Bladder cancer usually starts in the lining of your bladder as a primary cancer.
It's also known as urothelial cancer.
Bladder cancer is when cells in the lining of your bladder start to grow abnormally and multiply in an uncontrolled way to form a tumour.
Around 70% of cases of bladder cancer are non-muscle-invasive (superficial), which means the cancer cells have stayed in the lining of your bladder. At this stage, half of people diagnosed with non-muscle-invasive bladder cancer have a good chance of successfully managing it with regular surveillance and treatment for 10 years or more.
Other bladder cancer tumours grow into the muscle wall of the bladder. This is called invasive bladder cancer.
Sometimes bladder cancer spreads to other parts of the body. This is called advanced or metastatic bladder cancer.
There's no national screening programme in the UK for bladder cancer but earlier detection can improve your prognosis.
The main bladder cancer symptom is blood in your urine, which is usually bright red but not painful — this is called haematuria. You may not be able to see small amounts of blood in your urine — this is called microscopic haematuria and is detected with a urine test. If you can see the blood in your urine, it is called gross haematuria.
It’s important to see your GP if you notice blood in your urine. Even if it isn’t there all the time, it’s important to find out the cause. Blood in your urine may be caused by:
Other bladder cancer symptoms include:
However, these are often symptoms of other conditions, such as a bladder infection or enlarged prostate.
Different types of cells in your bladder can become cancerous. The type of bladder cancer you have depends on which cell type becomes cancerous. This will also determine the most appropriate treatment for you. There are three main types of bladder cancer:
Formerly called transitional cell carcinoma, this cancer occurs in the cells lining the inside of your bladder called urothelial cells. Urothelial cells expand when your bladder is full and shrink when your bladder is empty. These cells also line the inside of your ureters (tubes that connect your kidneys to your bladder) and urethra — bladder cancer can therefore start in these locations too. Urothelial carcinoma is the most common type of bladder cancer in the UK.
Squamous cell carcinoma
This cancer is more common if you have chronic (long-term) irritation of your bladder eg due to infections or long-term use of a urinary catheter. It is rare in the UK. It is more common in countries where schistosomiasis is common — this is a parasitic infection that can affect multiple organs including the bladder.
This is a very rare type of bladder cancer in the UK. It starts in cells that form the glands that secrete mucus in your bladder.
Cancer can be diagnosed according to different stages, which depend on how far the cancer has spread. Lower stages have a better chance of successful treatment as the cancer is smaller.
Bladder cancers can be staged according to TNM system. T refers to how far into the bladder the tumour has grown. N refers to whether the cancer has spread into nearby lymph nodes. M refers to whether the cancer has spread into another part of the body (metastasis).
The T stages are:
Bladder cancer up to the T1 stage is usually called early-stage bladder cancer or non-muscle-invasive bladder cancer. After the T2 stage, bladder cancer is usually called muscle-invasive bladder cancer. After the T3 stage, bladder cancer is advanced.
The N stages are:
The M stages are:
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Bladder cancer can occur at any age but your risk increases as you get older; most people with bladder cancer are aged 55 or over. You are also at greater risk if you are male. Other risk factors include:
If you have any symptoms of bladder cancer you should see your GP. They will:
You may be referred to a urologist, a consultant specialising in the urinary system.
Bladder cancer is usually diagnosed with a cystoscopy — a procedure to look inside your bladder and check for growths using a thin, telescope-like tube with a camera at the end called a cystoscope. This can be performed under a local anaesthetic (flexible cystoscopy) or a general anaesthetic. If your doctor detects abnormal tissue during your cystoscopy, they may carry out a biopsy at the same time.
During your cystoscopy, your bladder may also be rinsed out and the liquid collected, either via the cystoscope or a small tube passed into your urethra — the liquid can then be sent for a cytology test.
Other diagnostic tests are:
A CT scan involves using X-rays to take pictures of the inside of your body from different angles. A computer then combines these into a detailed 3D image. This allows your doctor to detect abnormalities or growths and take measurements of any tumours or enlarged lymph nodes, which may suggest the cancer has spread.
This involves using a contrast agent to highlight your urinary tract on an X-ray.
An ultrasound scan uses sound waves to create detailed images of the inside of your body to check if your kidneys or ureters are blocked. You do not need to take any contrast agent.
An MRI scan uses magnetic fields to create detailed images of the inside of your body. First, a special dye is injected into your vein or taken orally as a tablet or liquid — this improves the contrast of the images taken during your MRI scan. This type of scan allows your doctor to detect abnormalities or growths and take measurements of any tumours or enlarged lymph nodes, which may suggest the cancer has spread.
