Bladder Cancer

Overview

The bladder is a stretchy, hollow organ in your lower belly that stores urine. Bladder cancer starts when the cells lining the inside of the bladder begin to grow out of control. If it is not found early, the cancer can spread into the bladder wall and, eventually, to other parts of the body. The good news is that bladder cancer is often found at an early stage, when treatment works well.

Bladder cancer is not one of the most common cancers, but it is not rare either. In the UK, about 10,000 people are diagnosed with bladder cancer each year.

Most people diagnosed are over 60. Men are around 3 times more likely than women to get bladder cancer. People who smoke, have had long-term bladder irritation, or have worked with certain industrial chemicals are also more likely to develop it.

Symptoms

Common symptoms

• Blood in the urine – it may look pink, red, or dark brown. Sometimes you cannot see it, and it is found on a urine test.
• Needing to urinate more often, especially suddenly or urgently.
• Pain or a burning feeling when passing urine.
• A dull pain in the lower back or pelvis that doesn't go away.

Symptoms in children

• Bladder cancer is extremely rare in children. If a child has blood in the urine, it is almost always from a urinary tract infection, kidney stones, or an injury – not cancer. Still, any unexplained blood in a child's urine should be checked by a doctor.

Symptoms in older adults

• In older adults, symptoms like blood in the urine or changes in urination can be confused with a urinary tract infection, an enlarged prostate, or 'just getting older'. These symptoms should never be brushed off. If you notice blood in your urine even once, talk to a doctor.

Causes

Main causes

• Smoking – the harmful chemicals in smoke enter your blood, get filtered by your kidneys, and sit in your bladder, where they can damage the lining.
• Exposure to certain industrial chemicals, such as aromatic amines, used in dye, rubber, leather, and printing work.
• Previous cancer treatment involving certain chemotherapy medicines or radiotherapy to the pelvic area.

Risk factors

• Being over 60.
• Being male.
• Having a family history of bladder cancer.
• Long-term bladder irritation from repeated infections, bladder stones, or using a urinary catheter.
• Drinking well water contaminated with arsenic – this is more common in some parts of the world.

When to see a doctor

See a doctor urgently if:

• You see any blood in your urine, whether or not it hurts or comes and goes.
• You have pain or a burning feeling while urinating that does not go away within a day or two.
• You feel like you need to urinate constantly, or you produce very little urine despite feeling full.

Book a routine appointment if:

• You have a slow change in how often you urinate or in the strength of your stream, especially if you are over 50.
• You have mild, constant discomfort in your lower back or pelvis that lasts more than two weeks.
• You are just worried about bladder cancer and want to talk to a professional.

Diagnosis

Your doctor will start by asking about your symptoms and testing your urine. If blood is found, you will be referred to a urologist – a doctor who specialises in the urinary system. The most important test is cystoscopy, where a thin tube with a camera is passed through the urethra into the bladder. If anything unusual is seen, a small tissue sample (biopsy) may be taken.

Tests that may be done

• Urine test (urinalysis) – looks for blood, infection, or unusual cells in your urine.
• Cystoscopy – a narrow tube with a camera to look directly at the inside of your bladder.
• Imaging tests – such as an ultrasound, CT scan, or MRI scan, to see the kidneys and urinary tract.
• Biopsy – a small bit of bladder tissue removed during cystoscopy to check for cancer cells.

What to expect at your appointment

Most tests are done as outpatient procedures, meaning you do not need to stay in hospital overnight. A cystoscopy can feel a little uncomfortable, but local anaesthetic gel is used to numb the area. You will usually get the results within one to two weeks. If cancer is found, the doctor will tell you the stage and grade – how deep it has grown and how abnormal the cells look. Your specialist team will explain everything and give you time to ask questions.

Treatment

Your treatment depends on the stage and grade of the cancer, as well as your age, fitness, and personal wishes. The main options are surgery, treatment placed directly into the bladder, chemotherapy, radiotherapy, and immunotherapy. Your cancer team will sit with you and talk through the options in plain language, including the benefits and risks of each. You will never be forced into a decision.

