Types of CancerNavigation
Cancer of the bladder happens when abnormal cells appear in the lining of your bladder or in the bladder wall. Cancer cells can affect how the bladder works normally.
How your doctor treats your bladder cancer will depend on how far the cancer has grown into the layers of the bladder and the grade of the cancer.
The cells in the lining of the bladder (urothelium) are known as transitional cells. Because these cells line the bladder, they come into contact with waste products in the urine that may cause cancer, such as chemicals in cigarette smoke.
About 90% of bladder cancers diagnosed in Ireland are the transitional cell type. Bladder cancer affects about 490 people in Ireland each year and is more common in men than in women.
Your Bladder Cancer Team
We use a multidisciplinary approach in diagnosing and treating bladder cancers and hold a meeting every second week with Urology Consultants, Radiation and Medical Oncology, Pathology, Radiology and Specialist Nurses, where your investigations are reviewed by the team and treatment options discussed.
- Ms Little
Secretary: 01) 809 2935
- Mr Cheema
Secretary: 01) 809 3046
- Mr Power
Secretary: 01) 809 3046
- Mr Smyth
Secretary: 01) 809 2339
- Mr Mohan
Secretary: 01) 809 3135
- Mr Davis
Secretary: 01) 809 2339
- Mr Forde
Secretary: 01) 809 2935
- Mr Quinlan
Secretary: 01) 809 3135
- Ms Mc Lornan
Secretary: 01) 809 3310
Clinical Nurse Specialist (CNS)
You will meet the nurse at your outpatient visit or during your inpatient stay. The nurse will support you throughout your whole patient journey by providing information, education and support.
Ms Clodagh Sharpe CNS
Contact: 01) 797 7656
If you have surgery for your bladder cancer it may be necessary to remove part or all of your bladder. An opening will be created in your belly to create a new passage for urine. This is called a urostomy or stoma. The stoma nurses provide education on how to manage this stoma and you can contact them before and after the procedure if you have any questions. They are based in the outpatient department. For information on where they are located click here.
- Elaine Webb
- Suzanne Reid
Contact: 01) 852 8602
If chemotherapy is part of your treatment plan, medical oncology consultants provide expert opinion at the Multidisciplinary Team Meeting about the best type of treatment for your type of cancer.
If radiotherapy is part of your treatment plan, radiation oncology consultants provide expert opinion at the Multidisciplinary Team Meeting about radiotherapy .
A pathologist looks at the cells from your tumour under a microscope to determine the type of cancer you have when you are diagnosed. If you have surgery they will examine the tumour to see how advanced it is. This helps us in deciding the best treatment for you.
A radiology consultant will review your x-ray and scan imaging to determine the location and how widespread your cancer is. This helps to decide what treatment is most suitable for you.
Other Healthcare Professionals
If you need the support of physiotherapy, occupational therapy, dietician, psychology, psycho-oncology, counsellors or medical social work during your hospital stay, to help you with your treatment we will organise these for you.
Referral to the Bladder Cancer Service
Referrals are sent by a General Practitioner via Health mail or by letter. Sometimes they may be sent from the Accident and Emergency Department or from other hospitals within the RCSI hospital group.
Your referral will be reviewed by a Consultant Urologist and you will be given an appointment for the most appropriate clinic. If you have visible haematuria (blood that can be seen in your urine), you will be referred urgently to the Visible Haematuria Clinic. If you have other symptoms suspicious for bladder cancer you will be referred to an urgent urology clinic.
If you have been referred with visible haematuria to the nurse specialist you will be contacted to discuss your referral, your symptoms and medical information. The nurse specialist will arrange tests for you and a urology clinic appointment.
If you have been referred to an urgent urology clinic you will meet your Doctor in clinic. They will decide which tests you will need to have done.
Types of Bladder Cancer
The most common form of bladder cancer is transitional cell bladder cancer (TCC), which is also called urothelial cancer.
It starts in the transitional cells in the lining of the bladder. About 90% of bladder cancers diagnosed in Ireland are the transitional cell type.
There are 2 types of transitional cell bladder cancer (TCC):
- Non-muscle invasive or superficial bladder cancer (NMBIC)
- Muscle invasive bladder cancer (MIBC)
Most patients with bladder cancer have non muscle invasive bladder cancer, that will not develop into muscle invasive bladder cancer type.
