Bladder cancer

The function of the bladder

The urinary bladder (referred to as ‘the bladder’) is the organ that collects and stores urine produced by the kidneys (Fig. 1a & 1b). It is a hollow stretchy bag made of muscle tissue that sits on the pelvic floor muscles. The bladder expands as urine from the kidneys collects before being passed out of the body through the urethra (Fig 2.).

Fig. 1a: The male lower urinary tract.
Fig. 1a: The male lower urinary tract.
Fig. 1b: The female lower urinary tract.
Fig. 1b: The female lower urinary tract.
Fig. 2: A healthy bladder.
Fig. 2: A healthy bladder.

What is bladder cancer?

Bladder cancer is the growth of abnormal tissue (tumour) in the bladder. There are several stages of bladder cancer. Your treatment and experience will depend on the specific characteristics of the tumour (referred to as “staging” the tumour) and the expertise of your medical team.

This section provides general information about bladder cancer, diagnosis, and various treatment options. Discuss with your doctor what is best in your individual situation.

What causes bladder cancer?

Several biological factors and harmful substances can increase the risk of developing bladder cancer. A higher risk does not necessarily mean that someone gets cancer. Sometimes bladder cancer develops without any known cause.

Risk factors for bladder cancer

Bladder cancer develops slowly and is more common in older people (age 60 and older). According to the European Association of Urology’s bladder cancer guidelines, tobacco smoking contains many harmful substances and is responsible for almost half of the bladder cancer cases.

Another well-known source of risk is occupational exposure to chemicals used in the production of paint, dye, metal and petroleum, although workplace safety guidelines have helped reduce this risk.

Infections from certain parasites and chronic urinary tract infections increase risk of developing bladder cancer.

Bladder cancer prevention

A higher risk does not necessarily mean that someone gets cancer. Sometimes bladder cancer develops without any known cause.

It is important to maintain a healthy lifestyle. If you smoke, try to stop. Follow workplace safety rules and avoid exposure to harmful chemicals. Some evidence suggests that drinking a lot of fluids, mainly water, might lower bladder cancer risk. Eating a balanced diet with lots of fruits and vegetables has health benefits and might protect against cancer. If you have questions or need support to maintain a healthy lifestyle, ask your healthcare team for assistance or referrals.

Stages of the disease

A tumour that grows towards the centre cavity of the bladder without growing into the muscle tissue of the bladder is called non–muscle invasive. These tumours are superficial and represent an early stage. This is the most common type of bladder cancer. In most cases, these tumours are not aggressive and rarely spread to other organs, so they are not usually lethal, they can however appear again (=recurrence) or develop aggressive features (=progression)

As the cancer grows into the muscle of the bladder and spreads into the surrounding muscles, it becomes muscle- invasive bladder cancer. This type of cancer has a higher chance of spreading to other parts of the body (metastatic disease) and is harder to treat. In some cases, it may be fatal.

If bladder cancer spreads to other parts of the body such as the lymph nodes or other organs, it is called locally advanced or metastatic bladder cancer. At this stage, cure is unlikely, and treatment is limited to controlling the spread of the disease and reducing the symptoms.

Follow-up

After any kind of cancer treatment follow-up is essential to minimise complications and to detect and treat recurrences early. After complete removal of the bladder or other treatments, you will be asked to see your general practitioner, urologist, oncologist, radiologist, or a nurse practitioner at specific, fixed time intervals for monitoring and evaluation.

A specialist should have the lead in coordinating and interpreting all of the results from the follow-up visits. That specialist—in most countries, the urologist— should also be the main contact for questions about your disease or related issues.

Symptoms of complications

  • After monitoring of cancer, the functional results must be observed and controlled. Functional complications after bladder removal include vitamin B12 deficiency, high acid levels in the blood (metabolic acidosis), worsening kidney function, urinary infections, urinary stone formation, tightening of stoma openings (stricture), other stoma complications in patients with ileal conduit diversions (leakage, inversion, skin irritation), neobladder continence problems, and emptying dysfunction. Ask your doctor for information about the major symptoms of these complications and their prevention.

This information was last updated in March 2017.

It contains general information about bladder cancer. If you have any specific questions about an individual medical situation you should consult your doctor or other professional health care provider.

This information was produced by the European Association of Urology (EAU) Patient Information Working Group.

The content of this leaflet is in line with the EAU Guidelines on Bladder Cancer 2016.

Contributors:

  • Dr. Mark Behrendt, Amsterdam (NL)
  • Dr. Juan Luís Vasquez, Herlev (DK)
  • Ms. Sharon Holroyd, Halifax (UK)
  • Dr. Andrea Necchi, Milan (IT)
  • Dr. Evanguelos Xylinas, Paris (FR)