What are the Symptoms?
Bladder cancer most often affects people over the age of 55 and is more common in men than women. The most common early sign is blood in the urine (haematuria), which is usually painless.
Other possible symptoms can include:
- Needing to pass urine more often than usual
- A sudden urge to urinate (urgency)
- Pain or burning when passing urine
- Difficulty passing urine
- Lower abdominal or back pain (in more advanced stages)
These symptoms are not always caused by cancer. They can also be due to an infection, bladder stones, or other benign bladder conditions. However, it’s important to have any of these signs checked promptly by your doctor. Early diagnosis makes treatment easier and more effective.
Types of Bladder Cancer
Most bladder cancers start in the cells that line the inside of the bladder (transitional cell carcinoma or urothelial carcinoma). These are divided into:
- Non-muscle-invasive bladder cancer (NMIBC): the cancer is only in the lining and has not spread to the muscle wall
- Muscle-invasive bladder cancer (MIBC): the cancer has spread into the muscle layer of the bladder wall
- Advanced or metastatic bladder cancer: the cancer has spread to other parts of the body
Diagnosis of Bladder Cancer
A number of tests may be used to diagnose bladder cancer and to assess how far it has spread (known as staging). You may not need all of the following tests; your doctor will explain which are recommended and why.
Urine Tests
A urine sample may be checked for signs of infection or for abnormal cells (urine cytology). If cancer cells are found, further investigation is needed.
Cystoscopy
This is the main test used to examine the bladder. A thin, flexible tube with a camera (a cystoscope) is passed into the bladder through the urethra. It allows the doctor to look directly at the bladder lining and take a biopsy if needed.
This procedure can be done under local or general anaesthetic and usually takes just a few minutes.
Biopsy
If suspicious areas are seen during the cystoscopy, a biopsy (tissue sample) will be taken. This is the only way to confirm whether bladder cancer is present.
In many cases, a Transurethral Resection of Bladder Tumour (TURBT) is carried out at the same time. This involves removing the tumour from the bladder wall using a thin wire loop.
Imaging Tests
Further tests may be done to see if the cancer has spread beyond the bladder. These can include:
- CT urogram: a type of CT scan that looks at the kidneys, ureters, and bladder
- MRI scan: particularly useful for local staging
- Ultrasound scan: to examine the bladder and nearby organs
- Chest X-ray or CT scan: to check for spread to the lungs
- Bone scan: if bone symptoms are present
Treatment Options
Treatment depends on the stage, type and grade of the cancer, and your overall health.
Non-Muscle-Invasive Bladder Cancer (NMIBC)
- Transurethral Resection of Bladder Tumour (TURBT) – This is usually the first step and may be curative for small, low-grade tumours.
- Intravesical Therapy – A liquid drug (such as BCG or mitomycin C) is put directly into the bladder to reduce the risk of recurrence.
- Follow-up Cystoscopies – Regular check-ups are needed to detect any recurrence.
Muscle-Invasive Bladder Cancer (MIBC)
- Radical Cystectomy – Surgical removal of the bladder. In men, this may include the prostate; in women, it may involve the uterus and part of the vagina. Reconstruction of the urinary tract is done during the same procedure.
- Radiotherapy – An alternative to surgery in some cases, often combined with chemotherapy (known as chemoradiation).
- Neoadjuvant Chemotherapy – Chemotherapy given before surgery or radiotherapy to shrink the tumour.
For Advanced or Metastatic Cancer
- Systemic Chemotherapy – Used to control the disease and relieve symptoms.
- Immunotherapy – Newer treatments such as checkpoint inhibitors may be available.
- Palliative Treatments – To manage symptoms and maintain quality of life when cure is not possible.
Your treatment will be tailored to your individual needs, and your doctor will discuss the options in detail with you, including risks and side effects.
More Information
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