Bladder cancer

Blood in the urine is the most common symptom of bladder cancer, and it is typically painless. It may come and go, but nevertheless, it should be investigated.

Other symptoms include passing urine more often, having pain when you pass urine or needing to pass urine urgently, even if only a little comes out.

You may get other non-specific symptoms like weight loss, back pain, loss of appetite, and feeling tired and lethargic, but these can point to any number of conditions and cancers. 

Bladder cancer most often occurs out of the blue, but some things put you at higher risk. There are risk factors that you have no control over, such as your family history: you are more likely to get bladder cancer if a close family member has had it. Bladder disease, usually caused by repeated and prolonged bladder infections, increases your risk, as well as having had a kidney transplant or systemic sclerosis. 

Exposure to certain chemicals can harm the bladder, usually through work in particular industries, such as those involving combustion or handling carbon or crude oil, but also producing dyes, rubber, textiles, chemicals, and plastics.

There are risk factors that you have some control over, of which smoking is number one – it’s the cause of half of all cancers. Obesity is another – you should address your weight if your BMI (body mass index) is over 25.

You should see your doctor with any concerning symptoms, such as blood in your urine or abdominal lumps and bumps. They will ask about your symptoms, and your family history and check any other medical conditions or medications. They will examine your abdomen, looking for any pain or swelling.

They will ask you for a urine sample, looking for any simple signs of bladder disease or damage, and also to exclude any urine infection. They may request some blood tests.

They may then request further investigations, such as an ultrasound scan of the kidneys, ureters, and bladder. If there is an immediate concern for bladder cancer, your doctor will refer you urgently to a bladder specialist called a urologist.

They will perform a cystoscopy, which is where a thin tube with a camera is passed into your urinary tract to look at your bladder and take samples of the tissue. They may perform a CT scan to gain more information.

As with all cancers, treatment depends on the size, whether it has spread to other areas, and how to fit you are overall. If the cancer has not invaded the muscle, surgery can be done to remove only the cancerous area through a technique called Transurethral Resection of Bladder Tumor (TURBT). Chemotherapy medications are usually given after this technique to reduce the recurrence of the cancer. 

If the cancer has spread to the muscle, removal of the whole bladder is undertaken, in a procedure called a cystectomy. Unfortunately, the outcome of treatment options can have a significant impact on your life, even if you have been cleared of bladder cancer.

After cystectomy, the surgical team needs to create a urinary diversion: a new way of collecting and eliminating urine. This may involve reconstructing a new bladder with some of your small bowel, or the bowel may be used to attach to a bag held outside the body (an ileal conduit leading to a stoma), which collects urine and is then emptied by you at intervals.

Radiotherapy is another treatment option and is often used in combination with chemotherapy and/or surgery. 

Most people want to know whether they will survive a particular cancer. This is a tricky question, as so much depends on an individual’s risk factors, age, and general health, as on the type of tumor, how far advanced it is, and whether it has spread.