Bladder cancer is linked to several risk factors and exposures that can damage the cells lining the bladder and increase the chance of abnormal growth. Common causes and risk factors include:

• Smoking – The biggest known risk factor. Harmful chemicals from tobacco are absorbed into the bloodstream and filtered by the kidneys into the urine, where they can affect the bladder lining.

• Age and gender – Bladder cancer is more common in people over 65 and occurs more frequently in men than women.

• Chemical exposure – Long-term exposure to certain industrial chemicals (such as those used in the rubber, dye, leather, and chemical industries) may increase risk.

• Chronic bladder inflammation – Repeated urinary infections, long-term catheter use, or bladder stones may raise the risk, particularly for rarer bladder cancer types.

• Previous cancer treatment – Certain chemotherapy drugs or pelvic radiation therapy can increase risk later in life.

• Family history or genetic factors – A family history of bladder cancer or inherited gene mutations may slightly raise your risk.

• Arsenic in drinking water – In some regions, this has been linked to increased bladder cancer risk.

Understanding your risk factors can help with early detection and prevention. If you have concerns or symptoms like blood in the urine, it’s important to consult your doctor promptly.

The most common early symptom of bladder cancer is blood in the urine (haematuria). This may cause your urine to appear pink, red, or brown — or it may not be visible at all and only detected on a urine test.

Other symptoms can include:

• Frequent urination

• Urgency – a sudden, strong need to urinate

• Pain or burning during urination

• Difficulty urinating or a weak stream

• Lower abdominal or back pain (in more advanced cases)

• Unexplained fatigue or weight loss (in later stages)

These symptoms can also be caused by non-cancerous conditions, such as urinary tract infections or an enlarged prostate. However, if they persist, it’s important to see your doctor for further evaluation. Early detection of bladder cancer greatly improves the chances of effective treatment.

Diagnosing bladder cancer usually begins when a patient presents with symptoms like blood in the urine or urinary discomfort. To confirm the diagnosis and understand the extent of the disease, several tests may be performed:

1. Urine Tests

   • Urinalysis checks for blood, infection, or abnormal cells.

   • Urine cytology examines urine under a microscope to look for cancerous or precancerous cells.

   • Urine tumour marker tests may also be used to detect specific proteins linked to bladder cancer.

2. Cystoscopy

   • A key test where a thin, flexible camera (cystoscope) is passed through the urethra to look directly inside the bladder. If any abnormal areas are seen, a biopsy can be taken.

3. Biopsy (Transurethral Resection of Bladder Tumour - TURBT)

   • A small sample of tissue is removed during cystoscopy and sent to the lab to determine if cancer is present, what type it is, and how aggressive it may be.

4. Imaging Tests

   • CT urography or MRI may be used to assess the kidneys, ureters, and surrounding structures, and to check whether the cancer has spread.

Once diagnosed, the cancer is graded and staged to determine how aggressive it is and whether it’s confined to the bladder lining or has invaded deeper layers or nearby tissues. This helps guide the most appropriate treatment plan.

Treatment for bladder cancer depends on the type, stage, grade, and whether the cancer is confined to the bladder lining or has spread deeper. Your overall health and preferences also play a role. Common treatment options include:

1. Non-Muscle Invasive Bladder Cancer (Early Stage)

• Transurethral Resection of Bladder Tumour (TURBT)
  A minimally invasive procedure to remove the tumour via a cystoscope.

• Intravesical Therapy
  Medication (such as BCG immunotherapy or chemotherapy) is placed directly into the bladder to destroy remaining cancer cells and prevent recurrence.

2. Muscle-Invasive Bladder Cancer (More Advanced)

• Radical Cystectomy
  Surgical removal of the bladder, often recommended for invasive or aggressive cancers. In men, this may include the prostate; in women, part of the reproductive organs may also be removed.

• Urinary Diversion Surgery
  After bladder removal, a new way to store and pass urine is created using a section of the intestine.

• Chemotherapy and/or Radiation Therapy
  Used before (to shrink the tumour) or after surgery, or as an alternative in patients who cannot undergo surgery.

3. Advanced or Metastatic Bladder Cancer

• Systemic Chemotherapy
  Used to treat cancer that has spread beyond the bladder.

• Immunotherapy
  Medications that help your immune system recognise and attack cancer cells (e.g. immune checkpoint inhibitors).

• Targeted Therapies
  Used in select cases based on genetic testing of the tumour.