Understanding bladder cancer: A guide

In his latest online article, Professor Rakesh Heer gives us his insights into bladder cancer. He talks about the common symptoms, when to seek medical attention, diagnosis, treatment options, lifestyle changes or preventative measures and how does bladder cancer affect bladder function and overall quality of life.

What are the common symptoms of bladder cancer and when should I seek medical attention if I experience them?

Bladder cancer commonly manifests through symptoms and signs such as the presence of blood in the urine (haematuria), increased frequency of urination, urgent need to use the bathroom, and occasionally recurring urinary tract infections. Visibility blood in the urine can be quite striking. Even if this resolves on its own, it is a significant sign that should not be overlooked. It is crucial to seek prompt medical attention by consulting your GP or a specialist. There are instances where blood in the urine is not visible to the naked eye, known as microscopic or non-visible haematuria. This condition may be detected during routine checks at your GP's office using a dipstick test, or individuals may use home testing kits, which could reveal microscopic haematuria. In either case, it is essential to be referred to a specialist for further evaluation.

How is bladder cancer diagnosed and what are the different types of tests and imaging used in the diagnostic process?

Bladder cancer diagnosis primarily involves a telescopic examination of the bladder and imaging scans. The telescopic procedure, known as cystoscopy, is usually conducted with a local aesthetic, using a numbing gel to anesthetise the urethra and provide lubrication. The insertion of a narrow telescope into the bladder is generally well-tolerated and takes only a few minutes.

If the patient finds the procedure challenging under local anaesthesia, it can alternatively be performed under general anaesthesia. This approach allows for a thorough examination of the bladder lining, enabling the identification and assessment of potential masses indicative of bladder cancer. If a mass is detected, a more invasive procedure called transurethral resection of bladder tumour (TURBT) is carried out. Under general anaesthesia, a larger instrument is passed through the urethra into the bladder to sample the tissue. A formal diagnosis is then made by examining this tissue under a microscope.

In the majority of cases, bladder cancer affects only the lining, and TURBT effectively removes the tumour, providing clearance. To assess the full extent of bladder cancer, scans, typically a CT scan and occasionally an MRI, are employed.

What are the treatment options available for bladder cancer including both surgical and non-surgical approaches?

In the majority of instances, bladder cancer is identified in its initial stage, rendering it highly treatable through TURBT. Hence, it is crucial to promptly consult with your GP or a specialist upon experiencing any symptoms. Following the transurethral resection of bladder tumour, there may be tendencies for recurrence, prompting the monitoring of the bladder through repeated cystoscopies. The risk of recurrence is determined based on tissue findings and the initial cystoscopy results. For individuals with low-risk disease, periodic cystoscopies can be conducted for up to a year, and if the results remain clear, discharge is considered safe. Those with higher-risk disease may require bladder washes with chemotherapy or immunotherapy to minimise the risk of recurrence.

Are there any lifestyle changes or preventive measures that can help reduce the risk of bladder cancer?

The most significant contributing factor to bladder cancer is smoking. If you are a smoker, it is strongly advised to quit, and your GP can provide various resources and assistance to support you.

How does bladder cancer affect bladder function and overall quality of life and what support resources are available for patients during and after treatment?

In cases where bladder cancer is detected early, the overall quality of life for patients is generally quite positive, as this constitutes the majority of diagnoses. Following the initial transurethral resection of bladder tumour (TURBT), a healing process takes place on the exposed surface where the cancer was removed, potentially causing bleeding and cystitis symptoms lasting one to two weeks. However, for the vast majority of individuals, the bladder typically returns to normal functioning after this initial healing period. In instances of higher bladder cancer risk, bladder washes may be necessary to mitigate that risk. While these washes can be irritating and may induce transient cystitis symptoms, these effects are typically short-lived.

Professor Rakesh Heer is a distinguished urologist with over 25 years of experience. You can schedule an appointment with Professor Heer on his Top Doctors profile.