Every year more than 2,400 people in Australia are diagnosed with bladder cancer. Bladder cancer occurs when abnormal cells in the lining of the bladder multiply faster than normal, causing a tumour or tumours to develop. Most of these arise from the inner-most lining of the bladder and are called Transitional Cell Carcinomas (TCC).
Sometimes these stay localised to the surface layers of the bladder (Superficial Bladder Cancer) and sometimes they can grow more deeply through the wall of the bladder into the muscle layers and beyond (Muscle-Invasive Bladder Cancer). These cancerous cells, as well as growing into and through the bladder wall can also travel to sites outside the bladder, including the bones, liver, lungs and lymph nodes. These secondary tumours are called metastases.
Superficial and muscle-invasive bladder cancers require different treatments and have different outcomes (prognosis). Some superficial bladder cancers can turn into muscle-invasive ones. If bladder cancer spreads outside the bladder and local lymph nodes it is treatable, however ‘cure’ is usually not possible. In this case most treatments are aimed at slowing down the growth of the cancer and reducing the symptoms (palliation).
What are the Causes of Bladder Cancer?
There are lifestyle factors such as cigarette smoking, and exposure to certain toxic dyes that increase the incidence of bladder cancer. Bladder cancer is very uncommon before the age of 60 and is more common in men than in women.
In some parts of the world, exposure to schistosomiasis, a type of infection that occurs especially in Egypt, other parts of the Middle East and Africa, can cause a certain type of bladder cancer called Squamous Cell Carcinoma. Sometimes these can be mixed with TCC in the same cancer.
What are the Symptoms of Bladder Cancer?
Common symptoms include the presence of blood in the urine and irritation when passing urine including urinating more frequently during the day and/or night.
There may be associated stinging or burning but not necessarily.
These problems can also occur (much more frequently) with bladder infections. If antibiotics are given for a possible bladder or urinary tract infection but symptoms keep recurring, and/ or if bleeding in the urine is not associated with any pain, bladder cancer needs to be considered.
Symptoms of advanced bladder cancer may include pain in the bones or abdomen/pelvis or weight loss caused by cancer spread. It would be very unusual that these symptoms would occur without there having been any bleeding noted in the urine at an earlier stage.
What are the Treatments for Bladder Cancer?
The available treatments for bladder cancer depend on the stage at which the cancer has been diagnosed, especially the extent to which the cancer has grown into the wall of the bladder, the amount of cancer in the bladder, the symptoms caused by the cancer, the bladder function as well as the general health of the individual.
If the cancer is diagnosed when very superficial (on the surface of the bladder wall) then local surgical removal with or without chemotherapy or other agents being put into the bladder afterwards may be the only treatment required. If the cancer spreads more deeply into the muscle wall (muscle invasive bladder cancer) then complete removal of the bladder, called cystectomy, is one option for treatment. This will also involve the urine from the kidneys being diverted into a bag on the skin through the abdominal wall or less commonly, a ‘new’ or neobladder being made out of piece of bowel that will store the urine once the bladder has been removed.
Chemotherapy (drug therapy) adminstered in the vein may be recommended before and/or after major surgery. It is used to make the bladder cancer more easily removable from surgery and if used after surgery, will help reduce the risk of the cancer returning.
A less invasive treatment for muscle invasive bladder cancer in suitable patients is radiation therapy to the bladder with or without chemotherapy. This is called organ-conserving treatment as the bladder remains and ideally is functioning well after treatment. This is why only patients who have reasonably good bladder function are suitable for this kind of treatment.
The quality of life is often better in these patients who do not have to have the bladder completely removed. There are other features that are required to make someone an ideal candidate for bladder conservation. After this approach patients are required to have regular ‘check’ cystoscopies (a camera check inside the bladder) so that if the cancer returns, it can still be removed. This is called salvage cystectomy.
Some people who have more advanced cancers at diagnosis including those that might have spread to other parts of the body still might benefit from radiation therapy. Bleeding in the urine can often be reduced or stopped, and pain in the bladder or other places such as the bones, can be reduced or delayed with short courses of palliative radiation therapy.
What are the Side Effects of Radiation Therapy?
The side effects of radiation therapy for bladder cancer can be divided into the following.
Side effects during/soon after treatment (Early or ‘acute’ side effects)
General – tiredness is not uncommon during radiation therapy and may be worse if you are having chemotherapy at the same time. This will improve a few weeks to a few months after the treatment is over.
Local – most people will notice the need to pass urine more frequently and stinging or burning when passing urine in the second half of their treatment. With the extra fluid given along with chemotherapy, this may be worse on some days compared to others through the treatment course.
Treatment can be delivered between 2 to 7 weeks (Monday to Friday) depending on the goal of treatment and other factors. Keeping the urine dilute (drinking plenty of water) and using urine alkylising agents, e.g. Ural, can help reduce stinging and burning when passing urine.
The bowels may also be affected temporarily with increased gas and/or diarrhoea or mild change in bowel habit. This is because some portions of bowel may be within the field receiving radiation. Again, these early side effects will almost certainly settle back to normal a few weeks after treatment is completed.
Keeping well hydrated and using medication to slow bowel activity (if prescribed by your doctor) can help this. Sometimes diet might need to be modified.
Side effects well after treatment (Late or long-term side effects)
The bladder sometimes becomes smaller in volume after radiation therapy, especially if it is small to begin with – this means that you may need to pass urine more frequently over the long term. This is why radiation therapy may not be the best option for patients who have very poor bladder function at presentation. If the bladder is working well before treatment, then this is not likely to be a problem.
A change in bowel habit is not uncommon post bladder radiation therapy and may manifest as a desire to use the bowels more frequently or be more constipated. Any exposure to radiation increases the risk of a second cancer developing in that area, usually decades later. This risk is not entirely attributable to radiation received as part of your treatment. All X-rays and scans received over your lifetime contribute to this risk, as does unavoidable exposure to environmental radiation. The risk of a cancer being caused by radiation therapy is in the order of 0.5 – 1% at 10 years.
Visit BEAT Bladder Cancer Australia Inc for more bladder cancer information and support.
The best person to discuss radiation therapy for bladder cancer is a radiation oncologist. You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment option for you.
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Page last updated: 09/09/20