Bladder cancer

Bladder cancer diagnosis

The symptoms of bladder cancer are very similar to many other conditions, so it's very important that your doctor identifies the exact cause of your symptoms. Initial diagnosis includes:

Urinalysis

• A urine sample to test for blood and infection.

Physical examination of the abdomen and pelvis

• May also include an internal examination of the rectum in men or the vagina in women.
• Depending on the results of the examinations, your GP may then refer you to a urologist at your local hospital for further tests, including:

Blood tests

• Give an idea of your general health and how well your kidneys are working.

Ultrasound scan

• Uses sound waves to produce a picture of the inside of the abdomen.
• Before the scan you will be asked to drink plenty of fluids so that your bladder is full and the picture is clear.
• Takes about 15 minutes and is completely painless.

Intravenous pyelography (IVP)

• X-ray examination of your kidneys, ureters and bladder.

Cystoscopy

• Allows the urologist to look at the inside of your bladder, using a small tube with a camera on the end, which is inserted into your urethra. If tissue samples are required, you may need to have a general anaesthetic

Chest X-ray

• Examines your heart and lungs to check that they are healthy.

CT or CAT scan (computed tomography)

• A type of X-ray examination, in which a large number of cross-sectional pictures of your body are created. These make up a 3D image of your internal organs.

Radioactive bone scans

• May be performed to check whether any cancer has spread to the bones.
• A tiny amount of radioactive liquid is injected into a vein, and then you will have a scan 2 to 3 hours later. Abnormal areas show up in the scan.

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Bladder cancer treatment

Treatment depends on the type of bladder cancer, the stage of the disease (how far it has spread) and the grade of the tumour. The doctor will also take into consideration your age and general health.

Treatment for early (superficial) bladder cancer

Usually removed surgically by a cystoscope (a tiny camera that allows the doctor to look inside your bladder). The cancerous growths are simply cut off at the stem. This procedure is known as a transurethral resection of a bladder tumour (TURBT).

Following this, you'll need cystoscopies every 3 to 4 months. Most follow-up cystoscopies can be carried out under local anaesthetic in your hospital's outpatient department.

If the cancer comes back, the tumours can usually be surgically removed while they are still in the early stages. However, you may also be offered anticancer drug treatment, including:

Intravesical chemotherapy

• Chemotherapy given directly into the bladder - targeting cancer cells in the bladder lining.
• Can be a one-off treatment, or over the course of six weeks.
• Limited side effects, though cystitis common (inflammation of the bladder).

Intravesical immunotherapy

• A vaccine called BCG (bacille Calmette-Guérin) is inserted directly into the bladder.
• This triggers the body's immune system to attack the cancer cells.
• Side effects of treatment include feeling unwell, pain when you pass urine and skin rashes.

Treatment for invasive bladder cancer

Surgery is the most common treatment for invasive cancers. Radiotherapy and chemotherapy may be used in addition (adjunctive therapy).

Cystectomy

• Large or invasive tumours may mean that the bladder has to be removed.
• If the whole bladder is removed, the operation is called a total cystectomy.
• You will still be able to pass urine after this operation, but your bladder will hold less urine, and you may need to pass urine more often.

Urostomy

• A urostomy is a new storage place for urine. Under general anaesthetic, both ureters are redirected through a small hole (stoma) in your abdomen leading to a watertight bag. You'll need to empty this when needed.

Continent urinary diversion

• An alternative to urostomy. Urine is removed through the stoma - but you do not need an external bag.
• Urine collects in a pouch formed in the abdomen using a piece of bowel - known as self-catheterisation.

Bladder reconstruction

• Surgeons make a completely new bladder out of a piece of the small or large intestine.
• Unlike your old bladder, you will need to tense your stomach to empty it. You will have lost the nerves that tell your brain when your bladder is full.

Radiotherapy

• An alternative to surgery, radiotherapy uses high-energy rays to destroy cancer cells, while avoiding damage to the surrounding normal cells.
• Usually given as a series of daily treatments at your hospital. The number of treatments depends on the size and type of cancer, but each treatment takes 10 to 15 minutes and usually continues for up to six weeks.

Chemotherapy

• Chemotherapy drugs are injected into the bloodstream, reaching cancer cells anywhere in the body.
• Other cells in the body can also be affected, resulting in side effects such as sickness and hair loss.
• A course of several drugs is given over a few days. The course may then be repeated every few weeks for several months.

Treatment for advanced bladder cancer

If the cancer has spread outside the bladder, or comes back after the initial treatment, the main treatment is chemotherapy. This is known as palliative chemotherapy. The aim is to try to slow the growth of the cancer. It can also help maintain a good quality of life for as long as possible.

Unfortunately, once cancer has spread to other parts of the body, the chance of a cure is rare. If you have been offered chemotherapy, discuss the pros and cons with your doctor. There are other options available to you to control your symptoms of cancer. These vary depending on your symptoms.

Need more information?

Speak to your GP for advice about bladder cancer, especially if you have specific concerns about your symptoms and treatment options. You can also find useful websites via our links section.

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How TUF Helps

We've invested £1m into the fight against bladder cancer

Dr Andy Feber and Professor John Kelly – a new test to save lives and save the NHS millions

Andy and John are based at  UCL and are using funding from TUF to produce a new test for bladder cancer.

Previous tests required an uncomfortable procedure, called a cystoscopy, which requires passing a small camera in a tube through the urethra and into the bladder. As well as being uncomfortable, this can cause infections.

Andy and John’s test is based on a simple urine sample which can be sent away for testing. Their testing system, UroMark, examines 150 markers in urine that are specific to bladder cancer, where previous testing only examined two or three markers.

UroMark is highly accurate – it can detect bladder cancer in 98% of cases – which means that bladder cancer can be detected earlier, which will reduce the number of hospital admissions and improve survival rates. As well as this, UroMark is cheaper than the current testing system; it is believed that this test will save the NHS around £25 million a year.   

Pramit Khetrapal – testing for the reoccurrence of bladder cancer

Pramit is a researcher at UCL. He’s using his TUF funding to develop a new blood test for the reoccurrence of bladder cancer.

Between 35-50% of advanced bladder cancer patients die around two years after having had surgery to remove their bladder. In most patients, this happens because the cancer comes back.

The current theory is that the cancer has already spread from the bladder to other parts of the body before surgery, but is too small to be detected by CT scans. After patients undergo major surgery to cure the cancer by removing the bladder, this microscopic cancer deposit grows and appears on CT scans in other parts of the body.

Pramit is aiming to develop a new blood test that will find cancer-related DNA mutations in the body before they are detectable by a CT scan. If the test is successful, it may be able to detect cancer at an earlier stage, and will help doctors to select patients for treatment while the cancer is still microscopic and not visible on scans. Detecting this cancer early could mean that it is possible to treat, which could improve survival for patients with bladder cancer.

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How You Can Help

All of the work that we do to fight urology disease is funded by supporters across the country. Without support from people like you, we cannot do what we do.

When you donate to The Urology Foundation you join the front line of the fight against urology disease. Your money helps us to:

• Fund ground breaking research into urology diseases so that we can find better cures and treatments
• Provide training and education to equip all urology professionals with the tools they need to support and treat patients in hospitals across the UK and Ireland

Donate today to be a part of this fight. Or, to find out other ways you could support TUF, visit our Get Involved page.