Bladder Cancer: An Overview of One of Canada’s Most Common Cancers

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Did you know that Bladder Cancer is the fifth most common cancer in Canada?1 If this comes as a surprise, this might have something to do with the fact that people can be hesitant to talk about “below the belt” cancers. 

But it’s important that we break this taboo. In 2020, approximately 12,200 individuals were diagnosed across the country, and an estimated 2,600 died from bladder cancer.2

Who gets bladder cancer?

While the exact cause of bladder cancer is not known, there are certain risk factors associated with its development.  

  • Smokers have a 3x higher risk of developing bladder cancer1
  • Men are 3x more likely than women to develop bladder cancer1
  • 90% of those who develop bladder cancer are over the age of 503
  • Environmental exposures can increase risk, such as certain chemicals used by some leather workers, hairdressers, mechanics and painters1

But while there are some known risks, the bottom line is that anyone can get bladder cancer.  

What are the signs and symptoms of bladder cancer?

The most telling bladder cancer symptom is hematuria, or blood in the urine.  Other symptoms can include frequent, urgent, or painful urination.  Individuals may also experience pelvic, groin, or back pain.   When bladder cancer is more advanced, constitutional symptoms such as weight loss or lack of energy can also be present.4

While it might seem obvious to call a doctor when there is blood in the urine, Dr. Srikala Sridhar, Medical Oncologist at the Princess Margaret Cancer Centre, says it’s not uncommon for people to delay in reaching out to health professionals.  “It’s scary to see blood in your urine. Some people don’t want to talk about it.  They tell themselves they’ll do something about it if it persists.  Women may attribute it to something gynecological or think it is something simple like a urinary infection, and so the appropriate referral to a urologist can be delayed.  We need to change that.  Early detection can make a difference in the disease outcome.  If you see red, don’t hesitate to call your doctor.”

Types of Bladder Cancer

There are several types of bladder cancer, but the most common form is urothelial carcinoma (UC), which accounts for about 90% of all bladder cancers.5

Bladder cancer is often divided into 3 groups based on how much it has grown into the bladder wall.6

Non-invasive bladder cancer is in the inner lining of the bladder (urothelium).6

Non-muscle-invasive bladder cancer has grown into the connective tissue layer (lamina propria) and is contained completely within the bladder.6

Muscle-invasive bladder cancer has grown into the muscles deep within the bladder wall (muscularis propria) and sometimes into the fat that surrounds the bladder.6

As well, metastatic bladder cancer occurs when the cancer has spread from the bladder to other parts of the body such as the lymph nodes, liver, lungs, and bone.6 In Canada, approximately 10-15% of patients are diagnosed at the metastatic stage.7

How is bladder cancer treated?

Treatment options for bladder cancer depend on a number of factors, including the type of cancer, grade of the cancer (to what extent the cells are irregular, as well as how aggressive, or fast-growing they are) stage of the cancer (size and whether it has spread), and a patient’s overall health and preferences.8

There is a range of bladder cancer treatments.  Treatments can include: 

  • Surgery, to remove the cancer cells (including in many cases removal of the bladder itself)
  • Chemotherapy in the bladder for non-invasive bladder cancer that has a high risk of recurrence or progression 
  • Chemotherapy for the whole body, to increase the chance of a cure for a person whose bladder has been removed, or as a primary treatment if surgery is not possible
  • Radiation therapy, to destroy cancer cells, often when surgery isn’t possible or desired
  • Immunotherapy, to trigger the body’s immune system to fight cancer cells, either in the bladder or throughout the body
  • Targeted therapy, to treat advanced cancer when other treatments haven’t worked.9

Often treatment entails a combination of these approaches in an attempt to cure cancer, keep it from returning (maintenance therapy) or slow its progression. 

Ferg Devins, Chair of Bladder Cancer Canada, and a bladder cancer survivor himself recommends taking an active role in your own care, “Have a pen and paper with you at all times so you can jot down your questions and take them with you to your appointments.  Don’t hesitate to ask for a second opinion.  Sometimes the additional perspective will reinforce what needs to happen, a new option will open up.  Keep the lines of communication open with your health professionals.  There are ways to make the path a little bit better.”

What are the latest innovations and advances in bladder cancer?

If you were to ask Dr. Sridhar, there is a lot to be hopeful about thanks to recent innovations and advancements in the world of bladder cancer, “No matter the stage or grade of bladder cancer, innovations and advances in research are continually improving management of care,” she says. She highlights a number of areas of progress, including improved bladder preservation strategies, advances in the area of immunotherapy such as maintenance therapies (which are taken after treatment, to try and stave off cancer’s return)10, greater holistic management in the field, and an explosion of clinical trials.

Devins would concur. “It’s an exciting time. There are world renown researchers right here at home in Canada.  We are at the leading edge of patient care and new therapy approaches.”

Finding support

Regardless of where you are in your bladder cancer journey, Devins emphasizes that there is a wealth of support out there.  

Bladder Cancer Canada is an amazing organization that was built by bladder cancer patients for bladder cancer patients.” As well as offering information and resources, the organization also provides a wide range of supports.  Devins knows how important this is from experience. “When you are waiting for or receiving a diagnosis of Cancer it can be very frightening and isolating.  Bladdercancercanada.org has discussion forums, peer support and online support.  It’s an active and engaged community.”

His message is truly one of hope.  “You can learn to adjust to the changes that come with bladder cancer and lead a similar lifestyle as before.  When it comes to metastatic cancer, treatments today can extend life, comfort, and time with loved ones.”

Adds Dr. Sridhar, “Bladder cancer is more treatable than ever before.  People are living longer, with a better quality of life.  There are new treatments and better clinical trials in even the past 5 years that are keeping options open for those with bladder cancer.”

Visit bladdercancer.org to learn more about the disease.

1 Bladder Cancer Canada. Bladder Cancer Facts. Available at: https://bladdercancercanada.org/en/bladder-cancer-facts/

2 Canadian Cancer Society. Bladder Cancer Statistics. Available at: https://cancer.ca/en/cancer-information/cancer-types/bladder/statistics 

3 Government of Canada. Bladder cancer in Canada. Available at: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/bladder-cancer-canada.html 

4 Bladder Cancer Canada. Symptoms. Available at: https://bladdercancercanada.org/en/symptoms/

5 Canadian Cancer Society. What is Bladder Cancer? Available at: https://www.cancer.ca/en/cancer-information/cancer-type/bladder/bladder-cancer/?region=on

6 Canadian Cancer Society. Cancerous Tumours of the Bladder. Available at: https://cancer.ca/en/cancer-information/cancer-types/bladder/what-is-bladder-cancer/cancerous-tumours

7 Bladder Cancer Canada, Metastatic Bladder Cancer. Available at: https://bladdercancercanada.org/en/bladder-cancer-definitions/ 

8 Bladder Cancer Canada. Staging and Grading. Available at: https://bladdercancercanada.org/en/staging-and-grading/

9 Canadian Cancer Society. Treatment Types. Available at:  https://cancer.ca/en/treatments/treatment-types 

10 National Cancer Institute. Maintenance Therapy. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/maintenance-therapy