Bladder cancer affects both men and women and is responsible for approximately 3% (Aua.com.au, n.d.) of all cancers diagnosed in Australia each year.
The risk of developing bladder cancer increases with age. In fact, most people diagnosed are 60 or older (Cancer Council NSW, 2013), with men about three times more likely than women to be diagnosed with bladder cancer. Currently, there is no screening test used routinely to screen for bladder cancer in Australia.
Statistically, there were 2,459 new cases of bladder cancer in Australia in 2010 (Canceraustralia.gov.au, 2015). Since then, more than 2400 Australians have been diagnosed with bladder cancer each year (Canceraustralia.gov.au, 2015). However, that figure is tipped to rise by 2020, when it is estimated that around 2,800 Australians will be diagnosed with bladder cancer (Canceraustralia.gov.au, 2015).
But there is some good news. Incidence rates for bladder cancer have decreased in recent years, from 17.9 cases per 100,000 people in 1982 to 10.1 cases per 100,000 in 2010 (Canceraustralia.gov.au, 2015).
Bladder Cancer develops when cells within the bladder grow abnormally which causes them to multiply and divide uncontrollably. More than 90% of bladder cancers form in the lining of the bladder (the urothelium) and are known as urothelial carcinomas, or transitional cell carcinomas.
If cancer cells stay within the lining of the bladder, it is referred to as a superficial bladder cancer. Around 90% of bladder cancers are superficial (Cancer Council NSW, 2012) and can be treated simply and effectively.
Sometimes though, cancer cells can spread to the muscle wall of the bladder, to other organs and into lymph nodes. When this happens, it is called invasive bladder cancer and partial or complete removal of the bladder is necessary.
Although definite causes are unknown at this stage, certain factors are known to be associated with the risk of developing the disease. These include:
Non-invasive vs invasive
Bladder cancer can either be superficial (non-invasive) or invasive. Non-invasive bladder cancer means that the cancer is contained to the lining of the bladder. Invasive bladder describes a cancer that has moved in the bladder muscle wall and possibly beyond. These type of cancers are much harder to treat.
Generally though, there are three main types of bladder cancer and each is determined by the type of cell in which the cancer first develops.
This is the most common of the three types of bladder cancers with about 90% of all bladder cancers starting from the innermost urothelial layer of the bladder wall. Depending on its shape and how it grows, Urothelial cancer can be divided into two subgroups:
Squamous cell carcinoma
Squamous cell cancers accounts for around 8% of all bladder cancers (Cancer Council NSW, 2012). It starts in the thin, flat squamous cells lining the bladder. It is more likely to be invasive.
This type of bladder cancer is the rarest contributing around 1–2% of all bladder cancers (Cancer Council NSW, 2012). This cancer develops from the cells that produce mucus and is likely to be invasive.
Unfortunately, bladder cancer doesn’t present itself with definitive symptoms. In fact, bladder cancer is often picked up as a result of a routine urine tests. Generally though, symptoms may include:
It’s important to note that if you have any of these symptoms, it doesn’t necessarily mean that bladder cancer is present. These symptoms are often associated with a bladder or urinary tract infection. Kidney or bladder stones, or an enlargement of the prostate in men, could also cause the presence of blood in your urine. In any event, consult your doctor as soon as possible if you have any of these symptoms.
If your doctor suspects bladder cancer, there are a number of tests he will order to confirm diagnosis including:
Bladder cancer grading describes how quickly a cancer might grow. By determining the grade your doctor/specialist can decide how likely the cancer is to come back and what treatment (if any) you need after surgery.
The cells look like normal bladder cells, are slow growing and there is little likelihood of them spreading.
The cells look abnormal, are growing aggressively and there is a likelihood of them spreading to the muscle wall.
Treatments for bladder cancer vary according on whether the cancer is determined to be non-invasive or invasive.
If the bladder cancer is found to be invasive, a partial or complete removal of the bladder, known as cystectomy, is often recommended. This is a lengthy operation performed under general anaesthetic.
After surgery for a cystectomy, urine needs to be expelled from the body in one of the following ways:
You specialist will discuss with you which option is best suited to your circumstances.
It’s very difficult for a doctor to offer a prognosis for bladder cancer largely because effective recovery from the disease depends on a range of different factors including:
Bladder cancer can be effectively treated if found in the early stages and before it spreads outside the bladder. The five year survival rate for Australians with bladder cancer is around 58 per cent.
You should be aware that life after a cystectomy (bladder removal) will be dramatically different.
For men: surgery for bladder cancer ultimately damages nerves to the penis, and the removal of the bladder usually includes the prostate, which unfortunately results in impotence and infertility.
For women: part of the interior vaginal wall may be removed along with the bladder, which means a narrowing/shortening of the vagina which can cause discomfort during sex. Sometimes, the ovaries, fallopian tubes and uterus are removed also leading to infertility and immediate menopause.
Living with a urostomy
If you have a cystectomy, the surgeon will create an artificial opening to your urinary system called a urostomy. This involves the diversion of urine through an opening or ‘stoma’ on the abdominal wall, which is then collected in an external pouch. The doctor and stoma nurse will discuss the position of the stoma with you before the operation and how to look after it post operation.
Even though it’s a significant change, with time and patience you’ll find you can resume your regular activities.
Kimberly-Clark Australia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice.
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Better Health Channel, (2015). Bladder cancer - Better Health Channel. [online] Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/bladder_cancer [Accessed 4 Apr. 2015].
Cancer Council NSW, (2013). Bladder cancer symptoms | Cancer Council NSW. [online] Available at: http://www.cancercouncil.com.au/73741/b1000/bladder-cancer-10/bladder-cancer-symptoms/?pp=32209&cc=9541&ct=1 [Accessed 4 Apr. 2015].
Cancervic.org.au, (2014). Living with a urostomy - Cancer Council Victoria. [online] Available at: http://www.cancervic.org.au/about-cancer/cancer_types/bladder_cancer/living-with-urostomy.html [Accessed 4 Apr. 2015].
PhD, C. (2015). Bladder Cancer: Read About Treatment, Prognosis and Symptoms. [online] MedicineNet. Available at: http://www.medicinenet.com/bladder_cancer/article.htm [Accessed 4 Apr. 2015].