Bladder cancer

What causes bladder cancer?

There are certain things that can affect the chances of developing bladder cancer. These are called risk factors.

The risk of bladder cancer is higher in people over the age of 60. It’s less common in people under the age of 40.

Smoking is a risk factor of bladder cancer. Smoking may cause about 5 in 10 (50%) bladder cancers.

Another risk factor is industrial chemicals, like dyes. Many of these substances have now been banned, but bladder cancer can develop over 30 years after exposure. The Department for Work and Pensions website has information on claiming benefits if you have become ill due to exposure to a harmful substance at work.

Macmillan Cancer Support have more information about the causes and risk factors of bladder cancer.

If you notice any symptoms, don't wait, get in touch with your GP practice as soon as you can and have it checked. They can test your pee (urine) for blood and send it to a lab to check for a urine infection (UTI). They may also send the sample to be checked for cancer cells.

They may also examine you internally. This is because the bladder sits close to the bowel, and to the prostate or womb. For this, the doctor gently inserts a gloved finger into the back passage (rectum) or vagina to feel for any obvious changes. This is called an internal examination.

If your GP suspects cancer, or isn't sure what's causing your symptoms, they'll refer you to a urologist, a doctor who treats bladder and kidney problems. In some cases, you may instead see a urology nurse specialist.

If your test results or symptoms suggest bladder cancer, your GP will refer you urgently, meaning you should get an appointment with a specialist as soon as possible.

Most people are seen by a nurse or doctor at a haematuria clinic, or in a hospital's urology department. There, the doctor or nurse may test your pee and examine you internally again. If they feel you need further tests, they will arrange these too, and usually most of them can be done on the same day.

Get Checked Early has more information on what to expect when getting checked.

Tests

You may be given some of the following tests.

A cystoscopy is the main test used to check for signs of cancer inside the bladder. A cystoscope is a thin tube with a camera and light at the end, which a doctor or specialist nurse uses to look inside the bladder. There are different types of cystoscopy, and your doctor or nurse will explain which one you need.

You may also have blood tests, to check how well your kidneys and liver are working and to see how many blood cells are in your blood.

A sample of your pee may be tested for cancer cells, and also for substances linked to bladder cancer. This is known as molecular testing.

An ultrasound scan uses sound waves to build a picture of the inside of the body, and can show anything unusual in the urinary system. You'll be asked to drink plenty of fluids beforehand so the bladder is easier to see. This can feel a little uncomfortable, but you'll be able to pee again as soon as the scan is over, so do mention it to the person doing the scan if it worries you. During the scan, you'll lie on your back while they make you as comfortable as possible. They'll spread a cold gel over your tummy (abdomen) and move a small device that gives off sound waves over the area, and a computer turns these into a picture. The scan doesn't hurt and takes about 15 to 20 minutes.

A CT urogram uses a series of X-rays to build a 3D picture of the bladder, ureters and kidneys.

You may also need other tests, either to check areas near the bladder or to look for signs of cancer elsewhere in the body. A CT scan takes a series of X-rays to build a 3D picture of the inside of the body, while an MRI scan uses magnetism to build a detailed picture of a particular area. Sometimes a PET scan and a CT scan are done together, known as a PET-CT scan. The PET part uses a low dose of radiation to check how active the cells are in different parts of the body, and this can give more detailed information about cancer or unusual areas already seen on X-rays, CT or MRI scans.

Waiting for test results can be a hard time. Macmillan Cancer Support has more information that may help.

Staging and grading of bladder cancer

The stage of a cancer describes where it has been found and any other places it has spread to. Grading describes how the cancer cells look under the microscope compared with normal cells. Knowing both the stage and grade helps your doctors plan the best treatment for you.

Macmillan Cancer Support has more information about staging and grading of bladder cancer.

Treatment for bladder cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your treatment may depend on:

• the type of cancer
• the stage and grade of the cancer
• how many tumours there are
• your general health

Macmillan Cancer Support also have more information about treating bladder cancer and making treatment decisions.

