Bladder cancer

Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the bladder muscle.

• Smoking is the single biggest risk factor for bladder cancer. This is because tobacco contains carcinogenic chemicals.
• Exposure to certain industrial chemicals is the second biggest risk factor.Occupations linked to an increased risk of bladder cancer are manufacturing jobs involving:dyes,textiles,rubbers,paints,plastics,leather tanning.
• Radiotherapy to treat previous cancers near the bladder, such as bowel cancer
• Previous treatment with certain chemotherapy medications.
• Having a catheter in your bladder for a long time, because you have nerve damage that has resulted in paralysis.
• Long-term bladder stones.
• An untreated infection called schistosomiasis, which is caused by a parasite that lives in fresh water, this is very rare in Western countries

• Avoid or stop tobacco use. To reduce your risk of bladder cancer, don’t smoke and avoid using tobacco products altogether.
• Reduce chemical exposure.Chemicals found in the rubber, leather, printing, textiles and paint industries have been tied to certain cancers.People who work with these chemicals should always follow appropriate safety measures when working with them.
• Eat a well-balanced diet and maintain a healthy weight.
• Stay hydrated.

Blood in your urine,which is usually painless, is the most common symptom of bladder cancer. You may notice streaks of blood in your urine or the blood may turn your urine brown. The blood isn’t always noticeable and it may come and go.

Less common symptoms of bladder cancer include:

• a need to urinate on a more frequent basis
• sudden urges to urinate
• a burning sensation when passing urine
• If bladder cancer reaches an advanced stage and has spread, symptoms can include:pelvic pain, bone pain, unintentional weight loss, swelling of the legs.

If you have blood in your urine,even if it comes and goes, you should visit your Urologist, so the cause can be investigated.

Once you notice blood in your urine or other symptoms from your bladder your Urologist may suggest having a few tests which may include:

• Cystoscopy.This is probably the most fundamental test to diagnose or rule out bladder cancer. Your Urologist will examine the inside of your bladder by passing a thin tube with a camera and light at the end through your urethra.

Before having a cystoscopy, a local anaesthetic gel is applied to your urethra so you don’t feel any pain.The procedure usually takes about 5 minutes.

• Imaging scans.You may be offered a CT scan or an MRI scan if your Urologist feels that a more detailed picture of your bladder is necessary.
• Transurethral resection of a bladder tumour (TURBT).If abnormalities are found in your bladder during a cystoscopy or imaging studies, you will be offered an operation known as TURBT. This is so any abnormal areas of tissue can be removed and sent for biopsy.TURBT is carried out under general or spinal anaesthesia.

There is no single answer to this question as this largely depends on the stage of the disease, its histological characteristics and patient’s health status.

If you’ve been diagnosed with non-muscle-invasive bladder cancer, your recommended treatment plan depends on the risk of the cancer returning or spreading beyond the lining of your bladder.

• Low-risk non-muscle-invasive bladder cancer is treated with transurethral resection of a bladder tumour (TURBT).After surgery, you should be given a single dose of chemotherapy, directly into your bladder, using a catheter. The chemotherapy solution is kept in your bladder for around an hour before being drained away.
• People with intermediate-risk non-muscle-invasive bladder cancer should be offered intravesical chemotherapy or immunotherapy. The liquid is placed directly into your bladder, using a catheter, and kept there for around an hour before being drained away.This may need to be repeated frequently for up to 1 year after you have been diagnosed.
• If you have high-risk non-muscle-invasive bladder cancer, you should be offered a second TURBT operation, within 6 weeks of the initial investigation.This a crucial step to have an accurate diagnosis as it is quite common for high risk non-muscle-invasive tumours to be actually muscle invasive and the second procedure will clarify that.Based on the results of your biopsy your Urologist will discuss with you the options which include intravesical immunotherapy or removal of the bladder.

The recommended treatment plan for muscle-invasive bladder cancer depends on how far the cancer has spread.

Your urologist and oncologist will discuss your treatment options with you, which will either be:

• an operation to remove your bladder (cystectomy)
• radiotherapy

Your oncologist should also discuss the possibility of having chemotherapy before either of these treatments, if it’s suitable for you.

A radical cystectomy means taking out the whole bladder and the nearby lymph nodes. 

Your surgeon will also create another way for your body to collect and pass urine by using your small bowel.This is usually facilitated by creating a “new” bladder”, called neobladder or by creating a urostomy directly to your skin.Those options are thoroughly discussed by your Urologist before your operation.

In men, the surgeon also usually removes the prostate gland and the glands that store semen (seminal vesicles) 

In women, the surgeon usually removes the uterus and the fallopian tubes.

Sometimes the ovaries and part of your vagina are removed as well. Your surgeon talks this through with you beforehand.

The term cystectomy includes not only the removal of the bladder, but also the removal of the lymph nodes and the creation of a new way for your body to collect and pass urine.Each one of those steps even if considered individually is a major operation, so combining all those together means that cystectomy is one of the most technically demanding and complex procedures that can be performed.

Yes, robotic surgery can be utilised to perform a cystectomy, though, given its complexity only a very small percentage of Urologists can perform those procedures safely and achieve proper functional and oncological results.

The main advantages of robotic surgery over the older techniques are:

• Reduced post-surgery pain.
• Less blood loss.
• Fewer and smaller scars.
• Increased precision
• Faster recovery.
• Shorter hospital stay.
• Less risk of infection.

It is not therefore surprising the fact that robotic cystectomy has almost completely replaced open or laparoscopic approaches in most advanced health systems.

Traditionally cystectomy had been considered as the end of sexual life for both women and men.This has been challenged the last decade with the increasing utilisation of robotic technology and its intrinsic advantage of extreme precision, allowing to spare the nerves and vessels responsible for sexual function.Of course this does not mean that  all patients are candidates for techniques that spare the sexual function, as this can compromise the oncological outcomes. This should be discussed in detail with your Urologist before your operation. 

It can take up to 12 weeks to recover from a radical cystectomy. Even when you are ‘healed’ it can still be several months before you feel completely recovered.You might find your bowels do not work the same way they did before your surgery.

Traditionally open cystectomy had one of the longest hospital stays but with the robotic  approach you should be able to go home 3-7 days after the operation depending on the urinary diversion technique you had.

Bladder cancer is unfortunately one of the most unpredictable cancers which means that following your treatment , whether it is endoscopic resections, intravesical instillations, radiotherapy,chemotherapy or cystectomy , you will need to have a rigorous follow up based on the initial characteristics of the disease and the treatment you had.