Bladder cancer: warning signs and causes
The most common sign is blood in the urine, called peshab mein khoon in Hindi. It may come once and then disappear for weeks, which is why it is easy to ignore. Some people instead have burning, urgency or frequent urination without an infection.
Smoking (cigarettes, bidis or hookah) is the biggest cause, because chemicals from tobacco pass into the urine and sit against the bladder lining. Other risks are long-term work with dyes, rubber, leather, paint or certain chemicals, older age, and earlier radiotherapy to the pelvis.
See bladder cancer, blood in urine and our article on early signs of bladder cancer.
Tests for blood in the urine and bladder cancer
- Urine tests to rule out infection, and urine cytology, which looks for cancer cells.
- Ultrasound of the kidneys and bladder, and a CT urogram, which also checks the kidneys and ureters.
- Flexible cystoscopy: a thin, bendy camera passed into the bladder under local anaesthetic jelly, taking a few minutes. Read what to expect in our cystoscopy guide.
If a tumour is seen, the next step is TURBT, which both removes it and gives the tissue diagnosis. If the cancer has reached the muscle, a CT of the chest and abdomen, and sometimes an MRI, show whether it has spread.
Who needs which treatment: early or muscle-invasive cancer
Most bladder cancers are found while they are still in the inner lining. These are called non-muscle-invasive. Fewer have grown into the thick muscle wall; these are muscle-invasive and need a bigger treatment.
| Type | Usual treatment |
|---|---|
| Low-grade, non-muscle-invasive | TURBT, often a single dose of chemotherapy into the bladder, then check cystoscopies |
| High-grade, non-muscle-invasive, or carcinoma in situ (a flat, high-grade change in the lining) | TURBT, often a repeat TURBT, then a course of BCG into the bladder |
| High-grade cancer that keeps coming back despite BCG | Radical cystectomy is often advised |
| Muscle-invasive, not spread | Chemotherapy first where suitable, then radical cystectomy; or bladder-preserving chemoradiotherapy in selected patients |
| Spread to other organs | Medicines given by medical oncologists |
How TURBT is done, and when re-TURBT is needed
TURBT stands for transurethral resection of bladder tumour. Under spinal or general anaesthesia, a bipolar resectoscope (a telescope with an electric loop) is passed through the urethra. There is no cut on the skin. The tumour is shaved away in small pieces, including a sample of the muscle beneath it so the pathologist can tell how deep it goes. Bleeding points are sealed and a catheter is placed to wash the bladder. It usually takes 30-90 minutes.
For suitable low-risk tumours, a single dose of chemotherapy is put into the bladder through the catheter within a day of surgery to lower the chance of regrowth.
A re-TURBT, a second look a few weeks later, is advised when the tumour was large or high-grade, when the first removal may not have been complete, or when no muscle was in the sample. It catches cancer left behind and confirms the true stage.
Bladder instillations: BCG or chemotherapy
For non-muscle-invasive cancer, medicine is put directly into the bladder through a thin catheter, held for about one to two hours and then passed out in the urine. These are done in the clinic or day-care area, without anaesthesia.
- Chemotherapy instillations are used for low and intermediate-risk tumours.
- BCG is the weakened germ used in the TB vaccine. Placed in the bladder, it makes the immune system attack cancer cells in the lining. It is used for high-risk tumours: usually once a week for six weeks, then repeated courses for one to three years.
Burning, frequent urination, some blood in the urine and mild fever for a day or two are common. Call the clinic if a high fever or feeling unwell lasts more than two days. After BCG, sit to pass urine for the first hours and wash hands well.
Radical cystectomy and urinary diversion for muscle-invasive cancer
For suitable patients, medical oncologists give chemotherapy for a few months before surgery. Radical cystectomy then removes the bladder and nearby lymph nodes. In men the prostate and seminal vesicles are removed too; in women, the uterus, ovaries and part of the vagina are often removed, depending on the cancer. It is a major operation lasting several hours, usually done as open surgery.
