Health encyclopaedia

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Cancer of the bladder

The  bladder is a muscular bag situated in the midline of the pelvis at the lowest point in the abdomen, immediately behind the pubic bone. There are three principal layers in the bladder wall. The inside mucous membrane (mucosa), the muscle layer of circular and longitudinal fibres, and the outer layer, the peritoneum.

Primary bladder cancer constitutes about seven per cent of cancers in men and about three per cent of new cancers in women.  It is three times as common in men as in women.It is more common in white people than in black people and the average age at diagnosis is 65. At the time of diagnosis about 85 per cent of bladder cancers are still limited to the bladder only. The remainder have spread to the lymph nodes (glands).

Bladder cancer always starts in the mucosa. In the earliest stages it is confined to this layer and is called carcinoma in situ. For a time the cancer grows only towards the interior of the bladder. At this stage, if detected, it can be cured by simple local treatment without opening the bladder.

The next stage is for the cancer to spread outwards, deeper into the muscular layer of the bladder. At the same time the cancer will become larger on the interior surface and will spread sideways.

The advancing cancer will next grow right through the wall of the bladder to invade the peritoneum or the other tissues on the outside of the bladder. While the cancer is confined to the mucosa, spread to distant lymph nodes or further is unlikely. But by the time the muscle of the bladder wall is invaded, about 13 per cent of cancers will also have spread to lymph nodes.Once the cancer has penetrated the wall and is in the surrounding tissue, in almost 90 per cent of cases it has also spread to the lymph nodes.

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