Bladder Cancer

What is bladder cancer?

Bladder cancer begins when abnormal cells in the bladder lining grow uncontrollably. The bladder, a hollow organ in the lower abdomen, stores urine before it is expelled from the body. Bladder cancer can affect the bladder’s normal function and, if left untreated, can spread to surrounding tissues or distant organs.

There are several types of bladder cancer, with the most common being urothelial carcinoma (also known as transitional cell carcinoma). This type makes up around 90% of all bladder cancer cases. It starts in the urothelial cells, which line the inside of the bladder.

Urothelial carcinoma can be classified into two categories:

Non-Muscle-Invasive Bladder Cancer (NMIBC) — cancer remains within the bladder’s inner layers and has not invaded the bladder muscle. NMIBC accounts for most bladder cancer diagnoses and has a better prognosis when caught early.
Muscle-Invasive Bladder Cancer (MIBC) — in this more aggressive form, cancer has spread into the bladder’s muscle layers and potentially beyond. It requires more intensive treatment, such as surgery and chemotherapy.

Other, less common types of bladder cancer include:

Squamous Cell Carcinoma — often associated with chronic bladder irritation and infection, this type makes up about 1–2% of cases.
Adenocarcinoma — a rare form, accounting for around 1%, that arises from glandular cells.
Small Cell Carcinoma — this rare and fast-growing type accounts for less than 1% of bladder cancers.

What causes bladder cancer?

Bladder cancer occurs when the cells within the bladder undergo abnormal changes at the genetic level, leading to uncontrolled growth. Under normal conditions, cells grow, divide, and die in a regulated manner. However, in bladder cancer, genetic mutations disrupt this process, causing cells to multiply rapidly and form a tumour. The majority of bladder cancers begin in the urothelial cells, which line the inner surface of the bladder. These cells are constantly exposed to waste products filtered by the kidneys, including toxins and chemicals from the body. Long-term exposure to carcinogens in urine can damage the DNA of urothelial cells, leading to mutations. Over time, these mutated cells may lose their ability to function normally, triggering continuous growth and eventually forming cancerous tumours.

The process typically follows these steps:

DNA mutations

Changes in the genetic code of urothelial cells lead to uncontrolled cellular growth and a failure to undergo normal cell death (apoptosis). These mutations can involve oncogenes, which promote cancer cell growth, or tumour suppressor genes, which normally inhibit such growth.

Abnormal cell division

The mutated cells begin to divide uncontrollably. In normal tissues, cell division is carefully regulated, but in bladder cancer, the control mechanisms fail, resulting in the formation of a tumour.

Tumour formation

As the abnormal cells accumulate, they form a mass, which can invade nearby tissues. In its early stages, bladder cancer typically remains confined to the inner lining of the bladder. However, as it progresses, it can invade the deeper muscle layers and potentially spread to other parts of the body (metastasis).

The biological mechanisms behind bladder cancer progression can vary depending on the cancer’s type and grade, but the primary issue remains the accumulation of mutations that lead to the loss of cellular control mechanisms, causing unchecked growth and tumour formation.

What are the symptoms of bladder cancer?

Blood in the urine (hematuria), often painless and intermittent
Frequent need to urinate
Pain or burning sensation during urination
Feeling the urge to urinate but being unable to do so
Lower back pain, usually on one side
Unexplained weight loss or loss of appetite (in advanced stages)
Fatigue or weakness (in advanced stages)

If you experience any of these symptoms, it’s important to consult a urologist for further evaluation.

Who is at risk of bladder cancer in Singapore?

Bladder cancer can affect anyone, but certain factors can increase the likelihood of developing the disease. In Singapore, some common risk factors are linked to lifestyle choices and environmental exposures.

Smoking

The leading cause of bladder cancer, smokers are up to three to four times more likely to develop the disease.

Chemical exposure

Workers in industries such as dye, rubber, leather, and paint may face higher risks due to exposure to carcinogenic chemicals.

Age

Most bladder cancer cases occur in individuals over the age of 55.

Gender

Men are more likely to develop bladder cancer than women.

Previous cancer treatments

Chemotherapy or radiation treatments for other cancers can increase the risk.

Chronic bladder inflammation

Conditions like recurrent urinary infections or prolonged catheter use may elevate risk levels.

Family history

A family history of bladder cancer may increase your likelihood of developing it.

How is bladder cancer diagnosed?

At Allen Sim Urology, we understand that an early and accurate diagnosis is crucial for effectively treating bladder cancer. We are committed to providing comprehensive care, and uses advanced diagnostic techniques to ensure you receive the best possible treatment plan.

Common methods for diagnosing bladder cancer include:

What are the treatment options for bladder cancer in Singapore?

At Allen Sim Urology, we focus on the type, stage, and grade of the cancer, as well as your overall health and preferences while developing a treatment plan tailored to your needs. Common treatments include:

Transurethral Resection of Bladder Tumour (TURBT)

For early-stage bladder cancer, TURBT can be performed to remove tumours from the bladder lining. This minimally invasive procedure uses a cystoscope to access the bladder without making any incisions.

Intravesical therapy

To prevent the recurrence of cancer after TURBT, we may recommend intravesical therapy. This involves delivering chemotherapy or immunotherapy drugs directly into the bladder to target cancer cells.

Radical or Partial Cystectomy

For more advanced cancers, surgery to remove part or all of the bladder may be necessary. We specialise in both partial cystectomy, which removes only the tumour-affected portion, and radical cystectomy, which involves the complete removal of the bladder and surrounding lymph nodes.

Chemotherapy

Chemotherapy can be administered before or after surgery to shrink the tumour or reduce the risk of recurrence.

Radiation therapy

Radiation is another effective option, especially for patients who may not be suited for surgery. We provide advanced radiation therapy to target and kill cancer cells while preserving surrounding healthy tissue.

Immunotherapy

For certain types of bladder cancer, we suggest immunotherapy to boost your body’s natural defences to fight cancer. BCG therapy is one of the most effective immunotherapies for bladder cancer that remains confined to the bladder lining.

Listen to your body. If you’re experiencing any symptoms or have concerns about bladder cancer, consult a Urologist. Schedule a consultation with us for a comprehensive diagnosis and personalised treatment plan.

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