15th July 2024

Bladder malignancy

Bladder cancers are predominantly transitional cell cancers (TCCs) originating from the urothelium. Such cancers can, in fact, originate anywhere from the renal pelvis to the urethra. Squamous cell cancers are less common in the UK and the Western world, often occurring secondary to schistosomiasis infection.

The most common presenting complaint is painless haematuria, and around 15% of patients presenting with macroscopic haematuria will have bladder cancer. Patients may also have symptoms we often associate with prostatism, such as frequency urgency, nocturia and dysuria.

Cystoscopy is the mainstay of diagnosis, allowing visualisation of lesions and biopsy. Further imaging, such as CT or USS, can demonstrate obstruction and hydronephrosis, as well as allow staging.

The nature of TCCs means they often grow as papillary tumours, projecting into the bladder lumen initially. They are also often multifocal, around a third are synchronous at presentation. The majority are low grade at diagnosis, not invading muscle and therefore have a good prognosis.

Management is often surgical, with transurethral resection with or without intravesical immunotherapy bacille Calmette – Guérin (BCG).