Bladder Cancer

NICE guideline [NG2] Bladder cancer: diagnosis and management. Published: Feb 2015. NICE guideline [NG12] Suspected cancer: recognition and referral 1.6 Urological cancers. Last updated: May 2025.

Referral Guidelines

Refer with suspected bladder cancer pathway if:
  • ≥45 y/o with unexplained visible haematuria without UTIUrinary tract infection / persists or recurs after UTIUrinary tract infection treatment, or
  • ≥60 y/o with unexplained non-visible haematuria + dysuria / WCCWhite cell count

Consider non-urgent referral if:
  • ≥60 y/o + recurrent / persistent unexplained UTIUrinary tract infection

Diagnosis Guidelines

1st line and gold standard: cystoscopy
  • Direct visualisation, then TURBTTrans-urethral resection of bladder tumour for histology (ensure to obtain detrusor muscle)
  • If muscle-invasive bladder cancer is suspected at cystoscopy → consider delaying TURBT after CT / MRI staging.

Staging (indicated in muscle-invasive bladder cancer and high-risk non-muscle invasive bladder cancer):
  • 1st line: CT / MRI
  • 2nd line: PET CT

 

TURBT can, and is often performed at the initial diagnostic cystoscopy. TURBT is both diagnostic (biopsy for histology) and therapeutic (removal).

Management Guidelines

Bladder cancer classification that guides management (simplified from NICE):
  • Muscle-invasive bladder cancer
  • Non-muscle invasive bladder cancer
    • High risk - carcinoma in situ / lamina propria invasion / high grade (3)
    • Non-high risk

Offer:
  • Neoadjuvant chemotherapy (cisplatin combination), and
  • Radical cystectomy / radiotherapy
 

Offer cisplatin-based chemotherapy

Other management:
  • Palliative radiotherapy for bladder symptoms
  • Percutaneous nephrostomy / retrograde stenting for ureteric obstruction

Offer:
  • Repeat TURBTTrans-urethral resection of bladder tumour <6 weeks after 1st resection, and
  • Choice of:
    • Radial cystectomy (with urinary stoma / continent urinary diversion), or
    • Intravesical BCG

Offer:

  • TURBTTrans-urethral resection of bladder tumour, and
  • Intravesical mitomycin C
Author: Adams Lau
Reviewer:
Last edited: 30/08/25