What causes bladder cancer is not always clear, but the risk of developing bladder cancer increases with smoking, age, long term bladder problems and unsafe exposure to some industrial chemicals.

Bladder tumours usually form in cells lining the bladder. Once a tumour begins to enlarge, it may stay in the lining or grow into the wall of the bladder. If untreated, the tumour may then grow into other structures such as lymph nodes.
If the cancer enters the bloodstream it may spread to other areas of the body (metastasis).

Often the first symptom noticed is blood in the urine. Other symptoms such as needing to pass urine more often or feeling as if you need to go but can’t, affect about 1/3 of people with early bladder cancer. As the tumour grows these symptoms affect more people.

The first test to diagnose bladder cancer is usually a urine sample.
The next step is usually a cystoscopy (a tube to allow the doctor/ nurse specialist to look inside the bladder). If there is a tumour a small sample (biopsy) may be taken for testing. An ultrasound scan of the urinary tract may also be organised.

CT or MRI scans are also used to scan the body to see if the cancer has spread to other areas.

Treatment depends on the size of the tumour and how much it has grown into the bladder wall.

Surgery may be considered especially if the tumour is still small. The surgeon can insert a cystoscope through the urethra and cut out the tumour (TURBT) or burn it away (Cystodiathermy). As part of the operation the surgeon may instill a chemotherapy medicine (Epirubicin) into the bladder for one hour. A single epirubicin bladder treatment at the time of surgery has been shown to increase the length of time between bladder tumour recurrences.

Following Cystodiathermy or TURBT a patient is placed on a regular programme of cystoscopy surveillance at an outpatient clinic. This is to ensure that any recurrence of bladder tumours are detected early, while they are small.

If the tumour has grown more deeply into the bladder wall, the surgeon may perform an operation to remove some or the entire bladder (a partial or full cystectomy). If the whole bladder is removed, an artificial bladder will be created on the inside or a urostomy bag on the outside.

Radiation therapy (a high energy X-ray beam) can be used as the main treatment in some people. In others it may be used after surgery to remove any remaining cancer cells.

In early cancer, drugs (chemotherapy) or another treatment called Bacille Calmette-Guerin (BCG) may be placed directly into the bladder to kill cancer cells (intravesical treatment). BCG is a vaccine used to prevent tuberculosis but it is also used in the treatment of bladder cancer. The usual situation however is that chemotherapy is used in the later stages of cancer. Chemotherapy can attack cancer cells throughout the body (not just the bladder) and help prevent the cancer spreading.

• Total Cystectomy and Neobladder (PDF, 456.8 KB)