Bladder cancer is the second commonest urological cancer after prostate cancer. Men are more commonly affected than women but overall around 10,000 people are diagnosed with bladder cancer each year.
The main risk factor for bladder cancer is smoking however certain occupations put people at risk of developing a bladder tumour.
More on what we do
To diagnose bladder cancer we undertake a number of investigations and these are often done in the haematuria clinic. The tests include an ultrasound scan of your kidneys and bladder, an inspection of the bladder with a flexible camera called a cystoscope, this is done under local anaesthetic.
If we find bladder cancer we will discuss this with you at the clinic and then we will treat this as outlined below.
TURBT: Transurethral resection of bladder tumour
The first treatment and the final part of the diagnosis for bladder cancer is the removal of the tumour under a general or spinal anaesthetic using a cautery loop -TURBT. We aim to remove all of tumour from the bladder and we take a sample of the bladder muscle below the tumour for further staging of the tumour (determining the extent of the disease).
The vast majority of patients are treated with TURBT alone, a number of patients require a further TURBT shortly after the initial operation to ensure the tumour has been removed.
Once a bladder cancer has been diagnosed will monitor the bladder on a 3-6 monthly basis with flexible cystoscopy in an outpatient clinic, if the tumour comes back you will require another TURBT.
7-8 people out of 10 will have bladder cancers that are termed superficial; they grow on the surface layers of the bladder only. If the tumour is superficial, but of a higher grade you will be referred for a course of treatments that are instilled into the bladder which is called BCG (see section on BCG).
2-3 out of 10 patients diagnosed with bladder cancer will have an invasive form that is diagnosed in the same way. Invasive tumours are cancer that has grown deeper to invade the muscle layer surrounding the bladder. As a result of this growth it is not possible to treat the cancer by TURBT alone and in order to treat the cancer we must employ more radical measures to eradicate the disease.
The treatments available for muscle invasive bladder cancer include chemotherapy with either removal of the bladder and bladder substitution, or chemotherapy with radiotherapy. If you have this kind of bladder tumour the doctors will talk to you about all the different options we have to treat your disease.
This is a treatment used in patients with higher grade superficial bladder cancer. It is put into the bladder using an “In Out” catheter in the outpatient department by Karen Green or one of her trained team. You will be asked to hold onto the treatment for an hour.
Side effects from the treatment are feelings like you have a urine infection- passing urine frequently, burning or stinging when passing water or passing blood. It can give flu-like symptoms and muscle aching, if you develop this or get a high temperature then please contact Karen Green, your GP or the consultant who is looking after you. If it is out of normal working hours then contact the out of hours GP service or attend the emergency department.
When you have your first TURBT you will be consented to have this form of topical chemotherapy put into the bladder at the end of the operation. The reason for doing this is to prevent any cancer cells that are floating in the bladder at the end from seeding into the bladder wall, to reduce the risk of the tumours coming back.
This is kept in the bladder for 1 hour, this is the time that you will spend in the recovery area following your operation, at the end of the hour it will be drained away via a catheter that is placed in the bladder at the end of your operation.
We also use this form of treatment as a weekly instillation over 6 weeks for people who have low grade tumours that come back very regularly. The treatment is given in the outpatient department by Karen Green or a member of her trained team via a fine “In Out” catheter into the bladder. You will be asked to hold onto the treatment for an hour.
Treating more advanced bladder cancer
If your bladder cancer is higher risk or is known to have invaded into the wall of the bladder then you will need more radical treatment. This will be fully discussed with you in the clinic by Mr Brian Parsons or Miss Liz Waine and support will be provided by Mrs Karen Green. Most patients with this type of bladder cancer will have a course of chemotherapy before having either the bladder removed or having radiotherapy.
Having your bladder removed
If it is recommended that you have your bladder removed the details will have been discussed with you in clinic. The operation is done via a keyhole (robotic) approach to help you recover more quickly. We remove the bladder along with the prostate in a man, or the uterus (womb) in a woman.
We disconnect the ureters (tubes draining the kidneys into the bladder) and drain them into a new bladder made from small intestine or a small stoma (ileal conduit) and this drains into a bag on the wall of your abdomen. We expect you to be in hospital from 5-10 days after this type of surgery. Full details will be discussed in clinic.
Whilst all the consultants in the department perform TURBT the consultants with a special interest in bladder cancer are:
- Mr John McGrath
- Miss Elizabeth Waine
- Mr Brian Parsons
Our Cancer Nurse Specialist for bladder cancer is Mrs Karen Green
Where to find us
RD&E Wonford, Barrack Rd, Exeter EX2 5DW
Department of Urology (Level 2, Area G)
Secretary to Mr McGrath - 01392 406277
Secretary to Miss Waine - 01392 408478
Secretary to Mr Parsons - 01392 402733
Cancer Nurse Specialists - 01392 402747
One Stop Haematuria Clinic
If you have seen blood in your urine or if the GP has detected non-visible blood in your urine by testing it in the surgery then they will make a referral to this clinic. The clinic is designed to determine the cause of the blood in the urine.
The clinic will involve you being seen and assessed by a doctor, an ultrasound scan of the urinary system, under local anaesthetic a flexible camera will be used to inspect the lining of your bladder. The order of these tests varies but all are usually necessary.
Locally we have a patient support group for patients with any form of bladder cancer. The group is run by patients who meet on a regular basis and allow a forum for patients
FORCE Cancer Charity, which is available for all patients with a cancer diagnosis: forcecancercharity.co.uk.
The National Bladder Cancer Group is called Fight Bladder Cancer UK: www.fightbladdercancer.co.uk.
The Urostomy Association UK: urostomyassociation.org.uk.