Bladder Cancer Doctor Q&A

In Singapore, bladder cancer is the ninth most common cancer in men. This cancer usually occurs after the age of 40 years, mostly between 50 to 70 years of age. Bladder cancer is also about five times more common in men than in women.

As the featured doctor for our "Ask the Specialist" forum, don't miss this chance to ask Clin Asst Prof Jeffrey Tuan, Senior Consultant from the Department of Radiation Oncology at the National Cancer Centre Singapore, a member of the SingHealth group any question you may have about bladder cancer treatment.

This As​k The Specialist forum has closed. Thank you for your interest and participation.


1. Question by F*********
Dear Prof Tuan :  
I am 79.5 years old.  I had done two TURPs, the first in 2001 and the second, June 2017.  Obviously, the second ops was hardly effective compared to the first, as my urination problems re-occurred in early 2018.  Since then, I had been prescribed Tamsulosin (400mcg) nightly and undergoing uroflows at regular intervals.  The doctors opined that my bladder was weak and that nothing could be done to rectify this condition.  Would appreciate your assessment if I am more prone to getting bladder cancer because of my current conditions; and if there is nothing that could be done with regard to a weak bladder.

Answered by Clin Asst Prof Tuan :
Dear F******,
You are not at any increased risk of developing cancer. At your age, it is not unusual to have a weak bladder due to general weak muscle tone. Furthermore this may have been aggravated by your benign prostate enlargement (Benign Prostate Hypertrophy) leading to long term bladder outlet obstruction and over-stretching of the bladder muscular wall. Presumably your main symptoms are slow urine flow from the enlarged prostate. Regular and repeated pelvic floor (Kegel) exercises to improve muscle tone of the pelvic floor, which in turn may help improve your symptoms. Otherwise, oral medication such as you have been prescribed may help as well. Repeated TURPs may not lead to improvement of symptoms (as you have found out) and on the other hand may lead to urinary incontinence and leakage.

2. Question by J*******
Does the amount of water you consume daily influence your odds of getting bladder cancer? Will drinking less water increase your chances of getting bladder cancer?

Answered by Clin Asst Prof Tuan :
Dear J*******,
In general, daily water intake does not change the risks of getting bladder cancer. However, in certain industries where there is excessive exposure of chemicals, drinking more water may dilute the chemicals being excreted in the urine and therefore reduce the odds of getting bladder inflammation and cancer. It is good to remember that an adequate intake of water (1.5-2L) daily is generally encouraged for optimal kidney health and also in view of our hot and humid tropical climate.

3. Question by E******
Hi Prof Tuan 
Need your advice as to whether my bladder health is considered normal if I experience the following condition:-
1. My daily water intake is 1.5L and I normally clear my bladder 5-6 times daily. Is this normal? 
2.  At times, I have to exert some pressure to complete the urination, particularly towards the tail end.   
3.  Is it rather common for an individual to clear the bladder once or twice between 2-6am in the morning? 
Thank you!

Answered by Clin Asst Prof Tuan :
Dear E**,
You have a healthy intake of water daily and in general the symptoms described are within the range of what we expect to be normal. However, certain factors like age, previous pregnancy and abdominal surgery, types of beverage consumed, environmental temperature and bowel contents may influence the number of times going to the bathroom. Exerting pressure to complete the urination is common when one is older or after childbirth due to a weaker abdominal muscle tone. You are probably still able to empty your bladder without any significant exertion if you take a little more time on the toilet and let nature take its course. You may also consider limiting fluid consumption after 6-7pm to avoid getting up more than once at night.

4. Question by A***** 
Hi, Kindly advise if there are any symptoms to be aware of for bladder cancer. 
Are annual screening for bladder required? 
What are the available options for screening? 

Answered by Clin Asst Prof Tuan :
Blood in the urine (haematuria) is the most common presentation of bladder cancer. In more advanced cases, patients can present with swelling or pain in the abdomen or pelvis. At the moment, there is no effective way of screening for bladder cancer available for the general public. For persons at higher risk of developing such cancer (i.e. employees in the chemical industries), the company doctor will be monitoring them for any symptoms.

5. Question by E*****
Dear Sir 
I’m a smoker, Male, 45 years old with High Blood Pressure. 
Recently for the last 5 months I’m having issue holding my urination. 
It seems I can’t hold my urination more than a minute. Sometimes when I try hold, it will slowly dripped. 
And I notice I do drinks a lot of carbonated drinks at night and I will awake 2-3 times a night to urinate. It has been disrupting my sleeping. 
Is there anything I need to be concerned and how do I get it treated? 
I have visited Hougang Polyclinic on February 19 and was given diabetes medicine for 3 months. 
I completed the medicines and was not call up for any follow ups or given a new batch of medicine. 
Kindly advised. 

