Urology & Continence Care Today | May 2025

Cancer

Bladder cancer: what you need to know

Article topics: Bladder, Cancer

Around 10,500 people are diagnosed with bladder cancer in the UK every year. It's the 11th most common cancer in the UK, and the 7th most common cancer in men (Cancer Research UK, 2025a). Bladder cancer is most common in older people. Almost 60% of new cases are in people aged 75 years and over, and it is rare in people under 40 years of age. More men than women get bladder cancer. This may be because more men than women have smoked or been exposed to chemicals at work in recent decades (Cancer Research UK, 2025a).

Types of bladder cancer

The most common type of bladder cancer is urothelial (transitional cell) bladder cancer. Rarer types include squamous cell bladder cancer, adenocarcinoma, sarcoma and small cell bladder cancer. Cases of bladder cancer are also classified as either non-muscle invasive bladder cancer or muscle invasive bladder cancer depending on how far they have penetrated into the bladder wall. Muscle-invasive bladder cancer requires more intensive treatment because it is more likely to metastasise (spread to other parts of the body) (Cancer Research UK, 2025b).

Symptoms

The main symptom of bladder cancer in men and women is haematuria (blood in the urine), which is seen in 80% of patients. Other symptoms include problems passing urine, pain in the bones, lower back or stomach, feeling tired, or weight loss for no clear reason (Cancer Research UK, 2025c).

Diagnosis

If the patient has haematuria, they will usually be referred to a haematuria clinic. A full history will be taken, and they will have a scan of the urinary tract (usually ultrasound or computed tomography – CT) and a CT urogram, where dye is injected into the blood to give a picture of the urinary system (Action Bladder Cancer, 2025). Cystoscopy is almost always required – this uses a cystoscope inserted via the urethra to allow examination of the inside of the bladder and biopsies to be taken if required.

For a more detailed overview of the process of diagnosis, look at the European Association of Urology (EAU) guidance for diagnosis of non-muscle invasive bladder cancer (EAU, 2025a) or diagnosis of muscle-invasive bladder cancer (EAU, 2025b), or the National Institute for Health and Care Excellence (NICE, 2015a) guidelines.

Stages and grades

Bladder cancer needs to be staged and graded. The grade (1–3) indicates how likely the cancer is to spread and the stage (TNM) indicates the size of the cancer and whether it has spread. In terms of the staging, T describes the size of the tumour, N describes whether it has spread to the lymph nodes and M describes whether it has metastasised (Cancer Research UK, 2025d).

Treatment

Treatment depends on whether the cancer has invaded the muscle or not. If the patient has non-muscle-invasive bladder cancer, their treatment will be guided by the risk of the cancer recurring and progressing (NICE, 2015b; EAU, 2025c). If the patient has muscle-invasive bladder cancer, their treatment may include surgery, chemotherapy and radiotherapy, and should be guided by a specialist urology multidisciplinary team, looking at histopathology, imaging and discussion of treatment options (NICE, 2015c; EAU, 2025d).

Patients with incurable bladder cancer should have the options discussed with them – they may be referred to the urological team for symptom management or the palliative care team.

References

Action Bladder Cancer (2025) Diagnosis. https://actionbladdercanceruk.org/diagnosis/ (accessed 2 May 2025)

Cancer Research UK (2025a) What is bladder cancer? https://www.cancerresearchuk.org/about-cancer/bladder-cancer/about (accessed 2 May 2025)

Cancer Research UK (2025b) Types of bladder cancer. https://www.cancerresearchuk.org/about-cancer/bladder-cancer/types-stages-grades/types (accessed 8 May 2025)

Cancer Research UK (2025c) Symptoms. https://www.cancerresearchuk.org/about-cancer/bladder-cancer/symptoms (accessed 8 May 2025)

Cancer Research UK (2025d) Stages of bladder cancer. https://www.cancerresearchuk.org/about-cancer/bladder-cancer/types-stages-grades/stages (accessed 8 May 2025)

European Association of Urology (2025a) Non-muscle-invasive Bladder Cancer. Diagnosis. https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer/chapter/diagnosis (accessed 7 May 2025)

European Association of Urology (2025b) Muscle-invasive and Metastatic Bladder Cancer. Diagnostic evaluation. https://uroweb.org/guidelines/muscle-invasive-and-metastatic-bladder-cancer/chapter/diagnostic-evaluation (accessed 7 May 2025)

European Association of Urology (2025c) Non-muscle-invasive Bladder Cancer. Disease management. https://uroweb.org/guidelines/non-muscle-invasive-bladder-cancer/chapter/disease-management (accessed 7 May 2025)

European Association of Urology (2025d) Muscle-invasive and Metastatic Bladder Cancer. Disease management. https://uroweb.org/guidelines/muscle-invasive-and-metastatic-bladder-cancer/chapter/disease-management (accessed 7 May 2025)

National Institute for Health and Care Excellence (2015a) Diagnosing and staging bladder cancer. https://www.nice.org.uk/guidance/ng2/chapter/Recommendations#diagnosing-and-staging-bladder-cancer-2 (accessed 7 May 2025)

National Institute for Health and Care Excellence (2015b) Treating non-muscle-invasive bladder cancer. https://www.nice.org.uk/guidance/ng2/chapter/Recommendations#treating-non-muscle-invasive-bladder-cancer-2 (accessed 7 May 2025)

National Institute for Health and Care Excellence (2015c) Treating muscle-invasive bladder cancer. https://www.nice.org.uk/guidance/ng2/chapter/Recommendations#treating-muscle-invasive-bladder-cancer-2 (accessed 7 May 2025)

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