Bladder Cancer

Introduction

Bladder cancer is the second commonest urological cancer after prostate cancer.
It is the commonest of all the cancers, which affect the urinary tract lining (urothelium).
Males are more affected than females in a ratio of about 3:1. It is more common in the white race compared to the black race in a ratio of 4:1.
More than 80% of clients with bladder cancer are above 50 years.
The commonest pathological types are transitional cell carcinoma TCC (90%), Squamous cell carcinoma (8%) and adenocarcinoma and carcinoma in-situ (2%).

Causes of Bladder Cancer

The causes of bladder cancer include the following:

  1. Chronic Infections of the bladder like Schistosoma haematobium (Bilharzia) and chronic bacterial infections
  2. Smoking of cigarettes: cancer usually develops 10-20 years after smoking and 20 sticks a day/a packet carries a high risk of cancer development. Passive smoking may also carry the risk of cancer
  3. Occupational risks; environmental exposure to cancer-causing chemicals used in industries e.g. dye, textile, rubber, cable, printing etc.
  4. Genetic and familial factors

Symptoms of Bladder Cancer

  1. Bladder cancer may be asymptomatic in early disease (25%)
  2. Haematuria (usually painless).
  3. Painful only in advanced disease and infection/UTI
  4. Irritative symptoms: frequency, urgency, dysuria
  5. Flank pain (hydronephrosis)
  6. Pelvic pain from cancer invasion
  7. Oedema of lower limbs from advanced disease

Signs of Bladder Cancer

Signs of bladder cancer include the following:

  1. Pallor
  2. Wasting
  3. Palpable bladder mass
  4. Palpable kidney from ureteric obstruction and hydronephrosis
  5. Lymphoedema of lower limb/limbs
  6. Secondary UTI in 30% of cases

Investigations

  • FBC and ESR
  • Urine analysis and culture Urine cytology
  • Urea, creatinine, electrolytes
  • Ultrasound scan: Abdominopelvic
  • CT Scan /MRI for staging (By specialist)
  • Special Investigations: Abdominopelvic IVU
  • Urethrocystoscopy and biopsies (By specialist)
  • Examination under anaesthesia (Bimanual palpation of bladder through DRE and Pelvic examinations).

Treatment for Bladder Cancer

Treatment objectives

Treatment objectives of bladder cancer include the following:

  1. Surgical cure for early disease
  2. Prevention of recurrence, progression and metastases
  3. Management of complications
  4. Additional treatment with cancer drugs and radiotherapy where necessary (Neoadjuvant and adjuvant therapy)

Non-pharmacological treatment

  1. Cystectomy: Partial or radical with or without bladder replacement.
  2. Radiotherapy

Pharmacological treatment

Evidence Rating: [C]

A. Early Stage

BCG or Thiotepa bladder instillation for superficial tumours after Trans-Urethral Resection of Bladder Tumour (TURBT)

B. Advanced Disease

Chemotherapeutic agents recommended for advanced stage include Methotrexate, Vinblastine, Adriamycin and Cisplatin.

Referral Criteria

Refer all cases of bladder cancer for specialist evaluation and treatment.
All cases of chronic cystitis should be referred to specialist to exclude bladder cancer.