Self-care at home

• Most important: stop smoking if you smoke – ask your GP or practice nurse for help.
• Drink the amount of fluid your care team recommends – usually plenty of water, unless they tell you otherwise.
• Keep a diary of any symptoms like blood or pain, and share it at each appointment.
• Attend every follow-up appointment, even if you feel completely fine.

Medical treatments

Early-stage bladder cancer is often treated by removing the tumour during a cystoscopy (called transurethral resection). The doctor may also put a liquid medicine into your bladder to stop the cancer from coming back. If the cancer is more advanced, treatment may include chemotherapy, radiotherapy, or immunotherapy. In some cases, a combination is used. Your doctor will explain what each treatment involves and what side effects you might expect. Do not be afraid to ask about the effect on your daily life.

When is surgery considered?

Surgery is a common treatment. For a small tumour, it may be a minor procedure done through the urethra – no cut on the outside. For a bigger tumour, the surgeon may need to remove part or all of the bladder (called a cystectomy). If the whole bladder is removed, you will need a new way to store and pass urine – either a urostomy bag on your abdomen or a new bladder made from a piece of bowel. Your surgeons and specialist nurses will guide you through this, and you can talk to someone who has had the same surgery if you wish.

Living with this condition

After treatment, you will need regular check-ups, usually cystoscopy examinations every few months for the first couple of years. Many people need to adapt to changes in urination. If you have a urostomy bag, it may take a few weeks to get used to changing it, but specialist nurses teach you exactly how. With time, most people get back to a full and active life.

Lifestyle tips

• Stop smoking – it greatly lowers the chance of bladder cancer coming back.
• Stay active – aim for short regular walks and build up gradually.
• Look after your general health – get enough sleep and try to manage stress.

Diet and exercise

There is no special diet that treats bladder cancer, but a balanced diet – with plenty of vegetables, fruit, whole grains, and protein – helps you stay strong. Some treatments cause weight loss or poor appetite, so eat little and often if you find it hard. Gentle exercise like walking or swimming can improve energy, mood, and strength. Always check with your care team before starting a new activity, especially after surgery.

Mental health and emotional wellbeing

A bladder cancer diagnosis can bring up anxiety, low mood, or fear about the future. You may also worry about body image, intimacy, or how to manage a stoma. These feelings are common. If they last more than two weeks or stop you from doing normal things, talk to your GP or specialist nurse. They can refer you for counselling, and you can also join a support group to speak with others who really understand.

Prevention

You cannot fully prevent bladder cancer, but you can reduce your risk. The biggest step is not smoking – or stopping if you do. If you work with industrial chemicals, follow all safety rules, wear protective equipment, and ask your employer about safe handling. Drinking plenty of water every day may help dilute harmful substances in the bladder and flush them out more quickly.

Vaccines

There is currently no vaccine that prevents bladder cancer.

Screening programmes

There is no routine screening test for bladder cancer in the UK. For people at very high risk – for example, those with a history of heavy smoking or workplace exposure – doctors may offer regular urine checks or scans. If you notice symptoms on your own, always see a doctor rather than waiting for a screening test.

Complications

If left untreated

• The cancer can grow into the deep muscle wall of the bladder and spread to lymph nodes, bones, lungs, or liver.
• Repeated bleeding from the bladder can cause anaemia, leaving you tired and short of breath.
• A tumour can block the flow of urine, causing kidney damage or a painful build-up of urine.

Long-term outlook

The outlook for bladder cancer depends on the stage and grade at diagnosis. If it is caught when still confined to the inner lining, many people are cured. Even when the cancer is more advanced, treatments such as immunotherapy and targeted therapies have improved a lot in recent years and can control the disease for long periods. Your specialist will give you a realistic idea of what your outlook is, and will support you through every step.

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