Bladder Cancer

Bladder cancer is where a growth of abnormal tissue affects the lining of the bladder. Approximately 10, 000 patients are diagnosed with bladder cancer each year, and it occurs when the bladder lining comes into contact with harmful substances. One of the most common causes is cigarette smoke; it is broken down into a harmful chemical which passes out of the body through the urine. It is estimated that half of bladder cancers are caused by tobacco smoke.

The most common symptom associated with bladder cancer is blood in the urine. If you experience this you should see your GP immediately.

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and if so, to what parts of the body. This will involve an operation to remove the growth from the bladder (TURBT) and sometimes a scan of the rest of the body.

Transurethral Resection of Bladder Tumour

Bladder cancer can be easily removed under general anaesthetic using a similar instrument to the one used during cystoscopy. The operation is called Transurethral Resection of Bladder Tumour (TURBT). 

The TURBT operation will allow the urologist to inspect the inside of your bladder in more detail and remove the tumour from the inside of the bladder by 'scrapping' it away with a heated wire.

Any suspicious looking areas, lumps, growths or tumours will be removed or sampled and sent to a specialist doctor (pathologist). Once a definite diagnosis has been made a treatment plan will be devised for you. 

The majority of bladder cancers are small. They are called superficial bladder cancers and are confined to the inner lining of the bladder only. 

Sometimes you may require additional treatments to the operation including intravesical treatments (medicines injected into the bladder) after the operation to prevent recurrence of the tumour.

In some cases the tumour is no longer in the superficial part of the bladder wall and more extensive surgery is required such as a cystectomy (removal of the bladder). This is rare.

Intravesical (Inside the bladder) Treatment

Mitomycin
Mitomycin is a form of chemotherapy placed directly into the bladder. It can be used immediately after surgical removal of bladder cancer (TURBT) but also it can be given over a 6 week course in the outpatient department via a small temporary catheter.  Mitomycin reduces the chance of bladder cancers recurring.

BCG Immunotherapy
BCG stands for Bacillus Calmette-Guerin, a living but weakened tuberculosis vaccine developed by Drs. Calmette and Guerin in France in 1921.
It is currently the most effective non-surgical treatment for CIS (carcinoma in situ) and high grade, non muscle invasive cancer. 

Intravesical immunotherapy is a substance placed into the bladder to stimulate an immune response. lmmunotherapy stimulates your body's immune system to destroy cancer cells within the bladder and reduces the risk of the tumour re-growing. When it is placed inside the bladder a local inflammatory reaction is created which kills cancer cells.

Treatment involves placing a small amount of fluid, containing a live vaccine, into the bladder through a thin catheter, which is then removed. Treatments are normally given once a week for 6 consecutive weeks.

BCG immunotherapy is not appropriate for all types of bladder cancer and is used mainly for superficial bladders that are high grade. The effectiveness therefore depends on how aggressive (grade) and how deep stage the bladder cancer is. The majority of patients with aggressive (grade 3) superficial bladder cancer and/or carcinoma in situ will respond to treatment. 
However, even for those people who have had successful BCG treatment, the bladder cancer may return and require further removal and surgery.

BCG Protocol

Hyperthermic (heated) Mitomycin C
BUI is currently offering a newer and specialised technique of giving heated mitomycin (chemotherapy agent). This treatment can be an alternative to BCG or a cystectomy in highly selected situations. Patients will be offered this only after discussion at a specialist multi-disciplinary team meeting.  Patients can be referred from outside of Bristol for this treatment via their local Consultant Urologist.

The technique involves catheterisation for a period of an hour, whilst heated mitomycin is instilled around your bladder. The staff are specially trained to give this specialised treatment. More can be seen on the video below regarding this treatment. If you want to know whether you are suitable for this treatment, please consult your Consultant Urologist.  It can be up to 70-80% effective in preventing recurrent cancer and has an acceptable side effect profile (this includes lower urinary tract symptoms and rash).

Non-invasive bladder cancer

Invasive Bladder Cancer

Sometimes bladder cancer can involve the muscle of the bladder and are termed invasive. This is a serious diagnosis and needs specialist input from surgeons and oncologists to treat the problem. The best results are achieved by combining chemotherapy to shrink the cancer followed by an operation to remove the bladder along with the lymph nodes. Without the bladder, the urinary tract needs to be reconstructed and this can be performed with an ileal conduit which uses a spout of small bowel on the surface of the skin to direct the urine into a collection bag. It is also possible in some patients to make a new bladder from bowel and attach it to the urethra which remains.

Robotic-assisted radical cystectomy
Here at the Bristol Urological Institute we have the most experienced surgeons in the country providing robotic surgery for bladder cancer. They have performed the greatest number of these cases in the UK.  The smaller incisions, less blood loss and less anaesthetic requirements mean that patients recover far more quickly than the traditional open operation.

Our consultants Mr Koupparis and Mr Rowe were the first in the country to remove a patient’s bladder due to cancer and reconstruct a new bladder out of bowel using the Da Vinci robotic surgical platform.