Bladder cancer is a common urological malignancy, often presenting with painless visible haematuria. Most cases are diagnosed early, but recurrence is high and long-term surveillance is essential.
🚨 Painless visible haematuria in adults is bladder cancer until proven otherwise.
Peak incidence: adults over 60
Around 3x more common in men than women
Smoking is the most significant modifiable risk factor
Occupational exposures: rubber, dyes, leather, plastics
Other contributors: chronic bladder inflammation (e.g. long-term catheter use, recurrent UTIs), pelvic radiotherapy, previous chemotherapy
💡 Smoking accounts for ~50% of bladder cancer cases in the UK.
| Type | Frequency | Typical Associations |
|---|---|---|
| Transitional Cell Carcinoma (TCC) | >90% | Smoking, chemical exposure |
| Squamous Cell Carcinoma | ~5% | Chronic irritation (e.g. schistosomiasis, catheters) |
| Adenocarcinoma | <2% | Rare – congenital or chronic inflammation |
Painless macroscopic haematuria (most common presenting feature)
Irritative lower urinary tract symptoms (urgency, frequency, dysuria)
Advanced disease: pelvic discomfort, weight loss, or oedema from lymphatic obstruction
💡 Always consider malignancy in older adults with recurrent “UTIs” or persistent urinary symptoms.
| Test | Purpose |
|---|---|
| Urinalysis | Detects haematuria |
| Urine cytology | May detect malignant cells |
| Renal function (U&Es) | To assess for upper tract involvement |
| CT urogram | First-line imaging for upper tracts and bladder |
| Flexible cystoscopy | Gold standard for visualising bladder tumours |
💡 Cystoscopy is required even if imaging is normal.
Management depends on tumour depth (non-invasive vs muscle-invasive) and patient factors.
Early-stage disease is often treated endoscopically
Invasive disease may require surgery or other systemic therapies
Recurrence is common → ongoing cystoscopic surveillance is standard
💡 Full treatment decisions are guided by staging, histology, and patient fitness.
Even after treatment, bladder cancer has one of the highest recurrence rates of any malignancy.
Low-grade tumours: periodic cystoscopy over several years
High-grade tumours: more frequent, long-term monitoring
Fries Tips
🚨 Painless visible haematuria should always trigger further investigation
Smoking is the most important risk factor — ask clearly during history taking
Not all bladder cancer presents with blood — persistent LUTS in older adults can be a clue
Cystoscopy is the key diagnostic and surveillance tool
Superficial tumours can recur even after successful resection
