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Understanding Bladder Cancer

In this article:

Incidence and Mortality Statistics
Common Symptoms
Risk Factors
Diagnostic Methods
Treatment Methods
Personal Care

Overview of Bladder Cancer in Hong Kong

Incidence and Survival Rates of Bladder Cancer

The bladder is a hollow, pouch-like organ located behind the pubic bone in the pelvic cavity, responsible for collecting and storing urine. Bladder cancer occurs when the cell tissue lining the bladder undergoes pathological changes. Most bladder tumours resemble small mushrooms and initially appear on the surface of the bladder lining, known as papillary tumours, which can take time to invade the bladder’s muscular walls and spread to other parts of the body.

Bladder cancer can be classified into three types:

  • Urothelial carcinoma:
    Which originates from the epithelial cells lining the bladder and urinary tract and is the most common type, accounting for 80% to 90% of all bladder cancer cases.
  • Squamous cell carcinoma:
    Originating from the flat cells in the bladder mucosa, it represents a small portion of bladder cancer cases, approximately 1% to 2%.
  • Adenocarcinoma:
    Cancer arising from the glandular cells in the bladder also accounts for about 1% of bladder cancer cases.

Bladder cancer can also be categorised based on the degree of invasion into the bladder wall:

  • Non-muscle invasive (non-invasive) bladder cancer:
    Refers to tumours that are confined to the inner bladder wall and have not invaded the muscular layer, representing early-stage bladder cancer, such as urothelial carcinoma.
  • Muscle-invasive (invasive) bladder cancer:
    Indicates that cancer cells have spread from the bladder’s two outer layers into the muscle layer, posing a greater risk of metastasis and being more difficult to treat, such as squamous cell carcinoma and adenocarcinoma.
  • Metastatic bladder cancer:
    Indicates that the cancer has spread to other parts of the body, such as the lungs, liver, or bones.

While bladder cancer is less common than lung or colorectal cancer in Hong Kong, it remains a significant health concern. According to the Hong Kong Cancer Registry, there are an average of about 400 new cases each year, with a notable male predominance, approximately three times more than females, and most patients are aged between 55 and 70.

Various factors, including the type and stage of the cancer, influence the survival rate for bladder cancer. According to the American Society of Clinical Oncology (ASCO), the 5-year survival rate for bladder cancer patients is 77%, with a 10-year overall survival rate of 70% and a 15-year overall survival rate of 65%. If bladder cancer has spread to nearby lymph nodes, the 5-year survival rate drops to 36%. If it has metastasised to distant sites, such as the lungs, liver, or bones, the 5-year survival rate is only 5%.

The exact cause of bladder cancer remains unclear, but several factors can increase the risk:

  • Smoking:
    Smoking is the most significant carcinogenic factor. The American Cancer Society reports that about one-third of bladder cancer patients are smokers, and smokers have double the incidence rate of bladder cancer compared to non-smokers.
  • Long-term exposure to industrial chemicals:
    Including dyes, rubber, leather, paints, printing, petroleum, and other organic chemical products can increase the risk of soft tissue sarcoma. When these substances are metabolised in the body, some are excreted in urine, which can lead to prolonged contact with carcinogenic substances and subsequent cancerous changes in the bladder lining.
  • Chronic bladder irritation and the presence of foreign objects:
    Conditions such as bladder stones or long-term catheterisation can also increase the risk of bladder cancer. Parasites that cause schistosomiasis, particularly in areas where this chronic parasitic infection is prevalent, have been linked to many cases of bladder cancer.
  • Other factors:
    Include long-term use of pain medications containing phenacetin, dietary nitrites produced by intestinal bacteria, and pelvic radiation therapy, all of which may increase the risk of bladder cancer.

Symptoms of Bladder Cancer

Common Bladder Cancer Symptoms: Painless Hematuria and Changes in Urination Habits

The early symptoms of bladder cancer are similar to those of urethritis but may not be very pronounced, making it easy for patients to delay treatment. If any of the following symptoms occur, they should be taken seriously.