Answered by Clin Asst Prof Tuan :
Dear E*****,
You do not have any symptoms of bladder cancer. What you have described is in keeping with benign prostate swelling (benign prostate hypertrophy) which is common at men around your age. Avoidance of carbonated drinks at night will help with the episodes to pass urine at night. An urologist will be able to advise you on the need for medication or lifestyle modification that will help your urinary symptoms. Smoking is a known risk factor for bladder cancer and you should speak to your local doctor about getting help in quitting the habit. Similarly you should go back to Hougang Polyclinic to review your diabetes and refill your prescription regardless of the reason why you have not been given a follow up appointment.

6. Question by C****
Hi Prof, 
What are the symptoms of a Bladder Cancer?

Answered by Clin Asst Prof Tuan :
Dear C****,
Blood in the urine (haematuria) is the most common presentation of bladder cancer. In more advanced cases, patients can present with swelling or pain in the abdomen or pelvis.

7. Question by A***
I have to wake up several times to pee every night. Is that a problem? 

Answered by Clin Asst Prof Tuan :
Dear A***,
In general, how many times you wake up at night to pee to depend on how much water you drink before your bedtime. Try reducing the amount of fluids just before bedtime and see if that helps.

8. Question by L**
Hi Prof Tuan, 
May I check with you about my bladder problem. 
Year 2009 I had my prostate removed due to cancer. After my surgery, I have urine leaking since 2009 until today. Is there any problem or bladder cancer that is developing? 
Appreciate your diagnosis. 
Thanking you in advance. 

Answered by Clin Asst Prof Tuan :
Dear L**,
Urinary incontinence or leaking is not an uncommon side effect after removal of the prostate. Although it is possible for some recovery after a period of time, this is usually limited to the first year immediately after completion of surgery. There is no relationship to bladder cancer in this instance. Speak to your surgeon who will prescribe the relevant medicine or exercise to help with the incontinence/leaking.  

9. Question by B******
Dear Prof Tuan, 
I am 56 (Male) turning 57 in November 
1.Currently I wake up 3 to 4 times each night to pass urine. I am diagnose as prostate mildly enlarge last June. Any link with Bladder Cancer?
2.What are the signs of Bladder Cancer to look out for with my age or years to come?

Answered by Clin Asst Prof Tuan :
Dear B******,
Benign prostate enlargement or Benign Prostate Hypertrophy (BPH) is common in middle aged men and not related to an increased risk of getting bladder cancers. Blood in the urine (hematuria) is the most common presentation of bladder cancer. In more advanced cases, patients can present with swelling or pain in the abdomen or pelvis. If you are seeing an urologist for the BPH, he can advise you on the symptoms to look out for bladder cancer and if any additional tests are required.

10. Question by W**
Dear Prof Tuan,
My daily water intake ranged around 2 litres. I am on Metformin 2 x 250mg daily.
1.Is it recommended to take 2 in one go or better to split into 2 after meals.
2.What is the recommended sugar intake? aka preferably less than how grams per day.
3.Is Coke (With Zero Sugar) harmful to us, as in 1 x 330ml alternate days?
Thank you.

Answered by Clin Asst Prof Tuan :
Dear W**,
These questions are not directly related to bladder cancer but here are some comments that might be helpful.
1.I think it is better to take 2 tablets of Meformin in one go. This is probably easier to remember taking your medicine and not forget.
2.The recommended sugar intake is as low as possible. This is especially specific to added sugar (for example in coffee and tea). There are guidelines on the Health Promotion Board (HPB) on recommended daily caloric intake which will depend on a person’s age, medical conditions and activity.
3.Plain water is the best form of hydration. We are fortunate to have clean tap water readily available everywhere in Singapore. Artificial sweeteners are used in place of sugar in such drinks which may also have some unintended effects if taken in excess.

About Clin Asst Prof Jeffrey Tuan

Clin Asst Prof Jeffrey Tuan is a Senior Consultant and Research Director in the Division of Radiation Oncology at the National Cancer Centre Singapore (NCCS).

Clin Asst Prof Tuan received his medical degree from the National University Singapore School of Medicine in 2000. He received his specialist training in the Division of Radiation Oncology at the National Cancer Centre Singapore and the Royal Marsden Hospital in London, UK.

Ref: M19