Bladder cancer: symptoms, tests, causes and treatment

The NHS says the main symptom of bladder cancer is blood in your pee. Cancer Research UK adds that it is the most common symptom, that it may look pink or red, rarely dark brown, and that sometimes there is so little blood that you cannot see it but a urine test will pick it up. The bleeding is not usually painful and may come and go.

Other symptoms listed by the NHS include:

• Pain, burning, stinging or itching when you pee.

• Getting lots of urinary tract infections.

• Needing to pee more often, or very suddenly.

• Losing your appetite and losing weight without trying to.

• Pain in your back and lower tummy.

• Aching, pain or tenderness in your bones.

• Feeling very tired for no reason and feeling generally unwell.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have blood in your pee, even if you do not have any other symptoms, it is the first time it has happened, there is only a small amount of blood, or you are not sure whether it is blood.

Many of these symptoms are common and have other causes. Cancer Research UK says that problems such as passing urine often or urgently are much more likely to be caused by something other than cancer, such as a urine infection, or an enlarged prostate in men. Even so, the NHS says it is important to be checked, because if cancer is the cause, finding it early may mean it is easier to treat. The NHS also says to try not to be embarrassed, as GPs are used to talking about these symptoms.

At the appointment the NHS says you may be examined (a rectal or vaginal examination can be needed depending on your symptoms), and may have a blood test or give a urine sample. The GP may refer you for more tests or to see a specialist, sometimes as an urgent referral. This does not definitely mean you have cancer.

If a GP refers you to a urologist, you may have another urine test. The NHS says the main test is a cystoscopy, where a thin camera is passed through the tube that carries pee out of your body (the urethra) to see inside the bladder. It may be uncomfortable but should not be painful. You will have painkilling medicine, or it may be done under general anaesthetic. A small sample of the bladder lining may be taken for testing (a biopsy).

You may get your results on the same day or after a few days. If you are told you have bladder cancer, you will usually need more tests to find out the size of the cancer, its type and how far it has spread (the stage).

• An ultrasound scan, MRI scan or CT scan.

• Blood tests.

• A bone scan.

The NHS says bladder cancer can often be treated. The treatment depends on the type of cancer, its size, where it is, whether it has spread and your general health. You will usually be offered surgery, and may also have chemotherapy, radiotherapy and targeted medicines.

The NHS says you will have regular check-ups during and after any treatments, and may have tests and scans. If you have symptoms or side effects you are worried about, you do not need to wait for your next check-up.

If cancer cannot be cured, the NHS says the aim of treatment is to slow the growth and spread of the cancer, help with symptoms and help you live longer. You will be referred to a symptom control or palliative care team, which can help you manage symptoms and get other support for you and your loved ones.

Your specialist team includes a clinical nurse specialist who is your main point of contact during and after treatment. The NHS notes that Macmillan Cancer Support has a free helpline, open every day from 8am to 8pm, on 0808 808 00 00.

The NHS says it is not always known what causes bladder cancer. Cancer Research UK says smoking tobacco is the biggest cause in the UK. The NHS says you may be more likely to get it if:

• You are over the age of 60.

• You are a man.

• You smoke or use chewing tobacco.

• You have had a urinary catheter in for a long time.

• You have had radiotherapy for cancer before.

• You are overweight.

• A close relative has had bladder cancer.

• You have certain conditions, such as diabetes.

• You have worked with chemicals, such as those used in the textile industry, or handling carbon or crude oil.

• You have had an infection called schistosomiasis (bilharzia).

The NHS says you cannot always prevent bladder cancer, but there are things you can do to lower your chance of getting it. These include trying to quit smoking, trying to lose weight, and wearing protective clothes and masks if you work in a job where you are exposed to harmful chemicals. It is still important to get any symptoms checked by a GP.

Bladder cancer is cancer found anywhere in your bladder, according to the NHS. Cancer Research UK explains that it starts in the inner lining of the bladder, which stores urine and sits in the lower part of the tummy. The stage, type and grade of the cancer help your doctor decide which treatment you need.

On the NHS, blood in your pee is assessed by your GP and, if cancer is suspected, you are referred to a urology service for cystoscopy and scans. Treatment is planned by a specialist team with a clinical nurse specialist as your point of contact.

Private urology services can also offer assessment, cystoscopy and imaging, and many people have private appointments to be seen sooner. Whichever route you take, ask who will coordinate your results, how the cancer is staged and who will arrange follow-up cystoscopies, since regular check-ups are a normal part of care.