Bladder cancer is characterised by the development of abnormal cells in the lining of the bladder. There are three main types of bladder cancer:

• Urothelial carcinoma, also known as transitional cell carcinoma (TCC), which develops in the cells of the bladder lining. It is by far the most common type of bladder cancer, accounting for about 90% of all cases.

• Squamous cell carcinoma, which begins in squamous cells of the bladder lining, and accounts for 4% of all bladder cancers.

• Adenocarcinoma, which begins in glandular cells in the lining of the bladder, and accounts for 2% of all bladder cancers.

The most common symptoms of bladder cancer include blood in the urine; abdominal pain; lower back pain; and bladder irritation.3,4

Around half of all bladder cancers are diagnosed at the early, non-muscle invasive stage (stage 0-I),5 meaning that cancer cells are found only within the inner layer of the bladder wall.6 As with many cancers, an early diagnosis is likely to improve the chances of survival.7

Approximately one third of cases are diagnosed when the cancer has spread deeper within the bladder,5 which is known as muscle-invasive bladder cancer (stages II and III).6 In the remaining cases, the cancer has spread to surrounding muscles and organs5 – and is known as metastatic bladder cancer (stage IV).6

Although around three-quarters of bladder cancer cases occur in men,1 women are more often diagnosed in the late stages, which is thought to contribute to a lower survival rate compared with men.7 Delayed diagnosis in women may be due to common symptoms of bladder cancer being previously misdiagnosed as urinary tract infections.8,9

When diagnosed with stage IV bladder cancer, the 5-year survival rate is 15% in women, compared with 27% in men. In fact, women have a lower 5-year survival rate, compared with men, across all stages at diagnosis.7 This demonstrates the need for greater awareness of the early symptoms of bladder cancer, particularly among women.

Continued research into tumour biology, and the introduction of cancer immunotherapies, has brought new hope and a new option for certain people with bladder cancer, after 30 years without advances. The hope is that the combination of earlier diagnosis and recent treatment advances will help improve survival rates for people with bladder cancer.

Dave and his wife Maureen talk about their experiences of bladder cancer; from spotting the signs and symptoms, to being diagnosed.

References

1. Bray et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin. 2018;68:394-424.
   *Calculation based on Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for bladder cancer, percentage of global incidence attributed to diagnosis in men

2. Cancer.Net. [Internet; cited 2019 April 5]. Available from: https://www.cancer.net/cancer-types/bladder-cancer/introduction/.

3. NHS. [Internet; cited 2019 April 5]. Available from: https://www.nhs.uk/conditions/bladder-cancer/symptoms/ .

4. Fight bladder cancer. [Internet; cited 2019 April 5]. Available from: http://fightbladdercancer.co.uk/learn/symptoms .

5. National Cancer Institute. [Internet; cited 2019 April 5]. Available from: http://seer.cancer.gov/statfacts/html/urinb.html

6. Cancer.Net. [Internet; cited 2019 April 5]. Available from: https://www.cancer.net/cancer-types/bladder-cancer/stages-and-grades

7. Dobruch J et al. Gender and Bladder Cancer: A Collaborative Review of Etiology, Biology, and Outcomes. Eur Urol. 2016;69:300-310.

8. Richards K.A et al. Urinary tract infection-like symptom is associated with worse bladder cancer outcomes in the Medicare population: Implications for sex disparities. Int J Urol. 2016;23:42-47.

9. Nicholson, B. D et al. Bladder cancer in women. BMJ. 2014;348:g2171-g2171.