Things you may not know about bladder cancer

28 May 2021

Every year in May it’s Bladder Cancer Awareness Month, a global campaign to focus attention on bladder cancer.

York Against Cancer funds research into bladder cancer at the Jack Birch Unit in the University of York, and in May 2021 we teamed up with scientists there to raise awareness of the condition through our social media channels.

We’ve now decided to post some of the information on our website to provide a lasting insight into the condition as well as into our research project. Here are some of the facts:

1. Did you know that bladder cancer represents about 1 in 20 (5%) of all new cancer diagnoses yet it receives less than 2% of cancer research funding? In the UK, there were on average 10,233 cases of bladder cancer diagnosed each year (data from 2015 to 2017).
2. It’s fair to wonder why we even have a bladder. Scientists think it evolved to prevent animals leaving a trail of pungent urine that predators could follow.
3. The bladder collects and stores urine produced by the kidneys before emptying. Urine contains toxic waste products being removed from the body, including chemicals absorbed from the environment. The bladder is able to store urine as a result of its unique urine-proof lining called the urothelium. Almost all cases of bladder cancer develop from urothelial cells.
4. The Jack Birch Unit at the University of York is specialised in the study of human urothelial cells. Unlike most cancer research units which concentrate only on tumour biology, the JBU studies normal cells to understand the process of cancer development and how we might prevent and treat it.
5. Ros Duke (below) is a senior technician in the JBU and she looks after the cell culture laboratory. The lab receives surgical samples of urothelium from local hospitals and Ros processes them to isolate normal human urothelial cells, which scientists can maintain and study in controlled laboratory conditions.
6. Scientists at the Jack Birch Unit took this photo (below) down the microscope, showing normal human urothelial cells growing in a dish.
7. Jeff Coulson (below), from York, is living proof that bladder cancer can be successfully treated. He was diagnosed after finding blood in his urine, going on to have his bladder removed and replaced with a new organ created from a section of his intestine. More than three years later, Jeff’s still going strong and walking long distances every week.  A CT scan in March 2021 was clear and he and his wife Pat enjoyed a walking and birdwatching holiday in Northumberland the following month. 
8. An interesting observation about urothelium (the waterproof lining of the bladder) is that it forms a stable urine-proof barrier in which individual cells are quiescent (quiet) and rarely divide. However, if the barrier is damaged, then the tissue becomes regenerative, with individual cells starting to move and divide. Our JBU scientists can study this process in the laboratory using timelapse microscopy and they think it demonstrates key pathways that are hijacked by cancer cells.
9. What causes bladder cancer? The main risk factor is cigarette smoking. However, the molecular signature (pattern of mutations) of bladder cancer is unusual and suggests that scientists do not yet fully understand what causes bladder cancer to develop. This is an active area of interest in the Jack Birch Unit.
10. Dr Simon Baker (below) is a senior scientist in the Jack Birch Unit and funded by York Against Cancer. Simon is interested in what causes bladder cancer and has developed a unique experimental system using human urothelial cells to study the causes and pathways of bladder cancer.   
11. Some bladder cancers have been linked to industrial or occupational exposure and indeed, the first legally proven case in the world of a cancer caused by industrial exposure to a chemical was in Yorkshire. Risks are very much reduced now that such dangers are better recognised and controlled.
12. Bladder cancer is a global problem. It is hoped that Bladder Cancer Awareness Month will help attract more investment into research that could identify causes, treatments and cures.
13. Bladder cancer is complicated and is not just one disease. Many bladder tumours are first detected because of blood in the urine and may be removed surgically, but may often recur and unpredictably progress to a more advanced or malignant state, requiring frequent follow up (known as “check cystoscopy”). Other bladder tumours are very aggressive and are only detected after they have already spread into the muscle wall of the bladder.
14. Sadly, once bladder tumours have spread to the muscle wall of the bladder, patient five-year survival is lowered, and this has not improved for the past 30 years. As bladder cancer is a collection of different diseases, we need new ways to detect, categorise and treat the different bladder cancer types.
