Quick answer
What is bladder cancer?
Bladder cancer is one of the commonest cancers in the UK — most often presents with blood in urine (visible or microscopic) with no pain. Smoking is the biggest risk factor. Diagnosis needs cystoscopy and biopsy — urine tests alone are not enough. Non-muscle-invasive bladder cancer is treated with removal via cystoscope (TURBT) plus BCG immunotherapy into bladder. Muscle-invasive disease may need bladder removal (cystectomy) or chemoradiotherapy. See a GP within 2 weeks for blood in urine — even once — especially if you smoke or are over 45.
Bladder cancer — never ignore blood in urine
Bladder cancer (urothelial carcinoma) — ~10,300 UK cases/year — painless haematuria is cardinal sign.
Men 3–4× commoner — smoking dominant risk
Risk factors
- Smoking — 50% attributable
- Occupational chemicals — rubber, dye, leather
- Chronic schistosomiasis — rare UK
- Previous pelvic radiotherapy
- Lynch syndrome
See urinary tract infection — UTI can cause blood — but must exclude cancer if haematuria without clear infection or recurrent
Investigation pathway
2-week wait haematuria clinic:
- Cystoscopy — office flexible often first
- Imaging — CT urogram
- TURBT if lesion seen
Do not treat repeated antibiotics without cystoscopy if haematuria persists
Staging and grading
NMIBC (Ta, T1, CIS):
- Confined to mucosa/lamina propria
- High grade CIS — flat aggressive — BCG essential
MIBC (T2+):
- Muscle invasion — systemic risk
Treatment summary
| Stage | Treatment |
|---|---|
| Low-risk NMIBC | TURBT + surveillance |
| High-risk NMIBC | TURBT + BCG induction/maintenance |
| MIBC | Radical cystectomy ± neoadjuvant chemo OR chemoradiotherapy |
| Metastatic | Immunotherapy, ADCs, chemotherapy |
Urinary diversion after cystectomy
Ileal conduit — urostomy bag
Neobladder — internal pouch — selected patients
Quality of life — specialist stoma nurses, peer support
Surveillance
Bladder cancer recurs in bladder — and upper tract
Cystoscopy schedules — up to 10 years
One episode red urine — GP referral — 90% not cancer — but 10% need you to show up.
Common questions
- What are the symptoms of bladder cancer?
- Painless blood in urine — pink, red, or cola-coloured — most common sign. May be intermittent — one episode still needs investigation. Frequency, urgency, dysuria less common — overlap with UTI. Advanced — pelvic pain, weight loss, bone pain, leg swelling if obstructed.
- How is bladder cancer diagnosed?
- Cystoscopy — camera into bladder — gold standard. TURBT — transurethral resection — removes tumour and provides histology. CT urogram or ultrasound for upper tract. Urine cytology supplementary — not standalone screening. Staging — non-muscle-invasive (NMIBC) vs muscle-invasive (MIBC) determines treatment.
- How is non-muscle-invasive bladder cancer treated?
- TURBT complete resection. Intravesical BCG immunotherapy — weekly then maintenance — reduces recurrence and progression for high-risk NMIBC. Intravesical chemotherapy (mitomycin C) for intermediate risk. Surveillance cystoscopy schedule — intensive first 2 years.
- How is muscle-invasive bladder cancer treated?
- Radical cystectomy — bladder removal with urinary diversion (ileal conduit or neobladder) — or trimodal chemoradiotherapy preserving bladder in selected patients. Neoadjuvant cisplatin chemotherapy before surgery improves survival. Metastatic — immunotherapy (pembrolizumab), enfortumab vedotin.
- Can bladder cancer be prevented?
- Stop smoking — most important. Hydrate well. Workplace exposure reduction. No proven screening for general population. Recurrence common in bladder — lifelong cystoscopy follow-up after treatment.