Your cancer doctor, radiotherapy specialist or nurse will explain the different treatments and their side effects before you agree to have treatment. They’ll also talk to you about the things you should consider when making treatment decisions.

You may have some treatments as part of a clinical trial.

Treatment for non-muscle-invasive bladder cancer

Non-muscle-invasive means the cancer cells are in the inner lining or the connective tissue that surrounds the inner lining of the bladder. They haven’t spread into the muscle layer below this.

Treatments may include the following.

Transurethral resection of the bladder (TURBT)

A TURBT is an operation to remove bladder cancer from the inside of the bladder. It’s the main treatment for non-muscle invasive bladder cancer.

Intravesical chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Intravesical chemotherapy is when the chemotherapy is given directly into the bladder through a tube called a catheter.

BCG

BCG is short for Bacillus Calmette-Guérin. It’s a type of immunotherapy drug.

Immunotherapy drugs use the body’s immune system to find and attack cancer cells.

For bladder cancer, BCG is given directly into the bladder through a tube called a catheter (intravesical).

Some people may have a cystectomy. This is surgery to remove the bladder.

You may be asked to think about this if you have:

• a high-risk cancer
• a cancer that keeps coming back and treatments are not working

Other treatments

Sometimes other treatments may be used to treat non muscle-invasive bladder cancer. The following treatments may only be available at some hospitals.

Heated intravesical chemotherapy

Heated intravesical chemotherapy is when chemotherapy into bladder is heated. This may make it work better.

Electromotive intravesical chemotherapy

Electromotive intravesical chemotherapy is when a small electrical current is given into the bladder at the same time as the chemotherapy. This may make it work better.

Tumour ablation

Tumour ablation treatment uses a laser called an infra-red light during a cystoscopy to burn any areas of cancer away.

New treatments are being developed for non-muscle-invasive bladder cancer. Some treatments may be offered as part of a clinical trial. This includes immunotherapy.

Treatment for muscle-invasive bladder cancer

Muscle-invasive means the cancer has spread into or through the muscle layer of the bladder wall.

Treatment usually aims to cure the cancer with one of the following.

Cystectomy

Cystectomy is surgery to remove the bladder, and make a new way for you to pass urine (pee), called a urinary diversion.

You may also have chemotherapy into a vein before or after the operation. These anti-cancer drugs help reduce the risk of cancer coming back.

Radical radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. Radical radiotherapy is radiotherapy with other treatments like surgery or chemotherapy.

Treatment for locally advanced bladder cancer

Locally advanced means the cancer has spread outside the bladder into nearby areas of the body.

The best treatment depends on what areas of the body are affected.

Some people will have treatment that aims to cure the cancer.

Others will have treatment that aims to control the cancer and any symptoms it’s causing.

Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

Immunotherapies

Immunotherapy drugs use the immune system to find and attack cancer cells.

Radiotherapy

Radiotherapy uses high-energy rays to destroy cancer cells. You may have radiotherapy to treat bladder symptoms, such as bleeding. It may also be given if bladder cancer has spread to the bones.

Bone strengthening drugs

Drugs called bisphosphonates or a drug called denosumab help strengthen the bones and may reduce bone pain.

Ureteric stent

If cancer has blocked the tube called the ureter between the kidney and the bladder, your doctor may suggest an operation to put a tube (stent) in to open the ureter. This is called a ureteric stent.

Nephrostomy

A nephrostomy is a tube that lets urine drain from the kidney through an opening in the skin on the back. You may need this if cancer has blocked the tube called the ureter between the kidney and the bladder. The nephrostomy tube is attached to a drainage bag outside the body.

You may have some treatments as part of a clinical trial. Your doctor will explain if this is available.

Macmillan Cancer Support have more information on treatment for bladder cancer and treatment decisions for bladder cancer.

After bladder cancer treatment

After treatment for bladder cancer, you’ll have regular follow-up appointments with your cancer doctor or nurse. These are usually every few months to start with.

