Bladder cancer is a cancer that develops in the lining of the bladder. It is one of the more common urological cancers and can affect both men and women.
The most common warning sign is blood in the urine (haematuria), which may be visible to the naked eye or detected on urine testing. Blood in the urine should not automatically be attributed to a urinary infection, particularly if it is unexplained, recurrent or persists after treatment.
When bladder cancer is diagnosed early, treatment can often be very effective. The appropriate treatment depends on the type and extent of the cancer.
What is bladder cancer?
The bladder is a muscular organ that stores urine. Its inner surface is lined by specialised cells called urothelial cells.
Most bladder cancers develop from these cells and are therefore called urothelial carcinoma. Bladder cancer can range from a tumour confined to the inner lining of the bladder to a more aggressive cancer that grows into the bladder muscle or spreads beyond the bladder.
What are the symptoms of bladder cancer?
The most common symptom is blood in the urine (haematuria).
This may be:
- Visible blood in the urine
- Blood detected only on urine testing
- Blood that appears intermittently and then disappears
Other possible symptoms include:
- Passing urine more frequently
- Urgency to pass urine
- Burning or discomfort when passing urine
- Recurrent urinary tract infections
- Difficulty passing urine
These symptoms are common and are often caused by conditions other than bladder cancer. However, persistent or unexplained urinary symptoms should be assessed appropriately.
Related: Blood in the Urine (Haematuria)
What increases the risk of bladder cancer?
Several factors are associated with an increased risk of bladder cancer.
Age
The risk of bladder cancer increases with age, although it can occur in younger adults.
Smoking
Smoking is the most important preventable risk factor for bladder cancer. Chemicals absorbed into the bloodstream are filtered by the kidneys and concentrated in the urine, exposing the bladder lining to potentially harmful substances. Stopping smoking reduces the risk of developing bladder cancer and has many other health benefits.
Occupational exposure
Long-term exposure to certain chemicals used in some industrial occupations can increase the risk of bladder cancer.
Previous bladder problems
Some individuals have an increased risk because of previous bladder cancer or certain chronic conditions affecting the bladder.
How is bladder cancer diagnosed?
If bladder cancer is suspected, investigation may involve several tests.
Urine tests
A urine sample may be examined for blood, infection and, in selected circumstances, abnormal cells.
CT or ultrasound
Imaging can assess the kidneys, ureters and bladder and may identify abnormalities within the urinary tract. A CT urogram may be recommended when there is concern about the entire urinary tract, particularly in patients being investigated for unexplained haematuria.
Flexible cystoscopy
Flexible cystoscopy is an important part of investigating visible or unexplained haematuria. A small flexible camera is passed through the urethra into the bladder, allowing the bladder lining to be examined directly. If a suspicious area is identified, further assessment and treatment can be arranged.
Transurethral resection of bladder tumour (TURBT)
If a bladder tumour is identified or strongly suspected, it will often need to be removed or biopsied using transurethral resection of bladder tumour (TURBT). A telescope is passed through the urethra into the bladder and the tumour is removed from inside the bladder, without the need for an external incision.
The tissue is sent to the laboratory for detailed examination. The pathology report establishes important characteristics of the cancer, including its type, grade and stage.
What do grade and stage mean?
Grade describes how abnormal the cancer cells look under the microscope and provides an indication of how aggressively the tumour is likely to behave. Stage describes how deeply the cancer has grown into the bladder wall and whether it has spread to surrounding tissues or elsewhere in the body. These findings, together with factors such as the number, size and appearance of tumours, help determine the most appropriate treatment.
How is bladder cancer treated?
Treatment depends on the type, grade and stage of the cancer.
Transurethral resection of bladder tumour (TURBT)
TURBT is commonly the initial treatment for bladder tumours. The tumour is removed through the urethra and the tissue is examined to determine the nature and extent of the cancer. In some patients, further TURBT may be recommended to ensure that the tumour has been completely removed or to obtain additional information about the depth of invasion.
Further treatment
Depending on the findings, additional treatment may be recommended. For some non-muscle-invasive bladder cancers, this may include treatment delivered directly into the bladder (intravesical treatment). Patients with higher-risk or muscle-invasive disease may require more extensive treatment and input from a specialist multidisciplinary team.
Treatment can include combinations of:
- Further bladder tumour resection
- Intravesical treatment
- Radical surgery
- Radiotherapy
- Systemic treatments such as chemotherapy or immunotherapy
The most appropriate treatment depends on the individual circumstances.
What happens after bladder cancer treatment?
Bladder cancer can recur, particularly when it is confined to the bladder lining. For this reason, patients often require ongoing surveillance after treatment.
Surveillance may include:
- Regular cystoscopy
- Urine tests
- Imaging
- Further treatment where necessary
The frequency and type of follow-up depend on the characteristics of the original tumour and the risk of recurrence or progression.
When should I seek medical advice?
Blood in the urine should always be assessed, even if it occurs only once, is painless or subsequently disappears.
You should seek medical advice if you notice:
- Visible blood in your urine
- Repeated unexplained blood detected on urine testing
- Persistent urinary symptoms without an obvious explanation
- Recurrent urinary tract infections
- Unexplained changes in your usual urinary pattern
Blood in the urine has many possible causes, most of which are not cancer. However, bladder cancer is one of the important conditions that needs to be excluded.
Frequently asked questions
Does blood in the urine always mean bladder cancer?
No. There are many possible causes of haematuria, including urinary tract infections, kidney or bladder stones, prostate problems and kidney conditions. However, unexplained blood in the urine should be investigated appropriately because bladder cancer can sometimes present in this way.
Is bladder cancer curable?
Many bladder cancers, particularly those diagnosed at an early stage, can be treated very effectively. The outlook depends on the type, grade and stage of the cancer and whether it has spread beyond the bladder.
Can bladder cancer cause urinary infections?
It can. Bladder cancer may occasionally present with recurrent urinary tract infections or irritative urinary symptoms. However, these symptoms are much more commonly caused by benign conditions.
Can bladder cancer be seen on an ultrasound?
Sometimes. Ultrasound can identify some bladder tumours, but it cannot reliably exclude bladder cancer. Cystoscopy remains an important investigation when bladder cancer needs to be excluded.
Do I need a GP referral?
You do not usually need a GP referral to arrange a private consultation. However, some private medical insurers require a GP referral or pre-authorisation before they will cover the cost of an appointment or treatment. If you are using private medical insurance, please check your policy requirements with your insurer before booking.
How quickly can I be seen?
Appointments are arranged as quickly as possible, with urgent symptoms prioritised.
Will I see a consultant?
Yes. You will be seen directly by Mr Ellis at every appointment.
Concerned about blood in your urine?
Blood in the urine is often caused by a benign condition, but it should not be ignored. A specialist assessment can establish whether further investigation is required and, where appropriate, arrange imaging and cystoscopy to identify the cause.
