Bladder Cancer

Bladder cancer is the 7th commonest cancer in Singapore and in the USA, it is 6th.

A common symptom of bladder cancer is blood in the urine. This may either be blood that is seen with the naked eye or blood that is detected through urine tests. Blood in the urine does not necessarily mean bladder cancer as there are other causes of blood in the urine such as urinary stones. Usually, further tests are needed for clarification.

These tests include radiologic imaging (X-rays and/or scans) and cystoscopy. Cystoscopy is direct visualisation of the bladder lining through an instrument, called cystoscope. The cystoscope is passed into the bladder and this procedure can be done in the clinic, under local anaesthesia. Through this procedure, the bladder lining can be seen and growth due to bladder cancer can thus be detected.

Following detection of bladder cancer, the next step is to remove the cancerous bladder growth. This can be accomplished by resecting the cancer using special instruments that, again, can be passed into the bladder. There is no need for open surgery (cutting through the skin, muscles, etc). This is generally done with either general or spinal anaesthesia and requires hospitalisation, usually for 1 day.

Once the bladder cancer is removed, the specimen is then sent for analysis by the pathologist – a specialist that studies the microscopic features of the bladder cancer. These features are important in confirming the diagnosis of bladder cancer as well as determining the stage, aggressiveness and type of the bladder cancer.

The commonest type of bladder cancers is papillary epithelial carcinoma. The aggressiveness of the bladder cancer is classified as either low grade or high grade. As for stage, the bladder cancer may either be non-muscle invasive, muscle-invasive or found within the bladder lining (carcinoma in-situ). Depending on the type, aggressiveness and stage, further assessment such as computed tomography (CT scan) may be necessary. Subsequent management of the bladder cancer also varies.

In cases of bladder cancer which are non-muscle invasive, low stage and low grade, no further treatment is needed. For others e.g. carcinoma in-situ, additional treatment with instillation of medication into the bladder will be beneficial. In both instances, bladder cancer can recur. Surveillance is thus necessary and this is done with regular checks using cystoscopy.

In cases where the bladder cancer is muscle-invasive, the treatment options include surgery to remove the bladder or radiation to the bladder. These options may be supplemented by chemotherapy. In situations where the bladder has spread beyond the bladder, the main treatment modality is chemotherapy.

The outcome (prognosis) for non-muscle invasive, low grade and low stage bladder cancer is excellent. The prognosis worsens with high grade and increasing stage. It is thus helpful to be evaluated early especially in cases of blood in the urine.