Bladder cancer: Symptoms, diagnosis and when to seek medical advice

What is bladder cancer, what causes it and who is most at risk?

Bladder cancer develops in the lining of the bladder. It occurs when there are changes in the DNA of the cells that line the bladder, causing them to grow abnormally. 

There’s no single known cause of bladder cancer but there are some recognised risk factors. The biggest preventable risk factor is smoking tobacco, with around half of cases in the UK occurring in smokers. Age is another risk factor, bladder cancer risk increases with age, and it is most common in people over the age of 75, although it can still occur at a younger age.

A small number of cases (around 5%) can be linked to exposure to harmful chemicals such as including aromatic amines, polycyclic aromatic hydrocarbons or mineral oils. Although most of these chemicals are no longer used in UK. Other risk factors include long-term bladder irritation or inflammation (such as bladder stone or recurrent urinary tract infection), a family history (a parent, sibling or child who has had bladder cancer) or previous radiotherapy treatment to the pelvis.

What are the symptoms of bladder cancer?

The most common symptom of bladder cancer is blood in the urine; in medical terms we call this haematuria. This may appear pink, red or brown and can occur without any associated pain. 

Other symptoms of bladder cancer include changes to your urinary function such as needing to pass urine more frequently, a sudden or persistent need to urinate, pain or burning when urinating or difficultly passing urine. Persistent pelvic pain or lower back pain should also be investigated.

These symptoms can be caused by several conditions, including urinary tract infections or other bladder conditions. However, any persistent changes to your urinary function, or unexplained symptoms should always be investigated by a specialist to rule out cancer. 

When should you seek medical advice?

If you notice blood in your urine, see your GP or a urological specialist immediately, even if it you only spot it once or it disappears. Blood in your urine does not necessarily mean you have bladder cancer, but it should never be ignored.

You should also contact your GP or a specialist urologist if you experience ongoing urinary symptoms, recurrent infections or unexplained pelvic pain.

Your doctor may do some initial tests such as a urine test to check for abnormalities, and they can refer you to a urological specialist for further investigations if required.

How is bladder cancer diagnosed?

Initial investigations may include; A urine test, to check for blood, infections or other abnormalities. A blood test, to assess your general health and kidney function, which can be affected by bladder cancer. Imaging scans, including ultrasound, CT, or MRI scans depending on your symptoms. A cystoscopy, a procedure that uses a small camera to examine your bladder.

If cancer is suspected at cystoscopy, the next step usually is to remove the tumour from the bladder by endoscopicly, this procedure is called transurethral resection of bladder tumour (TURBT). This is then sent to a lab, where the tissue is examined under a microscope (histological analysis). Further tests may be required to confirm your exact diagnosis and treatment options.

What are the best treatment options for bladder cancer?

The best treatment for bladder cancer depends on several factors, including the stage (how deep the cancers invaded the bladder wall) and grade (how aggressive the cells are) of the cancer, whether it has spread, and your overall health. There are two main distinguishing factors when it comes to treatment options for bladder cancer, non-muscle invasive bladder cancer, where the cancer is contained to the lining of the bladder. Or muscle invasive bladder cancer, where the cancer has invaded the muscle wall of the bladder or beyond.

Treatment options depend on the type of cancer you are diagnosed with, for non-muscle invasive bladder cancer, treatment may only include TURBT followed by regular checks. For more aggressive or multiple non-muscle invasive tumours, you may also be advised to have treatment directly into the bladder such as mitomycin C (a type of chemotherapy) or BCG treatment (a type of immunotherapy), these treatments can reduce the risk of cancer returning or progressing.

For muscle-invasive bladder cancer, a combination of treatment may be required such as chemotherapy/immunotherapy followed by surgery to remove the bladder, known as a radical cystectomy, or radiotherapy.

There is no single treatment option that is best for everyone, which is why a personalised treatment plan is essential to the best outcomes. If you are diagnosed with bladder cancer, we’ll discuss your treatment options with you and go through the potential benefits, risks and alternatives so that you can make a fully informed decision.

Don’t ignore changes to your urinary health

Bladder cancer develops over time and can cause symptoms that are easy to overlook. But changes to your urinary health, particularly blood in your urine should always be investigated, even if you otherwise feel well.

While your symptoms could be caused by several less serious conditions, catching cancer early can make all the difference to treatment outcomes.

¹ Cancer Research UK: https://www.cancerresearchuk.org/about-cancer/bladder-cancer