Bladder Cancer Treatment & Surgery in Singapore

This represents about 90% of all bladder cancers in Singapore. It begins in the urothelial cells lining the bladder’s interior. These cancers can be categorised as either non-muscle invasive (superficial) or muscle-invasive, depending on how deeply they penetrate the bladder wall. The distinction significantly impacts treatment approaches and prognosis.

Accounting for approximately 4% of bladder cancers, this type develops from thin, flat cells that may form in the bladder after prolonged irritation or infection. In Singapore’s context, this is less common due to good sanitary conditions and low rates of schistosomiasis, a parasitic infection linked to this cancer type.

This rare form, making up about 1-2% of bladder cancers, originates from glandular cells. It can be primary (starting in the bladder) or secondary (spreading from nearby organs like the colon or prostate). These cancers tend to be aggressive and require specialised treatment approaches.

Extremely rare but highly aggressive, this type accounts for less than 1% of bladder cancers. It grows rapidly and often requires immediate, intensive treatment combining chemotherapy with other modalities.

• Blood in the urine (haematuria). May appear pink, red, or cola-coloured
• Increased frequency of urination, especially at night
• Urgent need to urinate, even with minimal bladder filling
• Burning sensation or pain during urination
• Feeling of incomplete bladder emptying

• Pelvic or lower back pain
• Unexplained weight loss without dietary changes
• Persistent fatigue and weakness
• Swelling in feet or legs (oedema)
• Bone pain, if cancer has spread
• Loss of appetite

• Complete inability to urinate (urinary retention)
• Severe abdominal pain and distension
• Visible blood clots in urine
• Signs of kidney failure – nausea, confusion, decreased urine output
• Severe anaemia due to chronic blood loss

This minimally invasive procedure removes visible bladder tumours through the urethra without external incisions. For non-muscle invasive cancers, TURBT may be curative. The procedure usually takes 30-60 minutes under general anaesthesia. Patients usually stay overnight for monitoring. Recovery involves 1-2 weeks of restricted activities while the bladder heals.

Following TURBT, medications can be instilled directly into the bladder to reduce the risk of recurrence.

BCG (Bacillus Calmette–Guérin): An immunotherapy that stimulates the immune system to attack residual cancer cells. Treatment typically involves weekly instillations for six weeks, followed by maintenance therapy.

Intravesical Chemotherapy: Agents such as mitomycin C may be used as an alternative for patients with less aggressive cancers, or who cannot tolerate BCG. These treatments are typically delivered in an outpatient setting.

For patients with non-muscle invasive bladder cancer, ongoing monitoring is essential to detect early recurrence or new tumour growth. Cystoscopy uses a thin camera inserted into the bladder to examine the lining. Surveillance schedules vary depending on cancer risk but often occur every three to six months initially.

For muscle-invasive or metastatic bladder cancer, chemotherapy drugs are given intravenously and circulate throughout the body to destroy cancer cells.

• Neoadjuvant chemotherapy (before surgery) helps shrink tumours and improve surgical outcomes.
• Adjuvant chemotherapy (after surgery) may reduce recurrence risk.

Common regimens include gemcitabine-cisplatin or MVAC (methotrexate, vinblastine, doxorubicin, cisplatin). Treatment typically involves three to four cycles over nine to twelve weeks.

This major surgery removes the entire bladder and nearby lymph nodes.

• In men, the prostate and seminal vesicles are also removed.
• In women, the uterus, ovaries, and part of the vaginal wall may be removed.

The procedure takes six to eight hours and typically requires one to two weeks of hospitalisation. Urinary diversion is necessary and may include an ileal conduit (stoma on the abdomen) or a neobladder (new bladder constructed from intestinal tissue).

High-energy radiation destroys cancer cells while preserving the bladder. Often combined with chemotherapy (chemoradiation), this approach offers an alternative to surgery for muscle-invasive cancer. Treatment involves daily sessions over 6-7 weeks. Modern techniques like intensity-modulated radiation therapy (IMRT) minimise damage to surrounding tissues.

In selected patients, a combination of TURBT, chemotherapy, and radiation may be used to preserve the bladder. This trimodal approach offers an alternative to radical cystectomy while maintaining curative intent. Careful selection and close monitoring are essential to ensure treatment effectiveness.