  • Haematuria:
    This is the most common symptom of bladder cancer. This bleeding often occurs suddenly and is usually painless. Initially, there may be blood one day and none the next, leading patients to believe they have improved or recovered wrongly. Sometimes, blood clots can form, causing discomfort in the bladder muscles. Patients may also experience burning sensations during urination.
  • Increased urinary frequency and difficulty urinating：
    This can occur if the tumour invades the neck of the bladder, leading to feelings of obstruction.
  • Other symptoms:
    This may include back pain in the kidney area, swelling in the calves, or lumps near the bladder in the pelvic region. Additionally, symptoms such as weight loss, bone pain, rectal pain, pelvic pain, and anaemia may indicate advanced bladder cancer.

Common Diagnostic Methods

Bladder Cancer Diagnosis Methods: Cystoscopy and Biopsy Process

  • Blood tests
    Conducted to assess the patient’s health, blood cell counts, and kidney and liver function.
  • Chest X-ray
    Performed to check the health of the lungs and heart.
  • Intravenous Urogram (IVU)
    Detecting abnormalities in the kidneys, bladder, and urinary system.
  • Cystoscopy
    This is the most critical examination. During this procedure, a thin tube is inserted through the patient’s urethra into the bladder. The end of the tube is equipped with a light and camera, allowing the doctor to examine the bladder and urethra’s inner walls closely.
  • Biopsy
    A cystoscope was performed to remove tissue samples for analysis to determine whether the tumour is benign or malignant.

Based on the patient’s condition, further investigations may be necessary, such as:

  • Computed Tomography (CT) Scan:
    This scan takes multiple X-ray images of the pelvic region to accurately show the tumour’s size and location.
  • Radioisotope Bone Scan:
    This is typically used to check whether cancer has spread beyond the bladder.
  • Liver Ultrasound Scan:
    This method uses sound waves to produce images of the abdomen and liver. Patients may need to drink lots of fluids before the test to fill the bladder for more precise imaging.

After these diagnostic methods, if the doctor confirms that the patient has bladder cancer, further tests may be conducted to determine the cancer stage accurately. Factors for determining whether the cancer is early or late stage include tumour size, whether there is metastasis, and whether it has spread to more distant tissues, which can be categorised as follows:

StageDescription
0isNon-invasive bladder cancer, also known as carcinoma in situ (CIS), indicates early cancer cells present only in the bladder lining.
0aNon-invasive bladder cancer is where cancer cells grow in a small area of the bladder lining without spreading to nearby lymph nodes or distant tissues.
ICancer cells have begun to grow into tissues near the bladder lining but have not yet reached the muscular layer or spread to nearby lymph nodes or distant tissues.
IICancer cells have begun to invade the muscle of the bladder wall but have not yet fully invaded the surrounding fat tissue or spread to nearby lymph nodes or distant tissues.
IIIACancer cells have grown into the fat surrounding the bladder and may have spread to the prostate
or vagina but have not spread to the pelvic wall, abdominal wall,
or nearby lymph nodes or distant tissues.
IIIBCancer cells have spread to nearby lymph nodes but have not reached distant organs, or the cancer has spread into nearby tissues or other organs but has not spread to distant lymph nodes.
IVCancer has spread to nearby lymph nodes and may or may not have spread to nearby organs or distant lymph nodes.

Main Treatment Methods

Bladder Cancer Treatment Methods: Endoscopic Resection and Bladder Instillation

Once diagnosed, doctors will choose the most appropriate treatment for patients with confirmed bladder cancer. Treatment methods depend on the type of bladder cancer, extent of spread, patient age, and overall health.

For early-stage bladder cancer with cancer cells in situ (CIS), the most common treatments are:

  • Intravesical Chemotherapy: Directly placing chemotherapy drugs such as mitomycin-C or epirubicin into the bladder through a soft catheter, minimising side effects compared to intravenous chemotherapy.
  • BCG Immunotherapy: This immunotherapy stimulates the immune system to destroy cancer cells.

For small mushroom-shaped tumours in early-stage bladder cancer, the following methods may be used:

  • Transurethral Resection:
    Most bladder tumours are papillary and can easily be removed using a cystoscope. After cutting the tumour at the base, the affected area is cauterised with minimal bleeding, allowing multiple tumours to be treated in one session.
  • Intravesical Chemotherapy:
    Early-stage bladder cancer patients can receive chemotherapy directly in the bladder using drugs like mitomycin-C or epirubicin.
  • BCG Therapy:
    Introducing a vaccine called BCG (previously used for tuberculosis prevention) into the bladder is also effective for treating early bladder cancer.