15. Dr Andrew Mason (below) is a cancer informatician who collects and studies data on urothelial cells produced by the JBU as well as molecular data about bladder cancers produced by clinical centres around the world. He’s involved in analysing data from the NHS 100,000 genomes project.  Andrew holds a two-year fellowship funded by York Against Cancer.
16. With the continued spread of COVID19, many people affected by bladder cancer are among those at higher risk during the pandemic. Social distancing, wearing a mask and washing hands are the most effective measures to protect yourself and those around you.
17. How can we study bladder cancer in the laboratory? One approach is to engineer viruses to infect our normal human urothelial cells and introduce cancer genes – we are then able to study the impact of the modified gene on cell behaviour. This might sound like a horror-film scenario, but is safe as the viruses and the cells are engineered so they cannot survive outside of the laboratory.
18. In the time of the COVID19 pandemic, it’s important to be bladder cancer aware and look after yourself! Make sure to seek timely medical advice as well as support and information from trusted sources and organisations.
19. Dr Joanna Pearson (below) is a molecular biologist skilled at engineering the molecular code of cells and viruses to develop the tools the JBU needs to carry out its research. For example, introducing just one gene called telomerase is enough to convert normal human urothelial cells which have only a finite lifespan into immortalised cells. This is recognised as one of the first stages of cancer development.
20. Dr Jenny Hinley (below) is a histology and immunohistochemistry scientist who studies both healthy and cancerous tissue biopsies. Jenny uses specialist antibody techniques to identify proteins in tissues which can be viewed under a microscope.
21. Did you know that more than 500,000 people around the world are diagnosed with bladder cancer every year? Let’s be more bladder cancer aware and make sure bladder cancer is no longer a ‘forgotten’ cancer!
22. The most common symptom of bladder cancer is blood in your urine. 80-90% of patients of patients diagnosed with bladder cancer have this symptom. It is important to speak to your doctor about any blood in your urine – even if it doesn’t occur frequently.  Other symptoms include passing urine more frequently or urgently, pain or burning when passing urine, unexplained weight loss or pain in your back, tummy or bones.
23. 27% of bladder cancer cases in the UK are female and 73% are in males (CRUK, 2018). However, the overall survival rate once diagnosed with bladder cancer is better for men than for women at all age ranges. This may be due to a more aggressive disease in women, or it may be that women are being diagnosed at a later stage than men.  It is important that both men and women are aware of bladder cancer symptoms and seek medical help if needed.
24. Ryan Ellison (below) is a first-year PhD student in the Jack Birch Unit funded by York Against Cancer. His research project focuses on understanding the normal role in the healthy bladder of a protein called FGFR3, which is frequently mutated in bladder cancer. The idea is that by understanding the role of this protein in the normal bladder, we can understand what it is doing in the cancerous state, thus increasing our understanding of bladder cancer.
25. What steps can you take to help reduce your risk of bladder cancer? Don’t smoke; eat healthily and exercise; reduce exposure to chemicals; see a doctor if you notice any worrying symptoms; and be bladder cancer aware.
26. Did you know that York Against Cancer has a five-year investment in bladder cancer research? We’re supporting the Jack Birch Unit at the University of York with a £1.3m programme to progress their pioneering work.
27. Jenny Southgate (below) is the Director of the Jack Birch Unit and a Professor in the Department of Biology at the University of York.  Jenny first got interested in bladder cancer working at the Imperial Cancer Research Fund (now Cancer Research UK) in London and has dedicated much of her career to bladder cancer research.  It was after moving to St James’s University Hospital (Jimmy’s) in Leeds that she started working with normal human urothelial cells as a new way of studying what goes wrong in cancer.  This is the experimental system that she brought to the JBU at the start of the millennium and which now forms the basis of the JBU’s pioneering work on bladder cancer.
28. Bladder cancer can be often overlooked and mistaken for non-life-threatening urinary conditions. Remember that blood in the urine is the first and the most common symptom of bladder cancer! Don’t delay and see your doctor if you notice it.