The bladder is located in the lower part of the abdomen. Its function is to store urine from the kidneys until urination. Tumours of the bladder, like those in many other parts of the body, can be either benign (non-cancerous) or malignant (cancerous). The tumour normally originates from cells lining the bladder and produces a growth that projects into the cavity of the bladder. Benign tumours tend to remain localised, however, malignant tumours can grow through the bladder wall and may spread to other parts of the body.

How common are they?
Tumours of the bladder are uncommon, affecting about 1 in every 2,500 people per year throughout the western world. They are commonest in the 50 to 70 year age group, and are twice as common among men than women. Bladder cancer is the fifth most common cancer in men, and the tenth most common in women.

What causes bladder tumours?

Although the exact cause of bladder cancer is unknown several factors have been shown to increase your chances of developing it. They are:

• Cigarette smoking,
• Chronic bladder infections,
• Exposure through work to strong chemicals such as benzidine and some dyes,
• Treatment with chemotherapy such as cyclophosphamide.

What are the common symptoms of bladder tumours?

The most common sign of bladder tumours is the passing of blood in the urine (haematuria). The amount of blood lost may be enough to colour the urine red, or it may only be evident with a special dipstick test. The volume of blood passed is not indicative of the size of the tumour and may vary.

Unlike blood in the urine as a result of a bladder infection, bladder tumours do not usually cause pain or a burning sensation when passing urine. However, if you have a bladder tumour you will be more susceptible to bladder infections such as cystitis (inflammation or irritation to the bladder). Sometimes, there may be discomfort on the right or left side, if the tumour is complicated by hydronephrosis (swollen kidney tracts due to backflow of urine).

If the tumour has spread beyond the bladder itself, there may be symptoms relating to the other affected parts of the body. For example, a lump may be felt in the lower abdomen due to growth around the bladder itself. If the tumour has spread around the body, there may be pains in the bones, anaemia (low blood count) causing dizziness and tiredness, and sometimes a fever.

How are bladder tumours diagnosed?

If you present to your doctor with any of the above symptoms, a full history will be taken and a thorough physical examination performed. The tests for bladder tumours may include:

• A dipstick test on a urine sample. The dipstick contains chemicals that react with any blood that is present in the urine.

• If the sample is positive, the urine will be examined under a microscope to confirm the presence of blood cells and to see if there are any abnormal cells that may have come from a bladder tumour. The absence of these cells does not mean there is no tumour present.

• A check on the flow of urine from the kidneys down to the bladder, called an intravenous urogram (or pyelogram). A small dose of contrast liquid is injected into a vein and then several X-rays of the abdomen are taken over a period of about two hours. The contrast liquid passes into the urine via the kidneys and travels down into the bladder. These organs and the tubes that connect them are highlighted as white on the X-rays. If there is a blockage to the flow of urine at any point or if there is an irregularity in the wall of the bladder suggesting a tumour, this will be apparent on the X-rays. Also, dye can be injected into the bladder in a procedure called 'cystography'.

• An ultrasound scan of the abdomen may sometimes be taken instead of the intravenous urogram. This can show tumours within the bladder and it allows your doctor to check the size of both kidneys, which gives an indication of how they are functioning.

• Cystoscopy. This test examines the inside of the bladder, using a special instrument equipped with a lens and a light (cystoscope). The cystoscope is introduced through the urethra, the tube that carries urine from the bladder to the outside of the body, to see how large the tumour in the bladder is, and to take a small sample from the tumour for further study under a microscope.

Other tests may be performed to check whether a bladder tumour has spread to other parts of the body. These include:

• blood tests to check liver and kidney function and to test for the presence of anaemia
• a chest X-ray to check that the tumour has not spread to the lungs
• on occasions, a CT scan of the abdomen to check for spread of the tumour to areas around the bladder

What treatment is available?

The risk of bladder tumours can be reduced by changes in lifestyle. It is important to stop smoking, and to ensure that any infections of the urine are treated properly. People who work in the dye and rubber industries should make sure that preventative measures and regular employee checks are in place to screen for any bladder abnormalities.

The medical treatment for bladder tumours depends on the type of tumour and how far it has developed. Cancers that are caught early when they have not grown through the bladder wall can be cut away during cystoscopy. This is usually performed under a general anaesthetic. Miniature surgical instruments can be passed down the cystoscope to allow the urologist to deal with the tumours. After the operation, a catheter will be inserted into the bladder to allow urine to drain. For the first 24 to 48 hours after surgery, the catheter will also be used to wash out the bladder continuously to remove any debris.

Cancer that has spread beyond the bladder may require radiotherapy (cancer-killing X-rays) and/or chemotherapy (cancer-killing drugs), which is either injected into the veins or placed directly into the bladder. Regular cystoscopies will be carried out to check for return of the tumour. In some cases, if the tumour has spread through the bladder, urethra and the prostate (in men) or the womb and ovaries (in women), these tissues are removed. An artificial bladder can then be reconstructed using a small segment of bowel, which can either open directly at the skin surface, or drain into the rest of the digestive tract.

After treatment what can I expect?

If the tumour has not spread into the bladder wall and is removed by cystoscopy, the prognosis is good and 90 per cent of patients treated will still be alive after five years. Quality of life will be very good for these individuals, who can lead a normal life apart from regular check-ups.

In cases where the tumour has extended through the full thickness of the bladder wall, the survival rate after five years drops to 30 to 40 per cent. If the cancer has spread beyond the bladder and into the surrounding areas, then the survival rate falls to around 10 per cent at five years