kidney to the bladder to a small segment of bowel and bring that small segment of bowel out through the abdominal wall where it collects in a bag. 

So we would discuss the pros and cons of those two treatment options for patients and for appropriate patients we form a neobladder or a new bladder. 

So that’s generally the situation with bladder cancer. 

It is sensitive to chemotherapy, so if we have more aggressive cancers we might combine surgery with chemotherapy but the really important thing with bladder cancer is to stop smoking. 

There is also a slightly increased chance of there being cancers in the ureter and the renal pelvis, the lining of the tube from the kidney to the bladder, so we need to monitor that as well.

References

1. Bladder cancer statistics in Australia - https://www.canceraustralia.gov.au/cancer-types/bladder-cancer/statistics
2. Neal D Freedman, Debra T Silverman, Albert R Hollenbeck - Association between smoking and risk of bladder cancer among men and women - JAMA. 2011 Aug 17; 306(7): 737–745. doi: 10.1001/jama.2011.1142
3. Mark J. Hoegger , Benjamin S. Strnad, David H. Ballard, et al - Urinary Bladder Masses, Rare Subtypes, and Masslike Lesions: Radiologic-Pathologic Correlation - RadioGraphicsVol. 43, No. 1 - https://doi.org/10.1148/rg.220034
4. Hatem Kaseb; Stephen W. Leslie; Taylor L. Soon-Sutton, et al - Bladder Cancer - https://www.ncbi.nlm.nih.gov/books/NBK536923/
5. Karen H Kim Yeary, Han Yu, Margaret Gates Kuliszewski, et al - Outcomes of a Dietary Intervention to Reduce Bladder Cancer Recurrence and Progression in Survivors of Non-Muscle-Invasive Bladder Cancer - J Natl Compr Canc Netw . 2024 Feb 26;22(2):e237086. doi: 10.6004/jnccn.2023.7086.
6. BCG into the bladder - Cancer Research UK - https://www.cancerresearchuk.org/about-cancer/bladder-cancer/treatment/non-muscle-invasive/bcg
7. Sandra Guallar-Garrido and Esther Julián - Bacillus Calmette-Guérin (BCG) Therapy for Bladder Cancer: An Update - Immunotargets Ther. 2020; 9: 1–11. Published online 2020 Feb 13. doi: 10.2147/ITT.S202006
8. Pedro Francisco Fernandes, Pedro Nunes and Arnaldo Figueiredo - Septic Shock After Intravesical Therapy With Bacillus Calmette-Guerin: A Case Report of a Rare Life-Threatening Complication - Cureus. 2023 Oct; 15(10): e46563. Published online 2023 Oct 6. doi: 10.7759/cureus.46563
9. William B. Tabayoyong, Ashish M. Kamat, Michael A. O’Donnell - Systematic Review on the Utilization of Maintenance Intravesical Chemotherapy in the Management of Non-Muscle Invasive Bladder Cancer - Eur Urol Focus. 2018 Jul; 4(4): 512–521. - doi: 10.1016/j.euf.2018.08.019
10. Bladder Cancer Treatment - PDQ Cancer Information - https://www.ncbi.nlm.nih.gov/books/NBK66044/