Positron emission tomography (PET) scan combined with a CT scan (PET-CT scan)
This is often just called a PET scan. A small amount of a radioactive substance is injected into your vein and is taken up by cells that use a lot of energy, such as cancer cells. A scanner detects the radioactive substance and creates images of the inside of your body.
If you’re diagnosed with bladder cancer, your doctor will tell you the type, stage and the grade of your cancer. They'll also tell you if there's any metastasis (spreading) to other parts of your body. This is important to help them decide the most effective treatment options for you.
Bladder cancer is usually diagnosed in people over 55. It's also more common in men than women.
There are other risk factors that increase your risk of developing bladder cancer. These are:
Treatment depends on the type of bladder cancer, the stage and the grade.
If your bladder cancer is in the non-muscle-invasive stage it can be removed with a surgical procedure called Transurethral Resection of Bladder Tumour (TURBT). This may be followed by chemotherapy directly to your bladder.
Higher risk tumours are treated with a chemotherapy drug injected into your bladder.
Muscle-invasive cancers may need complete removal of your bladder and nearby lymph nodes (radical cystectomy) followed by radiotherapy.
Bladder cancer sometimes recurs in the months and years after treatment so you’ll need regular follow-up appointments and cystoscopies.
Physical and emotional side effects of treatment
Cancer and cancer treatment cause physical and emotional side effects and can also affect your social life and financial circumstances.
The management of all of these effects is called supportive care or palliative care. It is vital to your overall care and is delivered alongside your medical treatments to help eliminate, slow or stop the cancer.
Palliative treatments vary considerably and can include:
Palliative treatments can also include treatments similar to those used to eliminate the cancer eg chemotherapy, radiation therapy and surgery.
There is no guaranteed way to prevent bladder cancer. However, you can reduce your risk by:
How long will you live if you have bladder cancer?
No one can be certain of how long you will live after a diagnosis of bladder cancer. However, data is available on one-, five- and 10-year survival rates. These survival rates vary according to the stage of bladder cancer you have and are better with earlier stage bladder cancers. However, combining all stages, 75 out of 100 people diagnosed with bladder cancer survive for one year or more, 55 out of 100 people survive for five years or more and 45 out of 100 people survive for 10 years or more.
Is bladder cancer curable?
Bladder cancer can be cured but this depends on the stage of bladder cancer. Your chances of being cured are higher with earlier stage bladder cancer.
What is the main cause of bladder cancer?
There is no single cause of bladder cancer, however, your risk of developing bladder cancer is higher if you are a man, if you are aged over 55 and if you have a family history of cancer. Exposure to harmful chemicals, such as arsenic and chemicals used to make dyes, leather, paint, rubber and textiles, also increase your risk.
What happens to your body when you have bladder cancer?
When you have bladder cancer, cells in your bladder grow out of control and form tumours. This can cause blood in your urine and pain when you urinate. You may also need to pee urgently and more often. If bladder cancer spreads to other parts of your body, you may have symptoms associated with these organs too.
Is bladder cancer an aggressive cancer?
Some types of bladder cancer are aggressive, such as carcinoma in situ — this can lead to invasive bladder cancer, which spreads into your bladder muscles.
Can you have bladder cancer for years and not know it?
Symptoms of bladder cancer, such as blood in your urine and needing to urinate frequently, often overlap with other conditions. Some people may therefore not seek immediate medical help. In these cases, it is possible to have bladder cancer but overlook it for months or a year or more, until you develop more serious symptoms.
What are the symptoms of late-stage bladder cancer?
You can have pain when urinating at any stage of bladder cancer, although this is less common in the early stages. In late-stage bladder cancer, you may also feel tired or weak, find urinating difficult, and have pain in your bones, lower back or along one side of your body. You may also have swollen feet and unexplained weight loss.
Is there pain with bladder cancer?
Early-stage bladder cancer may not cause any pain. However, you may have pain when urinating. In later stages, if the cancer has spread elsewhere, you may have bone pain, pelvic pain or pain in other areas depending on where the cancer has spread.
What are the warning signs of bladder cancer?
One of the first warning signs is blood in your urine. You may also feel pain when urinating, need to urinate urgently and/or frequently.
What are the symptoms of bladder cancer in a female?
The symptoms of bladder cancer in women are the same as in men ie blood in your urine and frequent, urgent and/or painful urination. Although some of the symptoms of bladder cancer overlap with other conditions, such as urinary tracts infections, which are more common in women, it is important to see your GP if you have any of these symptoms so they can rule out bladder cancer.