Non-muscle invasive bladder cancer
This cancer is also known as superficial bladder cancer and is the most common bladder cancer. It only affects the lining of the bladder and hasn’t grown into the deeper layers of the bladder wall. It usually appears as small growths, shaped like mushrooms, growing out of the bladder lining, and is called papillary bladder cancer (or stage Ta) Your surgeon can remove these growths with a minor operation. However, it isn’t unusual for non-muscle- invasive or superficial bladder cancer to return. These include carcinoma in situ (CIS), stage T1 tumours and high-grade tumours.
Carcinoma in situ (CIS): This type appears as red ulcers inside your bladder. The cells are very abnormal and can grow quickly.
T1 tumours: These are superficial cancers that have grown from the bladder lining into the next layer (the lamina propria).
Carcinoma in situ and T1 tumours can grow quickly and sometimes spread to the muscle wall in the bladder and nearby tissues. This is then known as muscle-invasive bladder cancer.
Muscle-Invasive Bladder Cancer
Muscle-invasive bladder cancer is when the cancer cells have grown into the muscle layer of the bladder, or beyond (Stage T2,T3,T4). Muscle-invasive bladder cancer needs more intensive treatment than non-muscle invasive bladder cancer. This is because there is a risk that it could spread to other parts of the body.
Rarer types of bladder cancer
Squamous cell bladder cancer
Squamous cells are flat cells that make up the moist, skin like tissues lining your body organs. This type of bladder cancer develops from these cells and is usually muscle invasive.
This is a very rare type of bladder cancer. Between 1 and 2 out of every 100 people (1 to 2%) diagnosed with bladder cancer have it. This type of cancer is usually muscle invasive.
Very rarely, some people get a cancer of the bladder muscle or other structural tissues rather than the bladder lining. Cancers that start in the bladder muscle are called sarcomas.
Small cell cancer of the bladder
This is an extremely rare type of bladder cancer but it can spread very quickly.
Advanced (metastatic bladder cancer)
Bladder cancer can also spread beyond the bladder. If this happens, it is called advanced (metastatic) bladder cancer. If the tumour has spread to nearby organs, it is called locally advanced disease.
For example, to the womb and vagina in women or to the prostate in men. The lymph nodes in your pelvis can also be affected. If the cancer has spread to the liver, bones, lungs, or other parts of your body, these are known as distant metastases.
If you want more information about stages and types of bladder cancer the Irish Cancer Society has a booklet about this. Click here to be redirected to this booklet.
Risk Factors For Bladder Cancer
Some of the risks for bladder cancer include:
- If you have had chemotherapy or radiotherapy previously
- Exposure to certain chemicals
- People over 60 years of age have a higher risk for bladder cancer
Signs and Symptoms of Bladder Cancer
People with bladder cancer may experience the following symptoms or signs. Sometimes, people with bladder cancer do not have any of these changes, or, these symptoms may be caused by a different medical condition that is not cancer.
- Blood or blood clots in the urine.
- Pain or burning sensation during urination.
- Frequent urination
- Feeling the need to urinate many times throughout the night.
- Feeling the need to urinate, but not being able to pass urine.
- Lower back pain on one side of the body.
Most often, bladder cancer is diagnosed after a person tells their doctor about blood in the urine, also called haematuria. Visible haematuria means that enough blood is present in the urine that the patient can see it when they urinate. It is also possible that there are small amounts of blood in the urine that cannot be seen by the naked eye, this is called “non visible haematuria,” and it can only be found with a urine test.
Urine tests alone are not used to make a final diagnosis of bladder cancer, because haematuria can be a sign of several other conditions that are not cancer, such as an infection or kidney stones.
Investigations for Bladder Cancer
You will have a number of investigations that include:
- A health history review and physical examination.
- Blood and urine tests: Blood tests can help to check your general health. They will be done regularly during your treatment. Urinalysis and urine culture will be performed to check for infection or blood. One other type of urine test that can find out whether there is cancer is urine cytology, a test in which the urine is studied under a microscope to look for cancer cells.
- Radiology scans: These may include an X-ray, a CT Urogram a CT Thorax, or Ultrasound of your bladder, kidneys and ureters. For more information click on the name of the scan.
- Flexible Cystoscopy: This procedure is done in the Endoscopy unit and allows your doctor to see the tumour directly to assess it. On the day of the Cystoscopy, information on what has been seen on the cystoscopy will be explained to you. For more information about this procedure click here.
- Biopsy: A biopsy is where a small sample of tissue is removed from your bladder and examined under a microscope. This can give your doctor more information about what type of bladder cancer it is and its grade. You usually have a biopsy during a cystoscopy as part of diagnosing your cancer.
