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Bladder Cancer

Bladder Cancer - What it is


The bladder is a hollow, muscular organ that lies in the area surrounded by the hipbones, an area called the pelvis. The bladder acts as a reservoir to collect urine from the kidneys. The muscles of the bladder assist in the passing of urine from the lower urinary passage (urethra). The cells lining the bladder can develop abnormally and result in bladder cancer.

In Singapore, bladder cancer is the ninth most common cancer in men. This cancer usually occurs after the age of 40 years and is seen mostly in people between 50 to 70 years of age. It is about 5 times more common in men than in women.

Bladder Cancer - Symptoms

The most common symptom is passing out bloodstained urine. This is usually not painful. Blood in the urine associated with pain is usually due to infection or stone disease.

Bleeding in bladder cancer is usually more severe and linked with the passing out of blood clots. Occasionally, the cancer can cause blockage in the bladder and give rise to difficulty in passing urine.

If there is blood in the urine, especially if a person is above 40 years old, it is important to not rule out bladder cancer.

Bladder Cancer - How to prevent?

If your occupation requires exposure to chemicals that are known to cause bladder cancer (such as aniline dye), protective clothing may be beneficial. Smoking doubles the risk of developing bladder cancer. Therefore, the risk is reduced if you do not smoke.

Bladder Cancer - Causes and Risk Factors

This cancer has been associated with smoking, the exposure to certain chemicals related to the aniline dye industry, and chronic infections with schistosomiasis (a parasite) which is common in the Middle East and Africa.

Bladder Cancer - Diagnosis

​If bladder cancer is suspected, the doctor will arrange for a cystoscopy, an examination where a flexible fibre-optic tube with a light source is used to look at the urethra and the bladder. This can be done under local or general anaesthetic. Removal of a small amount of tissue from the lining of the bladder can also be done.

Scans of the pelvis and abdomen may be arranged to look at the other areas that may be affected by the cancer. A bone scan may be ordered if the bones are suspected to be affected by the cancer.

Bladder Cancer - Treatments

Surgery is recommended for most early bladder cancers. The procedure of removing bladder cancer in the early stage using a resectoscope is known as transurethral resection of bladder tumour (TURBT). This is done under general anaesthesia. After surgery, the patient may pass bloodstained urine for a while and a temporary urinary catheter (flexible tube passed through the urethra and into the bladder) connected to a drainage bag may be fitted.

When the cancer is fairly advanced, the total removal of the bladder is required. If possible, a new bladder is then made from a person's own intestines if possible. If not, urine is drained into a segment of small intestine that comes out the side of the abdomen i.e. ileostomy.

Radiation therapy may be an alternative to surgery for localised disease. This may also be used if the patient has other illnesses that prevent surgery. Alternatively, it may be used after surgery to try to reduce the chance of cancer recurring. Radiation involves concentrating high-energy rays into an area where the cancer was. Side effects, which are temporary, include redness of the skin, pain on passing urine, passing small amounts of urine frequently, and temporary loss of hair at the radiation site.

Chemotherapy is the use of drugs that kill cancers. Some chemotherapy drugs can be injected directly into the bladder for patients with early bladder cancer to prevent recurrence of cancer. Chemotherapeutic drugs can also be injected into the veins to kill bladder cancer cells that have spread throughout the body and to slow down the growth of the cancer. Side effects of chemotherapy injected into the hand veins include temporary nausea and vomiting, mouth ulcers, hair loss, loss of appetite and tiredness.

Immunotherapy can be used to boost the body's immune system. The anti-tuberculosis vaccine, BCG, injected into the bladder, has been effective in treating high risk superficial bladder cancers.

Treatment depends on many factors, including the stage of the cancer, the type of bladder cancer, and the patient's age and general health.

Prognosis of Bladder Cancer

Clinical examinations, x-rays and pathology reports all help the medical team decide the stage of cancer and what the next course of action should be. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with bladder cancer can be good.

Bladder Cancer - Preparing for surgery

Bladder Cancer - Post-surgery care

Bladder Cancer - Other Information

Is there any reliable test that can pick up bladder cancer early?

It is important for a person to seek medical attention early if there is blood in the urine or unexplained or longstanding bladder infection. The confirmatory test for bladder cancer is cystoscopy and biopsy of abnormal areas. People who have high exposure to chemicals that cause bladder cancer may be routinely tested.


For further enquiries on bladder cancer, please call the Cancer Helpline at (65) 6225 5655 or email to cancerhelpline@nccs.com.sg.

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