Bladder cancer (sometimes referred to as urothelial cancer), is a disease of the urinary tract. The urinary bladder is a hollow organ in the lower abdomen that stores urine produced by the kidneys before it is discharged from the body. This allows us to control when we want to pass urine, and allows one to pass urine at an appropriate time.

Bladder cancer occurs when there is abnormal, uncontrolled growth of cells within the urinary bladder with the potential to spread to other parts of the body. It is more common in men and in those who are over the age of 60 (the median age at diagnosis is 69 years). Other risk factors include smoking, exposure to certain chemicals at work, chronic bladder problems or repeated urinary tract infections, family history of bladder cancer and genetic conditions (e.g Lynch Syndrome).

Figure 1: Bladder Cancer

The most common symptom of bladder cancer is blood in the urine. Other common symptoms are painful urination and pelvic pain.

Figure 3: Symptoms of bladder cancer

When should you see a doctor for bladder cancer?

Signs and symptoms of bladder cancer are often mistaken for symptoms of a urinary tract infection or kidney stones. However, if you notice blood in your urine, or any of the other symptoms listed, even if they come and go, please go to the doctor so that the cause can be investigated.

Tests and procedures used to diagnose bladder cancer may include:

• Blood and urine tests: to help diagnose the bladder cancer or identify other conditions that may be causing the symptoms such as an enlarged prostate, urinary tract infection or kidney stones.
• Cystoscopy: This is the most common and reliable test for bladder cancer. During a cystoscopy, a thin tube with a camera on the end is inserted through the urethra to allow the doctor to examine the urethra and bladder for signs of disease. At SGH Urology, we may use a high-resolution visual tool called Narrow Band Imaging (NBI) to better identify suspicious growth.
  Cystoscopy is a simple, minimally-invasive procedure (typically performed in the clinic setting), where a small camera (scope) is inserted into the bladder via the urethra (urine passage) to allow your doctor to inspect the surface of the bladder to identify any tumours or suspicious growth.
  
  Figure 4: Flexible Cystoscopy
  
• Biopsy: During the cystoscopy, the doctor may pass a special tool through the scope and into your bladder to collect a cell sample (biopsy) for testing. This procedure is sometimes called transurethral resection. The cells are sent to the pathologist who will examine them under the microscope so that a diagnosis can be made.
  
• Urine cytology: A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.
• Imaging tests: The most common imaging test for bladder cancer is computerized tomography (CT) urogram. During a CT urogram, a contrast dye is injected into a vein in your hand and eventually flows into your kidneys, ureters and bladder. The contrast dye provides a detailed view to help identify any areas where there might be cancer.
  
• Other diagnostic tests that may be done include MRI (magnetic resonance imaging scans), PET (positron emission tomography) scans, bone scans and chest x-rays or chest CT scan. After confirming that you have bladder cancer, additional tests may be recommended to determine if the cancer has spread to your lymph nodes or other parts of the body.
  

For Non-muscle Invasive Bladder Cancer (NMIBC): 

For Muscle Invasive Bladder Cancer (MIBC):