If you have any problems or notice new symptoms between appointments, let your doctor or nurse know as soon as possible.

Non-muscle-invasive bladder cancer follow-up

The most important test for follow-up is a cystoscopy. How often you have a cystoscopy depends on the risk of the cancer coming back. High-risk and intermediate-risk tumours need to be monitored more often than low-risk tumours.You may also have your pee (urine) checked for cancer cells. At first, follow-up appointments will usually be every 3 to 6 months.

Muscle-invasive bladder cancer follow-up

You may have scans to check for any sign of the cancer coming back. Your doctor or nurse will explain what type of scans and how often you need these.You’ll have regular scans and blood tests to check your kidneys are working well, if you have a:

• urostomy
• continent urinary diversion
• bladder reconstruction

If you had a cystectomy but your urethra wasn’t removed during surgery, there’s a small risk that the cancer could come back there. You’ll have tests every year to check the urethra. These are called urethroscopies. This usually continues for 5 years.If you had radiotherapy, you’ll have regular cystoscopies. These are important because if cancer comes back, you may be able to have surgery to treat it again.

The cystoscopies will be every 3 months at first, but less often over time. You’ll have them for at least 5 years after treatment finishes.

Advanced bladder cancer follow-up

You’ll have regular appointments with your doctor or nurse to check how you are. They’ll also help manage any symptoms caused by the cancer. You may have tests and scans to monitor the cancer.You may also have appointments with a palliative care team. This is an expert team that helps manage symptoms, like pain or nausea.

There are palliative care teams based in hospitals, hospices or in the community. Your cancer doctor or nurse can give you more information.

Where to get support

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan bladder cancer forum – you can talk with others affected by bladder cancer, share your experience, and ask questions

ছোট ছোট কিছু পরিবর্তন, যেমন আরও পুষ্টিকর খাবার খাওয়া আর সক্রিয় থাকা, আপনার স্বাস্থ্য ও সার্বিক ভালো থাকার উন্নতি ঘটাতে পারে এবং শরীরকে সেরে উঠতে সাহায্য করে।

আপনি যদি আগে থেকেই স্বাস্থ্যকর জীবনযাপন করে থাকেন, তবুও চিকিৎসা শেষ হওয়ার পর আরও কিছু ভালো অভ্যাস গড়ে তুলতে চাইতে পারেন।

মূত্রথলির ক্যান্সারের কিছু চিকিৎসার পার্শ্বপ্রতিক্রিয়া চিকিৎসা শেষ হওয়ার পরও থেকে যেতে পারে। যেমন প্রস্রাব বা পায়খানার অভ্যাসে পরিবর্তন আসতে পারে, কিংবা যৌন জীবনে সমস্যা দেখা দিতে পারে। কখনো কখনো এসব পার্শ্বপ্রতিক্রিয়া অনেক দিন পর্যন্ত থাকে।

মূত্রথলির ক্যান্সারের প্রতিটি ধরনের চিকিৎসা সম্পর্কে আরও বিস্তারিত জানতে আপনার ক্যান্সার বিশেষজ্ঞের সঙ্গে কথা বলতে পারেন।

এই সময়ে সাহায্য ও সহায়তা পাওয়া যায়, আর সাধারণত এসব সমস্যা সামলে চলার উপায়ও থাকে। কোনো পার্শ্বপ্রতিক্রিয়া বা পরিবর্তন লক্ষ করলে এবং পরামর্শ চাইলে আপনার ক্যান্সার বিশেষজ্ঞ, নার্স বা ডাক্তারের সঙ্গে কথা বলুন।

ক্যান্সারের চিকিৎসা শেষ হওয়ার পর কী কী বিষয় মাথায় রাখবেন, সে সম্পর্কেও আপনার ডাক্তার বা হাসপাতালের ক্যান্সার বিভাগ থেকে আরও তথ্য জেনে নিতে পারেন।