Bladder Cancer

This section provides information about bladder cancer. Please follow the links below for information on how bladder cancer is treated within the Belfast Trust:

Types of Bladder Cancer   

There are three common types of bladder cancer:

  • Transitional Cell Bladder Cancer (TCC) is the most common type of bladder cancer. Nearly all cancers of the bladder start in the layer of cells (transitional cells) which form the lining of the bladder (transitional epithelium). These cancers are called transitional cell or urothelial cell cancers.
  • Invasive Bladder Cancer may appear as a tumour which has grown into the muscle wall of the bladder. This is known as invasive bladder cancer. Bladder cancer may also begin as a small growth only on the inner lining of the bladder (called papillary cancers). Sometimes these early cancers can start to grow into the muscle of the bladder and become invasive bladder cancer.
  • Carcinoma In Situ (CIS) is a type of early bladder cancer which appears as a red, ulcerated area in the bladder. In CIS the cells are very abnormal or high-grade, so it can grow quickly. If it’s not treated effectively, there’s a high risk that CIS will become an invasive cancer.
  • Rarer types of bladder cancer are squamous cell cancer and adenocarcinoma. Squamous cell cancers start from one of the types of cell in the bladder lining. Adenocarcinoma starts from glandular cells which produce mucus. Both of these types are usually invasive.

 

Investigations and diagnosis

As part of the pathway for diagnosis and management of Bladder Cancer, patients may be sent for a number of investigations at Belfast City Hospital or Mater Hospital. Please follow the links below for information on investigations for bladder cancer:

    • Cystoscopy
    • Ultrasound

Patients who are diagnosed with bladder cancer will discuss the results of their investigations with their consultant and will be discussed by the urological cancer multi-disciplinary team.

Treatment

Pre-assessment Clinic

Patients who are coming to Belfast City Hospital for surgery may be asked to attend an appointment with a member of the anaesthetic team for a pre-assessment prior to surgery to ensure they are fit and safe to undergo the treatment.

Patients will be informed of approximate date of surgery or waiting time by their surgeon and will be kept up to date by the Urology Scheduling office staff.

Surgery

Patients who have surgery to treat their bladder cancer will be admitted to level 3, Belfast City Hospital tower. For many patients with urology cancer, this may be the most appropriate treatment. The approximate length of a hospital stay will be 10 – 12 days. Surgically removing the cancer is a major operation and it can take a number of weeks to recover.

Types of Surgery:

  • Transurethral resection of bladder tumour (TURBT): This type of surgery involves the removal of any unusual growths or tumours on the bladder wall. Patients will have this surgery under general anaesthetic. Any abnormal areas within the bladder are carefully assessed by the surgeon and all visible tumour is then resected with a hot loop (diathermy). Tumour samples are sent to the histopathology laboratory. Patients will be reviewed at a results clinic within 3 – 4 weeks. 
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  • Partial Cystectomy: This procedure involves the surgical removal of part of the bladder in which a small tumour is located.
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  • Radical Cystectomy: This procedure involves the surgical removal of all of the bladder to prevent the spread of the cancer. It is the main treatment for muscle invasive bladder cancer and is occasionally followed by radiotherapy. Patients who have this procedure will have a new area created by the surgeon for storing urine following this procedure. This may be done by:

- Urostomy: The urethers are connected to a stoma which is connected to a urostomy bag that sits outside the body.

- Bladder Reconstruction

- Continent Urinary Diversion: A section of the bowel is used to make a pouch in the abdomen to store urine. This is a closed system to create a ‘new’ bladder.

Symptom control

Post operatively, patients will be encouraged to self manage as soon as they are able with guidance of the stoma nurse and ward nursing staff with the aim of independent management as soon as possible. At first the stoma will be slightly swollen and it can take several weeks before it settles down to its normal size. The nursing staff will help the patient look after the urostomy if one has been formed and will encourage emptying and changing of the bag as often as is necessary. When changing the bag, patients should allow themselves plenty of time and privacy so that they can do things at their own pace and without interruptions.

The size and position of the stoma will be the most important factor in how noticeable the bag or appliance is through clothing. The stoma position is not a choice. The stoma nurse will mark the site pre-operatively with the aim of optimum positioning but this may need to be relocated during surgery.

Before patients leave hospital, the nurse will make sure they have a good supply of urostomy bags. When at home, patients can get all their supplies from their chemist. As some chemists don’t have a very large stock, it’s often a good idea to give them an order well in advance or the stoma nurse can organise delivery to the patient’s home.

Once at home, patients will still be able to phone their stoma care nurse for advice and may have contact with a community stoma nurse. The staff at Belfast City Hospital can arrange for a district nurse to visit a patient when they first leave hospital and are recovering. The nurse can help to sort out any problems patients have with a urostomy.

Chemotherapy

Patients who are to receive chemotherapy to treat their bladder cancer, will discuss the specifics of this treatment with their consultant oncologist. For general information on how chemotherapy is administered in the Belfast Trust, please follow this link.

Radiotherapy

Patients who are to receive radiotherapy to treat their bladder cancer, will discuss the specifics of this treatment with their consultant oncologist. For general information on how radiotherapy is administered in the Belfast Trust, please follow this link.

Follow Up

As part of a patient review following cancer treatment, patients will be asked to return to the hospital to see one of the uro-oncology team. The frequency of these review appointments will differ for each patient. The review appointments allow the team to assess patient progress following treatment. The check-ups are also a good opportunity for patients to discuss any problems or worries they may have.

Follow up appointments will take place in one of two hospitals of the Belfast Health and Social Care Trust; Belfast City Hospital or the Mater Hospital.

If patients notice any new symptoms or have any worries they should contact the urology clinical nurse specialist, consultant or their local GP to discuss the symptoms as they may need additional treatment or rehabilitation services such as a dietician or physiotherapy services.

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