Bladder cancer: symptoms, causes and which doctor to see

For bladder cancer you can first see: Urology or Medical Oncology. In large hospitals, the Urology and Medical Oncology unit also deals with this. If you are not sure, a family doctor (general practitioner) can assess you first and refer you to the right specialist.

Common symptoms: painless visible blood in the urine (pink, red or cola-coloured); blood found only on a urine test; frequent urination and urgency; burning on urination without infection; at an advanced stage, pain in the pelvis, side or bones. Symptoms vary from person to person; a doctor’s examination is needed for a diagnosis.

The most common causes: smoking (the most important risk factor); long-term exposure to some chemicals used in the dye, rubber, leather and chemical industries; previous pelvic radiotherapy or some chemotherapy medicines; long-term bladder inflammation and long-term catheter use; older age and male sex. Only a doctor’s examination can determine the exact cause.

Superficial tumours are removed with a closed procedure through the urethra (TURBT); medicine may be put into the bladder to reduce the risk of recurrence, and regular cystoscopy check-ups are done. For tumours that have grown into the muscle layer, options such as removing the bladder, chemotherapy and radiotherapy are considered. Because bladder cancer tends to come back, long-term follow-up is needed.

It is more common in: people over 55; men (several times more common than in women); smokers and people who smoked for many years and stopped; people working in the dye, rubber, leather and chemical industries.

A urine test and ultrasound are the first steps; a CT urogram may be requested to find the cause of blood in the urine. For a definitive diagnosis, the inside of the bladder is looked at with a camera (cystoscopy) and tissue is taken from a suspicious area. Urine cytology is a helpful test.

Stopping smoking markedly reduces the risk over time. People who work with chemicals should follow workplace safety measures and not miss periodic health checks.

No. Urinary tract infection, stones and an enlarged prostate are much more common causes. But especially over 40 and in smokers, painless bleeding must always be checked for bladder cancer.

Superficial bladder tumours tend to recur; so cystoscopy check-ups are done at set intervals after treatment. When recurrences are caught early, they can again be treated with a closed procedure.

If the answer to any of these questions is yes, call 112 without delay: “Are there clots in the urine and are you unable to pass urine?” “With heavy bleeding, is there dizziness or a feeling of fainting?” “Is there high fever and pain in the side?” “Is there confusion, fainting or difficulty waking up?” “Is there facial drooping, slurred speech or sudden weakness in an arm or leg?” “Are you struggling to breathe even at rest?”

See a doctor: any visible blood in the urine; microscopic blood found on repeated urine tests; frequent urination and burning that do not go away despite treatment for infection; for the recommended cystoscopy check-ups after treatment.