For patients with aggressive bladder cancer, the following treatments may be considered:

  • Cystectomy:
    Suppose the cancer has invaded the muscle layer of the bladder. In that case, doctors may consider removing part or all of the bladder, requiring an opening in the abdomen to allow urine to exit the body. Some patients may have a new bladder created from intestinal tissue. If the entire bladder is removed, men may also need to remove the prostate, part of the urethra, and nearby lymph nodes, while women may need to remove the uterus, cervix, nearby lymph nodes, and part of the urethra.
  • Radiation Therapy:
    This treatment uses high-energy radiation to kill cancer cells while minimising damage to normal cells. Radiation therapy for bladder cancer may involve:
    • External Beam Radiation: The duration and frequency of treatment depend on the cancer type and size, usually spanning four to seven weeks, with each session lasting ten to fifteen minutes.
    • Internal Radiation: This requires general anaesthesia to place radioactive material directly into the bladder, releasing high doses of radiation to target the tumour.
  • Chemotherapy:
    If cancer cells have spread, chemotherapy may deliver cancer-fighting drugs via oral administration or injection. After removing mushroom-shaped tumours from the bladder, chemotherapy can be administered directly into the bladder to reduce the risk of recurrence.

If the entire bladder is removed, an artificial storage place for urine is necessary, with several options available:

  1. Neobladder Creation:
    A section of the intestine creates a new bladder, allowing the patient to urinate generally through the urethra without needing a bag.
  2. Urostomy:
    The small intestine is cut, connecting the ureters to the abdominal wall, allowing urine to drain into a bag placed on the skin’s surface.
  3. Ileal Conduit:
    A segment of the intestine forms a pouch for urine storage, with a catheter allowing urine to exit the body.

Healthy Living

Post-Bladder Cancer Surgery Care

Due to the high risk of recurrence, patients should have regular follow-up appointments. Additionally, those with an artificial urinary opening must learn how to care for it, including how to clean and change the urine bag.

Prevention Methods

Preventing Bladder Cancer

While the exact causes of bladder cancer are unclear, addressing the aforementioned risk factors by quitting smoking, minimising exposure to carcinogenic chemicals, and avoiding habits like holding in urine can help reduce the likelihood of developing bladder cancer.

Frequently Asked Questions

Bladder Cancer FAQs

What is the difference between blood in the urine from bladder cancer and urethritis?

The most typical symptom of bladder cancer is haematuria, which can resemble that caused by urethritis. However, blood from urethritis usually accompanies a burning sensation during urination, while bleeding from a tumour may occur without any pain or obvious cause.

Is bladder cancer hereditary?

Hereditary bladder cancer is uncommon, but mutated genes may be passed from parents to their children, increasing the risk of bladder cancer. Additionally, some individuals may have genetic factors that impair their body’s ability to eliminate waste, making them more susceptible to environmental carcinogens.

What side effects can occur from bladder cancer treatment?

Patients undergoing chemotherapy or radiation therapy may experience various side effects.

Including:

  • Pain around the anus
  • Stimulation of intestinal peristalsis leading to diarrhoea
  • Inflammation of the bladder, causing frequent urination and a burning sensation
  • Vaginal narrowing leading to discomfort during intercourse
  • Erectile dysfunction in men
  • Fatigue
  • Skin irritation and hair loss in areas treated with radiation
  • Nausea and vomiting
  • Hearing loss
  • Numbness or tingling in hands and feet

Most side effects can be managed with medication. They will gradually resolve after treatment, but radiation therapy may cause permanent damage to the bowel and bladder, leading to increased peristalsis, chronic diarrhoea, or frequency. Blood vessels in the bowel and bladder may also become fragile post-radiation, leading to bleeding during urination. Additionally, pelvic radiation may affect sexual function or fertility.

Will using an artificial urinary opening affect daily life?

Many individuals may find adapting to an artificial urinary opening challenging and frustrating, but most patients can live their everyday lives with time and patience. Many return to work and engage in activities they enjoy, such as swimming.

Is there a risk of recurrence of bladder cancer?

Bladder cancer has a high recurrence rate, making regular follow-up appointments essential for monitoring the condition. If recurrence occurs, timely detection dramatically increases the chances of successful treatment, so patients should promptly report any new symptoms or changes in their condition to their doctor.


▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.

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