Bladder cancer is an uncontrolled growth of cells lining your bladder wall. In the UK, around 1 in every 10,000 people gets bladder cancer, which makes it the seventh most common cancer in the UK. It mainly affects people over 55 years of age. It’s also more common in men than it is in women.

Your bladder is a hollow, muscular, balloon-like organ that collects and stores urine made by your kidneys. Carcinogens (things that can cause cancer) are filtered out of your body (by your kidneys) and go into your bladder with your urine. Any carcinogens that collect here are stored in high amounts and for long lengths of time. This gives them the chance to damage your bladder cells. It’s this damage that can lead to bladder cancer.

Types of bladder cancer

There are different types of bladder cancer that you could be diagnosed with. However, nine out of 10 people with bladder cancer have what’s called urothelial carcinoma. This is cancer of the cells that line your bladder wall. There are other types of bladder cancers that involve different types of cells. These include squamous cell carcinoma and adenocarcinoma, but in the UK, urothelial carcinoma is the most common.

If you have bladder cancer, it will be called either non-muscle invasive or muscle invasive. This shows the stage of your cancer. Around eight out of 10 people with bladder cancer have the non-muscle invasive type. If you do, it means your cancer hasn’t grown down into the muscle that surrounds your bladder.

Bladder cancer is also graded. The grade shows how different the cells are from those that normally line your bladder wall and therefore, how likely it is to spread. The cells are described as either well-differentiated (similar) or poorly differentiated (not so similar).

Well-differentiated cells are called low grade. They work similarly to the cells that are meant to be there, so they are not as much of a risk to your health as poorly differentiated cells. Poorly differentiated cells are called high grade. They don’t look or work how they should. Well-differentiated tumours grow and spread slower than poorly differentiated tumours.  Most people with bladder cancer have the low-grade, non-muscle invasive type.

Another term you may hear is papillary. Bladder cancers are usually papillary, meaning they are branch-like and grow into the hollow space inside your bladder. However, a small number of people with bladder cancer have carcinoma in situ (CIS). This type grows along the surface of your bladder making it a type of non-muscle invasive bladder cancer. But sometimes CIS can begin to grow down into (invade) the muscle layer surrounding your bladder.

Symptoms of bladder cancer

The most common symptom of bladder cancer is passing blood in your urine. Although this usually doesn’t happen every time you urinate, it’s important that you don’t ignore it if you see it.

Some other symptoms that you may notice include:

  • painful urination (dysuria) — when urinating you may feel a burning sensation
  • needing to urinate more often than usual
  • needing to pass urine more urgently

If you have these symptoms, you might not have bladder cancer. These symptoms can be caused by other things. For example, if you have a bladder infection, you may also find it painful to pass urine. Similarly, urgency to pass urine can also be a sign of having either an overactive bladder or, specifically for men, an enlarged prostate.

It’s not uncommon however for people with more advanced bladder cancers to have dysuria, and bladder infections are also quite uncommon in men. So, if you have any of the above symptoms, you should contact your GP surgery for advice.

If you have advanced bladder cancer, you may have other symptoms. These may include:

  • pelvic pain
  • back pain
  • bone pain
  • swelling in your feet

Diagnosis of bladder cancer

A urologist is a doctor who specialises in identifying and treating conditions that affect your urinary system.

You should see a urologist if you’re over the age of 45, have blood in your urine and no sign of your symptoms being caused by a bladder infection.

Your urologist will organise for you to have a cystoscopy. This is an essential procedure to diagnose bladder cancer. During the procedure your urologist passes a small tube-like camera up into your bladder and looks to see if there is anything unusual. If there is, he or she may take some samples. These samples are then sent to the laboratory and tested.

To help with your diagnosis, you may be asked to give a sample of your urine. You may also need to have some scans to make images of your bladder and the areas around it. These scans may include:

  • ultrasound
  • CT urogram
  • intravenous pyelogram
  • chest X-ray
  • CT scan
  • MRI scan
  • MR urogram
  • bone scan

If you’re unsure how any of these tests relate to your diagnosis, ask your specialist for advice.

Surgical treatments

Transurethral resection of a bladder tumour (TURBT)

Transurethral resection of your bladder tumour (TURBT) is the best way to diagnose and treat non-muscle invasive bladder cancer. This procedure is done under general anaesthesia and allows your surgeon to remove any unusual growths or tumours from your bladder wall. TURBT is often followed by chemotherapy or immunotherapy treatment which destroys any remaining cancer cells and reduces the chance of your cancer coming back. After TURBT, you might find it a little uncomfortable to pass urine and you might also see some blood in your urine. Try not to worry, this will settle shortly after the procedure.

Cystectomy

If you have more advanced muscle invasive bladder cancer, your doctor will recommend that you have your bladder surgically removed (cystectomy). Your doctor may also give you the option to have this treatment if you have high-risk non-muscle invasive bladder cancer. But it’s not usually necessary.

If you have the muscle invasive type and it’s just in your bladder, you may be able to have what’s called a partial cystectomy. This is when only a portion of your bladder is removed. However, having the whole of your bladder and surrounding areas removed in a radical cystectomy is usually the best option. Any affected areas are taken away, so it’ll stop your cancer from getting worse.

After removing your bladder, your surgeon will discuss with you the different options available for you to pass urine. This may involve:

  • having a bag on the outside of your body to collect your urine
  • using a catheter to drain urine from a new area inside your abdomen (tummy) that’s been created to collect your urine
  • having a new bladder created – allowing you to pass urine by tensing your tummy muscles

If you have a cystectomy, you may be offered chemotherapy with or without radiotherapy either before or after your surgery to help get the best outcome.