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Bladder cancer starts in the lining of the bladder. About three quarters of cases are found while still confined to the lining (non-muscle-invasive), and the rest have grown into the bladder's muscle wall or beyond.

That distinction drives everything. Superficial tumours are removed through the urethra and tend to come back, so they need years of camera checks. Muscle-invasive cancer needs major treatment, usually removal of the bladder or radiotherapy with chemotherapy.

Symptoms

• Blood in the urine, often painless and sometimes only once
• Needing to pass urine often or urgently
• Burning when passing urine without a proven infection
• Repeated urinary infections that do not settle
• Pain in the lower abdomen, side or bones in more advanced disease

Causes and risk factors

Smoking is the most important cause and accounts for around half of cases, because chemicals from tobacco are filtered into the urine. Past work with dyes, rubber, paints and some industrial chemicals raises risk. Other factors include previous pelvic radiotherapy, the chemotherapy drug cyclophosphamide, long-term catheters, chronic bladder irritation and, in parts of Africa and the Middle East, schistosomiasis infection. It is more common in men and after the age of 60.

How it is diagnosed

• Urine tests: Check for blood, infection and sometimes abnormal cells under the microscope.
• Cystoscopy: A thin camera passed through the urethra under local anaesthetic gel. It is the key test for any visible blood in the urine.
• CT urogram or ultrasound: Images the kidneys and ureters, which share the same lining and can carry tumours too.
• Transurethral resection (TURBT): Removes the tumour under anaesthetic. The pathology report gives the grade and shows whether muscle is invaded, which sets the treatment.
• Staging scans: CT of chest, abdomen and pelvis, and sometimes MRI, when the cancer is muscle-invasive.

Treatment options

• TURBT with a single dose of chemotherapy into the bladder: Standard first treatment for superficial tumours. A second resection is often advised for high-grade disease.
• BCG or chemotherapy bladder instillations: Weekly treatments through a catheter for 6 weeks, then maintenance doses for 1 to 3 years, to lower the chance of recurrence.
• Radical cystectomy: Removal of the bladder with a urinary diversion: a stoma bag, or a new bladder made from bowel in suitable people. Often preceded by chemotherapy.
• Radiotherapy with chemotherapy: A bladder-preserving alternative for selected people with muscle-invasive disease, given daily over 4 to 7 weeks.
• Immunotherapy and other systemic treatment: For cancer that has spread or returned, guided by an oncologist.
• Surveillance cystoscopy: Regular camera checks, every 3 months at first, because recurrence is common.

When it is urgent

Go to a local emergency department if you cannot pass urine, if you pass large clots or heavy bleeding that does not stop, or if you have fever and shivering with urinary symptoms. After bladder treatment, fever following BCG that lasts more than 2 days or comes with joint pain or breathlessness needs urgent medical review.

Travelling to Türkiye for treatment

Visible blood in the urine should be investigated promptly where you live, not saved for a trip. Travel can suit a second opinion on pathology and staging, a planned TURBT, or a cystectomy if you can stay about 3 to 4 weeks and have a stoma nurse and urologist arranged at home. BCG courses and surveillance cystoscopies run over years and are best organised locally. Bring your pathology slides or blocks and scan images.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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