Bladder Cancer Common Questions

Yes. Painless bleeding that stops on its own is a classic pattern for bladder cancer, and it is exactly this reassuring behaviour that leads people to delay. Even a single episode should be investigated. Most causes turn out not to be cancer, but bladder cancer cases that are found early are far easier to treat.

A thin flexible telescope is passed along the urethra into the bladder, using local anaesthetic gel. It takes a few minutes in the clinic. Most people describe it as uncomfortable rather than painful, and you can drive yourself home afterwards. Expect some stinging when passing urine for a day or two.

Not yet. This is an area of active research, but available urine tests do not currently have the accuracy needed to replace cystoscopy. Imaging also has limitations — in our DETECT I study, ultrasound missed half of the bladder cancers and CT missed one in five, so direct inspection remains the most reliable method.

Transurethral resection of bladder tumour. Once the patient is under general anaesthesia, a telescope is passed along the urethra and the tumour is shaved away and removed, with the base sealed to stop bleeding. No cuts are made in the skin. It both treats the visible cancer and provides the tissue that determines the stage and grade. See TURBT.

Because whether the cancer has reached the muscle wall is the single most important factor in planning treatment. Only by examining muscle in the sample can the pathologist say for certain. It is worth asking directly at your results appointment whether muscle was included.

For some high-grade or T1 tumours, a second procedure a few weeks later confirms nothing was left behind and that the depth was assessed correctly. It is not a sign that something went wrong — getting the stage right at the outset is what allows the correct treatment to be recommended.

BCG is a weakened bacterium originally developed as a tuberculosis vaccine. Placed into the bladder through a catheter, it provokes a strong immune reaction in the bladder lining so that your own immune system attacks remaining cancer cells. It is the most effective bladder instillation for high-risk non-muscle-invasive disease.

Each instillation takes a few minutes; you hold the fluid for one to two hours, then pass urine normally. Needing to pass urine more often, urgency, burning and some blood for a day or two are common. Flu-like symptoms on the first day are usual. Contact the team for a fever above 38.5°C, shaking chills, or symptoms lasting beyond 48 hours.

No. Recurrence is common in non-muscle-invasive bladder cancer and does not always mean treatment failed. Many people have one or more recurrences over the years, each dealt with by a further TURBT. What matters is high-grade recurrence and progression — the cancer becoming muscle-invasive. Surveillance and bladder instillation therapies such as BCG are important to prevent this.

Either through an ileal conduit, where urine drains continuously into a lightweight bag worn on the abdomen, or a neobladder, where a new reservoir made from bowel is joined to your own urethra so you pass urine in the usual way. The right choice depends on your cancer, kidney function, dexterity and what matters most to you. Ask to meet a stoma nurse before deciding. See robotic radical cystectomy.

Sometimes. Trimodal therapy — a thorough TURBT followed by radiotherapy with low-dose chemotherapy — can be an option for a single small, completely removed muscle-invasive bladder cancer without CIS, in a bladder that works well. In carefully selected patients, five-year survival is broadly comparable to surgery. It requires lifelong cystoscopic monitoring, and if the cancer returns, removing the bladder may still become necessary.