Due to the contact between the growth in the bladder and urine, the most common symptom of bladder cancer is presence of blood in the urine also known in medical terms as haematuria. Even if blood appears only once, medical advice should still be sought as soon as possible. Sometimes bleeding may not be seen to the naked eye and remain completely invisible (Invisible haematuria) and usually detected by the dipstick in doctor’s surgery or in hospitals on routine testing. Most of the times haematuria is not associated with any pain (painless haematuria).
Other symptoms include ‘cystitis’ like symptoms- frequent urination, pain while passing urine, burning sensation while passing urine and urge to pass urine. In men the symptoms may resemble prostate symptoms. Rarely the tumour may cause the blockage of one of the ureters causing loin pain.
In advanced disease there may be pain, loss of weight and appetite.
What is bladder cancer?
Bladder cancer arises from the lining of the bladder called urothelium. It is a specialised lining because it does not allow absorption of urine. Bladder cancer is the 7th most common cancer in the United Kingdom (Cancer Research UK) and 3% of all new patients with cancer. In men it is the 4th most common cancer and 13th most common cancer in women. Bladder cancer is age-related, being more common in older men and women; particularly the incidence rises after 50s and peaks in 80s.
- Smoking (cigarettes, pipes, tobacco, cigars): This is the most important risk factor. The chances of smokers getting bladder cancer are 3 times more than nonsmokers. The harmful substances collect in the urine and come in contact with the urothelium.
- Occupational: Some industrial chemicals cause bladder cancer (rubber, leather, textiles, paint products, printing). Occupations involving heavy exposure to chemicals (people exposed to chemicals such as petroleum or diesel fumes, painters, hairdressers) are also at risk of developing bladder cancer.
- Previous Cancer Treatments: radiation to the pelvic organs (prostate, uterus, rectum) probably have increased risk of developing bladder cancer. A chemotherapy drug called cyclophosphamide also increases the risk of developing bladder cancer.
- Chronic bladder infections: bladder stones, catheters left for a long time and long-standing bladder irritation could predispose to cancer. A parasitic infestation of bladder called schistosomiasis seen mainly in Africa and the Middle East is a risk factor for bladder cancer. Schistosomiasis is contracted by swimming in the infested water.
- Birth defects of the bladder: The bladder is attached at the top to umbilicus (Belly button) by a fibrous tissue called ‘urachus’. It is lined by cells at birth and gradually gets replaced by fibrous tissue. If the cells remain they can become cancerous. Rarely bladder can have defect at the front (ectopia vesicae); if left open with surgery, it could lead to BC.
- Genetics and Family history: men and women who have a family history of bladder cancer have a higher risk of developing bladder cancer themselves. This may be partly due them being exposed to same cancer inducing agent. Lynch syndrome increases the risk of bladder cancer and other parts of urinary tract; it is associated with cancer of colon, ovaries, uterus and other organs.
- Medications: Pioglitazone (Actos), a drug used for type II diabetes, was found to cause bladder cancer in animal studies; however European Medicines Agency (EMA) found a small increased risk of BC in humans. However the benefits outweigh the risk of bladder cancer. It is therefore avoided in patients who are at a risk of developing bladder cancer or those who have bladder cancer.
Mr Vinod Nargund is a Consultant Urological Surgeon specialising in Urological cancer, male sexual and fertility problems. He was trained in Urology at the City Hospital Belfast, the Royal Infirmary Bradford and the Churchill and John Radcliffe Hospitals in Oxford. You can view all of his qualifications on his biography page.