Bladder Cancer

Cancer occurs when body cells alter, multiply and interfere with ‘normal’ cells. Bladder cancer is unfortunately not uncommon.

One of the common symptoms of bladder cancer is blood in the urine. The bleeding is not usually painful and can come and go.

There can be a burning feeling when you go to the toilet and you may need to go more frequently than usual or may need to pass urine very urgently. These symptoms may be caused by some other problems, such as urinary tract infection but should always be investigated by your doctor.

The risk factors for developing bladder cancer include:

• Advancing age
• Smoking
• Occupational risks – bladder cancer was one of the first cancers that was proven to be caused by a carcinogen. It was discovered that people who worked with certain chemicals known as aromatic amines had a very high risk of developing bladder cancer.
• Long term indwelling catheters – people who manage and treat a bladder problem with an indwelling catheter have an increased risk of developing squamous cell bladder cancer.

A cystoscopy, where an instrument called a cystoscope is inserted into the bladder through the urethra, can be carried out to check for bladder tumours.

If the cancer is only present in the lining of the bladder it is called a ‘superficial’ tumour. This can usually be removed by a probe inserted through a cystoscope. If however, the cancer has spread to the bladder wall muscle, it is called an ‘invasive’ tumour. Surgery, chemotherapy and radiation can be used to treat an invasive tumour.

Life After Bladder Surgery

How you manage after surgery will depend to some extent on which type of surgery you had and whether it was for early bladder cancer or invasive bladder cancer.

If you have had a cystoscopy to remove early bladder cancer, then you should not notice any physical problems at all. Surgery for invasive bladder cancer involves removing some or the entire bladder. This is known as a cystectomy.

There are two types of cystectomy:

• a partial cystectomy  –  where only part of the bladder is removed
•  a radical cystectomy –  where all of the bladder is removed as well as near-by lymph nodes, part of the urethra, the prostate (in men), and the cervix and womb (in women)

A radical cystectomy means the patient will loose all normal bladder function. Further surgery will be required to compensate for the loss of bladder function by creating an alternative way for urine to leave your body. This type of surgery is known as urinary diversion.

Urinary Diversion

If your bladder is removed during a radical cystectomy, an alternative way of passing urine out of your kidneys will need to be found. There are a number of different treatment options, which are described below. In some cases, you may be able to make a choice based on your personal preferences.

Urostomy

A urostomy is the most common type of urinary diversion operation. During the operation, the surgeon will make a hole in your abdominal wall. This hole is known as a stoma. A small section of your small bowel will be removed and connected to your ureters (the two tubes which, in normal circumstances, carry urine out of the kidneys). The other end of the small bowel will be connected to your stoma. A flat, water-proof pouch is then connected to the stoma to collect the urine.

Continent Urinary Diversion

A continent urinary diversion is a similar sort of operation to an urostomy, except that you will not be required to use a pouch. A section of your bowel will be used to create an internal pouch that is used to store your urine. The pouch will then be connected to your ureters at one end, and to a stoma that is made in your abdominal wall at the other end. You can empty the pouch by inserting a catheter (a thin, flexible tube) into the stoma and use it to drain away the urine. Most people need to empty their pouch about four to five times a day.

Bladder Reconstruction

In some cases, it may be possible to create a “new bladder”, known as a neobladder. This can be done by removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra at one end and your ureters at the other end. Due to the loss of normal nerve function, around 20%-30% of people with a neobladder will experience some episodes of incontinence (the involuntary passing of urine), which usually occur during the night when they are sleeping. It may be useful to empty your neobladder at set times each day, and then once more before you go to sleep, because this may help to prevent incontinence.
If you have experienced any of the symptoms described above, visit your GP and discuss them, these symptoms could be caused by another problem, not necessarily bladder cancer.

For further and more detailed information about Bladder Cancer please contact Cancer Research UK, the UK’s leading charity dedicated to cancer research at www.cancerresearchuk.org

Help For Incontinence Problems

If you are concerned about any incontinence or bladder problems and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems.