Ask an expert about bladder cancer (UCLH web chat) 

As part of the NHS Be Clear on Cancer ‘blood in pee’ campaign, and tocelebrate the launch of our new urological cancers web pages, we hosted a web chat on bladder cancer with consultant urological surgeon Mr Tim Briggs.

Bladder cancer is the fourth most common cancer in men and eighth most common in women in the UK. Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the surrounding areas.

Our expert Mr Tim Briggs joined the pelvic cancer team at UCLH in 2012 where he routinely performs robotic cystoprostatectomies (removal of prostate and bladder) for the treatment of bladder cancer. Mr Briggs specialises in treating patients with bladder cancer using the latest robotic surgery techniques.

The conversation focussed on diagnosing, treating and living with bladder cancer.

Below is a transcript of the web chat.


10:05 UCLH: 
Good morning and welcome to our web chat. We will begin at 11am but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 11am.

Mr Tim Briggs will be joining us to take your questions on Bladder Cancer and will try to answer as many questions as possible within the hour long web chat. Your questions will only appear in the timeline when they are in the process of being answered, so please be patient.
 
10:55 Mr Tim Briggs: 
Welcome to our web chat on the subject of Bladder Cancer. My name is Tim Briggs - consultant urological surgeon and I am ready and waiting to take your questions
 
10:55 [Comment From Diane: ] 
Will my entire bladder be removed if I have to have surgery for bladder cancer?
 
11:03 Mr Tim Briggs: 
This depends. Firstly bladder removal is only for muscle invasive disease when the cancer has grown into the muscle of the bladder wall and for some patients with very high risk non muscle invasive cancer.
Patients can have Radiotherapy for bladder cancer as an alternative, but some cases are better treated with surgery. Some patients have a type of cancer called an Adenocarcinoma which arises at the dome (top) of bladder. These can be treated by a partial cystectomy( partial removal of bladder). Some patients have a cancer arising in an out-pouching from the bladder called a diverticulum and if there is no cancer in the rest of the bladder then a partial cystectomy is also possible. As you can see it all depends on many factors. These can be discussed with your urologist or oncologist.
 
11:04 [Comment From Veronica: ] 
Can a person live without a bladder? Will it be difficult?
 
11:13 Mr Tim Briggs: 
Yes as the bladder has two functions - firstly to store the urine and secondly to expel it. When we remove bladder we have to be able to deal with the urine coming down 2 small tubes from the kidney. These are called the ureters. We can perform a procedure called an Ileal conduit in which we isolate a short length of small bowel from the rest of the bowel and plug the ureters into one end and bring the other end of the bowel up to the patients skin. The patient then has a bag into which the urine drains. This is the simplest operation and the one most usually taken up by patients. The other option is to take a larger segment of small bowel and make a new bladder called a Neo Bladder). This is preferred by younger patients but it does take some time for it to function like a bladder. Special nurses help the patients when they have either of these two procedures so there is alot of advise and help for patients.
 
11:13 [Comment From wendy: ] 
What is the referal process if someone (male) visits their GP with blood in their urine-is it one of these one stop haematuria clinics?-what is done at these?
 
11:22 Mr Tim Briggs: 
This depends on a few things. Some patients cant see blood in their urine, its picked up by a dipstick test or on a urine sample sent to the labs and this is called microscopic (non visible) haematuria. If a patient sees blood then this is called macroscopic or frank haematuria.
Both types of patients are usually referred up to the haematuria clinics and under go slightly different tests. These include imageing of the kidneys and ureters by ultra sound or CT and some more urine tests and an inspection of the inside of the bladder which is called a cystoscopy. This is usually performed under local anaesthetic using a flexible fibre optic scope. Men should also have a PSA. In younger patients (
 
11:23 [Comment From Shaun: ] 
Are any new treatments or trial for bladder cancer?
 
11:25 Mr Tim Briggs: 
There are always a lot of trials ongoing but they all have strict entry criteria, the best thing to do is ask your urologist or oncologist.
 
11:25 [Comment From Vince: ] 
Are men/women/young/old more at risk of bladder cancer, or is there a group that is more at risk?
 
11:28 Mr Tim Briggs: 
Men are more at risk probably because of smoking history. This is the biggest risk factor. Although some young people get the disease over 50% of bladder cancer presents in over 75 year olds.
 
11:28 [Comment From Lisa: ] 
If I have blood in my urine, does this mean I have bladder cancer?
 
11:32 Mr Tim Briggs: 
No- the risk of your Urologist finding something wrong ( not just cancer) with Microscopic (non visible haematuria) is about 8-15% and with Frank or visible haematuria is around 30-50%. The safest thing to do is get checked out and then you will know. If you are a smoker -stop smoking as your risk will reduce.
 
11:32 [Comment From Sandra: ] 
What are the symptoms of bladder cancer? What should I be looking out for in terms of first signs?
 
11:42 Mr Tim Briggs: 
The most common is haematuria which is blood in the urine. The biggest risk factor for bladder cancer is smoking which the general population do not seem to be aware of this fact. You dont find many Urologists smoking.
Sometimes Urgency can be a symptom but more often than not it is part lower urinary tract symptoms which affect all of us as we age.
If men or women start getting alot of urinary tract infections then investigating them is necessary.
 
11:45 [Comment From Toni: ] 
Do I have to have blood in my pee everyday as a symptom of cancer - mine happens on and off - should I be worried?
 
11:51 Mr Tim Briggs: 
No , the bleeding can be intermittent so I would get it looked at. I have had a few patients who only had the bleeding once and then nothing for months. If there is a bladder cancer it can be growing in that time. When I was a Medical student at Barts the Consultant urologist said there we 3 rules in Urology
1. Always investigate blood in urine
2. Respect the male urethra (more likely to get strictures than females)
3. Always investigate blood in urine

Nothing has changed- the advise was good then and is good now
 
11:52 [Comment From WH: ] 
Are are there other causes for frank blood in the urine, other than infection?
 
11:54 Mr Tim Briggs: 
Yes there are many and quite often we dont find an obvious cause. When we do the investigations for blood in the urine what we want to tell the patient is that there is nothing seriously wrong- if there is we can get on and treat it.
 
11:54 [Comment From Louisa: ] 
My urine smells hideous - checked out at GP but no infection...anything ominous?
 
11:56 Mr Tim Briggs: 
Probably not- usually due to things in diet, asparagus makes the urine smell odd and some people just dont drink enough water. If your urine looks yellow you are probably not drinking enough.
 
12:06 Mr Tim Briggs: 
Further useful information can be found online at:

UCLH bladder cancer:
https://www.uclh.nhs.uk/Our...

NHS Choices:
http://www.nhs.uk/condition...

Macmillan:
http://www.macmillan.org.uk...

Cancer Research:
http://www.cancerresearchuk...
 
12:07 Mr Tim Briggs: 
Thank you for joining us today in our live web chat. We hope you found the chat useful and some of your questions have been answered.

 Useful links