Bladder cancer is one of the ten most common cancers in Australia. More than 2,000 cases of bladder cancer are diagnosed annually and it occurs much more commonly in men.
The exact cause of bladder cancer is uncertain, but the following make the development of bladder cancer more likely:
The principal symptom of bladder cancer is the presence of blood in the urine. This may be macroscopic (visible) or microscopic (invisible). Investigations include a urine test, imaging of the urinary tracts and an examination with a telescope (a cystoscopy).
Bladder cancers are either superficial or deep. Carcinoma in situ is a cancerous change in the cells lining the inside of the bladder. The presentation of carcinoma in situ (CIS) may be irritating voiding symptoms or, in association with a bladder tumor found at the time of cystoscopy.
CIS is best treated with BCG which is highly effective in treating this condition resulting in complete remission of the existing disease in up to 75 to 80% of those treated with repeated courses. It is administered through a urethral catheter on a weekly basis for six weeks. The BCG is held within the bladder for two hours on each occasion. The complications of BCG include urinary irritation, fever, joint pains and rarely, tuberculosis.
Superficial bladder cancers of low grade can be managed by check cystoscopy on a 6 to 12 monthly basis. Infrequent recurrences can be cauterized while if tumour recurrence is increasing BCG treatment will need to be considered.
Deep bladder cancers are those which invade into the bladder wall and are often referred to as muscle invasive bladder cancers. These require more aggressive treatment in the way of surgical removal of the bladder although radiation therapy is nevertheless an alternative.
Bladder cancers require lifelong follow up because of the tendency to recur. A cigarette smoker should cease cigarette smoking and regular check cystoscopies will be necessary.