Because the bladder is gone, urine needs a new path, called a urinary diversion:
| Ileal conduit | Neobladder | |
|---|---|---|
| What it is | A short piece of small bowel carries urine to an opening on the right side of the belly (a stoma) | A new bladder shaped from bowel and joined to the urethra |
| How you pass urine | Continuously into a bag stuck over the stoma | Through the urethra, by relaxing and gently straining at set times |
| Suits | Most patients; simpler and quicker | Fitter patients with good kidney function and no cancer in the urethra |
| Things to know | Bag changed every few days; skin care around the stoma | Night-time leakage is common at first; some people need to pass a catheter themselves |
You are taught how to care for the stoma or the neobladder before going home. Bladder-preserving treatment (thorough TURBT followed by chemotherapy and radiotherapy from oncologists) is an alternative for selected patients.
Hospital stay and recovery after bladder cancer surgery
| Time | After TURBT | After radical cystectomy |
|---|---|---|
| Day of surgery | Catheter with bladder wash | Close monitoring, drip, drains |
| Days 1-3 | Catheter out when urine clears; home in 1-2 days | Sitting and walking; fluids, then food as the bowel wakes up |
| Days 4-14 | Light activity; some blood in urine can come and go | Drains and tubes removed; stoma or neobladder training; home usually after 7-10 days |
| Weeks 2-12 | Pathology result and plan for instillations or re-TURBT | Strength returns slowly; no heavy lifting for about 6-8 weeks |
Seek help for fever, heavy bleeding or clots, being unable to pass urine, no urine in the stoma bag, vomiting or a swollen belly, leg swelling or breathlessness.
Risks of bladder cancer surgery
TURBT: bleeding, clots blocking the catheter, infection, and rarely a small hole in the bladder wall, which usually heals with a catheter left for longer.
Radical cystectomy: the bowel may be slow to start working, and wound infection, urine leak at the joins, blood clots and chest infection can occur. Later problems can include narrowing where the ureters join the bowel, kidney infections, vitamin B12 deficiency and changes in blood salts with a neobladder. Men often lose erections and both men and women lose fertility; this is discussed openly before surgery. Careful preparation, early walking, clot prevention and long-term check-ups reduce these risks.
Surveillance cystoscopies and stopping smoking
Non-muscle-invasive bladder cancer often comes back, so check cystoscopies are a normal part of care: usually at three months, then every few months to once a year depending on risk, for several years. Most can be done as a quick flexible cystoscopy. The kidneys and ureters are also imaged from time to time. After radical cystectomy, follow-up uses scans and blood tests instead.
Stopping smoking at any stage helps lower the chance of cancer returning. Ask for support if you find it hard. For an overview of other cancers, see urology cancer surgery.
Cost of bladder cancer treatment in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- Whether you need TURBT alone, a repeat TURBT, or radical cystectomy with urinary diversion
- The number of bladder instillations and whether BCG or chemotherapy is used
- CT urogram, cystoscopy, urine cytology and other tests
- The room category at ManglamPlus Medicity and the number of nights, which is much longer after cystectomy
- Stoma bags and supplies after an ileal conduit, and chemotherapy, which is billed separately
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Bladder cancer treatment with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Is blood in the urine always bladder cancer?
No. Stones, infection and an enlarged prostate are more common causes. But because bladder cancer can show this way, blood in the urine always deserves a check, especially if you smoke or are over 40.
What is the difference between TURBT and cystectomy?
TURBT removes the tumour through the urethra and keeps the bladder; it is used for most bladder tumours. Radical cystectomy removes the whole bladder and is used for cancer that has grown into the muscle or keeps returning despite treatment.
Will I need a urine bag after bladder cancer surgery?
Not after TURBT. After radical cystectomy with an ileal conduit, yes. A neobladder avoids a bag in suitable patients, and the choice is discussed before surgery.
Can BCG give me tuberculosis?
BCG is a weakened germ and serious BCG infection is rare. Follow the hygiene advice for the hours after treatment, and report a high fever or feeling very unwell quickly.
How often will I need cystoscopy?
Usually at three months after TURBT, then every few months to once a year depending on your risk, for several years.
Is bladder cancer treatment covered under RGHS, Ayushman or insurance?
Cover depends on the hospital’s empanelment and on your policy, and instillations or chemotherapy may be covered differently from surgery. Please confirm with the ManglamPlus Medicity billing desk. See cost, insurance and schemes.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.