Bladder cancer

There are three main types of bladder cancer.

• Urothelial carcinoma This is the most common type of bladder cancer¹. It starts in the lining of the bladder wall, which is called the urothelium. It can sometimes start in a kidney or the ureter, which is the tube that carries the urine from the kidney to the bladder.
• Squamous cell carcinoma This type of cancer starts in the thin, flat squamous cells of the bladder lining.
  
• Adenocarcinoma This starts in the glandular cells of the bladder.
  

Many bladder cancers can be diagnosed early if symptoms are investigated by a doctor. These symptoms may include:

• blood in your urine
• change in how frequently you urinate
• pain or burning when you urinate
• not being able to urinate when you feel you need to
• pain in one side of the abdomen or back

Having any of these symptoms doesn’t necessarily mean you have bladder cancer, but you should see your doctor for a check-up.

There is no clear reason for bladder cancer. However, some factors appear to increase the risk. These include:

• smoking²
  
• exposure to certain workplace materials and chemicals, such as asbestos and benzene³
• frequent urinary tract infections⁴
• previous chemotherapy or radiation therapy to the pelvic area⁵
• use of pioglitazone for diabetes⁶
• family history of bladder cancer⁷

Having any of these risk factors doesn’t mean you will develop bladder cancer, but you should see your GP if you are worried.

If you are found to have bladder cancer, your doctor will conduct tests to determine how far your cancer has progressed. Bladder cancer is commonly staged with the TNM system, which shows how advanced the cancer is. These letters stand for:

• Tumour: Your doctors will measure the size of the tumour and how much it has grown
• Nodes: Refers to whether cancer has spread to lymph nodes
• Metastasis: Refers to whether cancer has spread to other parts of your body

Your doctor may refer to bladder cancer as non-muscle-invasive bladder cancer (NMIBC), which means the cancer is only in the bladder lining. Muscle-invasive bladder cancer (MIBC) means the cancer has spread into the muscle or fatty tissue surrounding the bladder. Advanced bladder cancer means cancer has spread into other organs or lymph nodes of the body. 

Treatment for bladder cancer will depend on the nature of the tumour and whether it has spread to other parts of the body. Treatments that may be offered include:

• chemotherapy
  
• immunotherapy
• radiation therapy
  
• surgery
• targeted therapy
  

Whether you experience side effects and how severe they are will depend on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short-term and can be managed. These may include:

• bladder inflammation such as cystitis
• fatigue
• nausea or vomiting
• constipation or diarrhoea
• hair loss
• easily bruising or bleeding
• weight changes
• skin changes
• mood changes
• sores and pain around the mouth.

These symptoms tend to improve gradually once treatment stops. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects.

• Get as much rest as possible
  
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

General side effects include:

• fatigue
  
• blood in urine
• frequent urination
• burning when you urinate
• diarrhoea

Side effects may include:

• soreness and swelling around the treatment area
• tiredness and lethargy for a few weeks after you finish
• frequent urination
• burning when you urinate
• diarrhoea
• loss of appetite
• vaginal dryness
• difficulty getting erections

Most of these side effects will ease soon after treatment is finished. However, your team will discuss any long-term considerations with you.

Side effects of bladder surgery include:

• pain and swelling
• bleeding and infection
• urinary diversion – urine may be diverted from the kidneys to a tube through the skin for collection into a bag, or diverted into the bowel to be expelled with bowel contents. Occasionally a new bladder can be made which can allow urine to be stored and expelled the normal way
• dark or bad-smelling urine
• urine leakage
• erectile dysfunction
• premature menopause
• potential infertility in men and women

General side effects include:

• nausea, diarrhoea or stomach ache
• fatigue
• mouth sores
• loss of appetite
• changes in liver or kidney function
• dry eyes or skin
• change in how things taste
• anaemia (low red cell blood count). 

References

1. Bladder Cancer. https://www.ncbi.nlm.nih.gov/books/NBK536923/
2. Association between smoking and risk of bladder cancer among men and women. JAMA. Author manuscript; available in PMC 2012 Sep 13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3441175/
3. Occupational exposure to chemical and petrochemical industries and bladder cancer risk in four western Canadian provinces. https://pubmed.ncbi.nlm.nih.gov/15554606/#:~:text=Increased%20bladder%20cancer%20risk%20was,%25%20CI%201.00%2D4.87%5D).
4. Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancer study. https://www.nature.com/articles/bjc2014601
5. Risk and Prognosis of Secondary Bladder Cancer After Radiation Therapy for Rectal Cancer: A Large Population-Based Cohort Study. https://www.frontiersin.org/articles/10.3389/fonc.2020.586401/full
6. Pioglitazone use and risk of bladder cancer: population based cohort study. https://www.bmj.com/content/352/bmj.i1541
7. Family History and Risk of Bladder Cancer: An Analysis Accounting for First- and Second-degree Relatives. https://aacrjournals.org/cancerpreventionresearch/article-abstract/15/5/319/694470/Family-History-and-Risk-of-Bladder-Cancer-An?redirectedFrom=fulltext