- TURBT: After your cystoscopy you may have a further biopsy to find out the type and stage of your cancer. This sometimes also includes the removal of the tumour using a procedure called Transurethral resection of bladder tumour. Click here for more information about TURBT.
It may sometimes be necessary to organise further scans before deciding your treatment.
- MRI scan: This is a scan that uses magnetic energy to build up a picture of the tissues inside your body. During the test you will lie inside a tunnel- like machine. For more information about MRI click here.
- Bone scan: With rare types of bladder cancer, you may need to have a bone scan. The scan can check for signs that cancer has spread to the bones. For more information about bone scans click here.
Surgery, chemotherapy and radiotherapy are the main treatments for bladder cancer. A team of multidisciplinary health care professionals will be looking after you.
The type of treatment you receive will depend on:
- The size and stage of your cancer
- The type and grade of your cancer
- If the cancer has spread or not
- Your age and general health
The way bladder cancer is treated mainly depends on the stage and grade of the disease at diagnosis. Non-muscle-invasive bladder cancer is treated differently to muscle-invasive bladder cancer.
In this section we give a brief overview of the treatments used for bladder cancer.
Types of treatment
Surgery for non-muscle-invasive cancer aims to remove the tumour from your bladder. Surgery is the main treatment for this type of bladder cancer. See BAUS guideline on TURBT.
Surgery for muscle-invasive bladder cancer usually involves removing the whole bladder. Click on male or female for information from BAUS (The British association of Urology Surgeons) on cystectomy for male and female.
Radiotherapy is used to treat muscle-invasive bladder cancer.
It uses high-energy X-rays to kill cancer cells. The aim of radiotherapy is to destroy the cancer cells with as little damage as possible to normal cells. For more information about radiotherapy, click here.
Chemotherapy is the use of drugs to kill or control the cancer cells. For non-muscle-invasive bladder cancer, intravesical chemotherapy (chemotherapy into the bladder) may be given after your surgery to reduce the risk of the cancer coming back. See BAUS guideline on bladder instillations.
For muscle-invasive bladder cancer, chemotherapy may be given:
- Before surgery or radiation to shrink the cancer and reduce the risk of it coming back. This is also called neo-adjuvant chemotherapy.
- With radiotherapy, to make the treatment more effective. This is also called chemoradiation
- On its own for advanced (metastatic) bladder cancer
- After surgery if there is a high risk of the cancer coming back (recurrence). This is also called adjuvant chemotherapy.
For more information about chemotherapy click here.
Immunotherapy drugs help your immune system to work better to fight cancer cells. These treatments can change special immune cells to help them attack the cancer directly. They also change other parts of the immune system to make it more difficult for cancer cells to grow or spread.
Hearing that you have bladder cancer can be a huge shock. You may be feeling:
- Upset and overwhelmed by your emotions
- Confused by all the information being given to you
- Worried about what will happen next
However you feel it is important to know you are not alone, if you need to talk to someone, or if you want support or advice:
- Ask to speak to the cancer nurse or the medical social worker at the hospital. They can help you and your family to cope with your feelings and advise you about practical matters
- Talk to one of the Irish Cancer Society nurses in confidence – visit a Daffodil Centre or call the Support Line on 1800 200 700. You can email the nurses at firstname.lastname@example.org
- Speak to an Irish Cancer Society Survivor Support volunteer who has had a cancer diagnosis and really knows what you are going through. The Irish Cancer Society nurses can put you in touch with a volunteer
- Talk to other people going through the same thing. Join the Irish Cancer Society online community at cancer.ie/community
Click on the name to be redirected to the site for further information.
Opening Hours: Monday to Friday 8am – 4pm
Contact: 01) 797 4880
Contact: 01) 707 4880
Contact: 041) 980 5100
Have you thought about quitting smoking?
Smoking is one of the highest risk factors for bladder cancer. When you smoke, the chemicals from cigarettes pass into your bloodstream and are filtered by the kidneys into your urine. The bladder is repeatedly exposed to these harmful chemicals, as it acts as a store for urine. This can cause changes to the cells of the bladder lining, which may lead to bladder cancer. It’s estimated that more than a third of all cases of bladder cancer are caused by smoking. If you quit smoking you also reduce the risk of non muscle invasive bladder cancer from returning.
Beaumont Quit Smoking advisors
Contact: 01) 809 2941
Contact: 1800 201 203 or try the website QUIT
Patient Information Resources - Bladder Cancer
Irish Cancer Society booklet on Cancer of the Bladder