What is Bladder Cancer?

Bladder cancer occurs when the cells in the inner lining of the bladder begin to grow and divide abnormally and uncontrollably. Over time, these abnormal cells can form a tumour.

Types of Bladder Cancer

There are several different types of bladder cancer, based on the type of cell where the cancer starts:

  • Urothelial carcinoma (also called transitional cell carcinoma)
    – This is the most common type, making up over 90% of all bladder cancers. It begins in the urothelial cells that line the inside of the bladder.
  • Squamous cell carcinoma
    – A less common form, accounting for 1–2% of cases. It is often linked to chronic bladder irritation or infection.
  • Adenocarcinoma
    – A rare type, making up less than 1% of bladder cancers. It begins in the glandular (mucus-secreting) cells of the bladder lining.

Stages of Bladder Cancer

Bladder cancer is generally grouped into two main categories based on how deeply it has grown into the bladder wall:

Non-Muscle Invasive Bladder Cancer (NMIBC)

  • Also known as superficial bladder cancer
  • Most bladder cancers fall into this category
  • The tumour is confined to the inner lining or just beneath it, and has not invaded the muscle of the bladder wall
  • These cancers have a low risk of spreading, but often recur, so regular follow-up is needed

Muscle-Invasive Bladder Cancer (MIBC)

  • The cancer has grown into the muscle layer of the bladder wall
  • This type is more serious and may spread to nearby organs, lymph nodes, or distant parts of the body
  • Treatment is typically more aggressive and may include surgery, chemotherapy, and/or radiation therapy
Bladder Cancer Surgery, treatments & symptoms - With Urology SA

What Causes Bladder Cancer?

Several risk factors can increase the chance of developing bladder cancer:

  • Smoking – the most significant risk factor
  • Age – risk increases with age, particularly after 55
  • Gender – more common in men than women
  • Occupational exposure – to chemicals in industries such as textile, rubber, and petrochemical
  • Chronic bladder inflammation – from infections or long-term catheter use
  • Family history – a genetic predisposition may increase risk
  • Certain medications – such as previous treatment with the chemotherapy drug cyclophosphamide

What Are the Symptoms of Bladder Cancer?

The most common symptom is:

  • Blood in the urine (haematuria) – often painless and may be visible or microscopic

Other possible symptoms include:

  • Frequent or urgent urination
  • Burning or pain during urination
  • Inability to pass urine
  • Pain in the lower abdomen or one side of the lower back
  • Unexplained weight loss and fatigue in advanced cases

Sometimes bladder cancer is found incidentally, such as during tests for other conditions or during a cystoscopy.

How is Bladder Cancer Treated?

Treatment depends on the type and stage of cancer.

TURBT (Transurethral Resection of Bladder Tumour)

  • Standard treatment for non-muscle invasive bladder cancer
  • Performed under general or spinal anaesthetic
  • A cystoscope (thin telescope) is inserted through the urethra into the bladder
  • A wire loop is used to remove the tumour
  • No external cuts are made
  • Most patients require a catheter for 1–2 days
  • A repeat procedure may be needed to ensure all cancer is removed
  • Low risk of complications such as infection or bladder injury

Radical Cystectomy

  • Common treatment for muscle-invasive bladder cancer
  • Involves complete removal of the bladder and nearby lymph nodes
    – In men: the prostate, urethra, and seminal vesicles are also removed
    – In women: the urethra, uterus, and part of the vagina are removed; ovaries may be preserved in younger women
  • Can be done as an open surgery or robotically (keyhole)
  • After bladder removal, urine diversion is necessary:
    • Ileal conduit (a stoma and external urine bag)
    • Neobladder (a surgically created bladder from bowel tissue)

Immunotherapy and Intravesical Chemotherapy

  • For non-invasive bladder cancer or to prevent recurrence after TURBT
  • Immunotherapy (e.g. BCG therapy) boosts the immune system to attack cancer cells
  • Chemotherapy drugs may be instilled directly into the bladder to destroy cancer cells