Bladder cancer is a relatively common cancer that affects around 21,500 people each year in the UK. The most common symptom is blood in the urine (wee), and if you’re experiencing this, or any of the other symptoms we’ll discuss in this article, it’s important to speak to your GP, even if your symptoms come and go.

There are a number of tests used to diagnose (or rule out) this type of cancer, including a bladder cancer MRI (magnetic resonance imaging) scan. As with all cancers, the earlier it’s diagnosed, the better your chances of recovery. If you’re concerned, read on to learn the symptoms, what you should do and how an MRI scan can diagnose bladder cancer.

What is Bladder Cancer?

The bladder is sometimes referred to as the urinary bladder by doctors and specialists. The urinary bladder forms part of the urinary tract, which comprises of the:

Kidneys
Ureters (the tubes that take urine from the kidneys to the bladder)
Bladder
Urethra (the tube that empties urine from the bladder when you go to the toilet)

Bladder cancer, sometimes referred to as bladder carcinoma, is a type of cancer where a tumour (a collection of abnormal, fast-growing cells) develops in the bladder. The majority of bladder cancers (around 90%) are a type of urothelial or transitional cell carcinoma - that is, they develop from the cells of the lining of the bladder wall, called urothelial or transitional cells. There are two types of transitional cell carcinoma - non muscle invasive and muscle invasive.

Non muscle invasive bladder cancer

If a bladder tumour is detected and is contained within the lining of the bladder, it’s known medically as early bladder cancer, or non muscle invasive bladder cancer, as it hasn’t spread into the deeper layers of the lining of the bladder wall. There are three main types of non muscle invasive bladder cancer:

Papillary bladder cancer - characterised by small, mushroom-like growths that grow from the bladder lining
Carcinoma in situ (CIS) bladder cancer - characterised by flat, fast-growing tumours
High grade T1 tumours - early but fast-growing bladder cancers that have spread into the layer underneath the wall lining called the lamina propria, but not the muscle layer

Muscle Invasive Bladder Cancer

Sometimes, a bladder tumour can spread further, into the muscle layer of the urinary bladder called the detrusor muscle. Bladder cancer that has spread from the bladder lining, through the connective tissue into the detrusor muscle is known as muscle invasive bladder cancer. This kind of muscle invasion by a bladder carcinoma results in larger, more aggressive tumours that require different treatment and are more serious as they’re more likely to spread outside of the bladder.

Metastatic Bladder Cancer

Cancer that started in the bladder and has spread beyond the muscle layer of the bladder is known as advanced or metastatic bladder cancer. Some bladder cancers can spread to the layer of fat that surrounds the bladder, called the perivesical fat. The perivesical fat is surrounded by lymph nodes, and if bladder cancer reaches this layer and spreads to the lymph nodes, there is a higher chance that it will spread, via the lymph nodes, to other parts of the body.

If you’re diagnosed with bladder cancer, your specialist will explain what type you have, and they will discuss tumour staging with you, which describes what stage your cancer is, and what your treatment options are.

Symptoms

The symptoms of bladder cancer include:

Passing blood in your urine either all or some of the time (the medical term for blood in your urine is haematuria)
The need to pass urine more frequently or more urgently
A burning pain when passing urine
Frequent urine infections

Remember, the main symptom of a bladder carcinoma is blood in the urine. The other symptoms listed above are less common - therefore if you have blood in your urine, speak to your GP.

If left untreated, some bladder cancers also cause:

Pain in the pelvic region or lower back
Unexplained weight loss
A general unwell feeling
Swelling in the legs and feet

Can an MRI Scan Detect Bladder Cancer?

Yes, if you have symptoms of a bladder carcinoma, a bladder cancer MRI scan is one of the most important diagnostic tools available to doctors in order to diagnose the condition. Once you have a diagnosis, your medical team will be able to put a treatment plan in place.

What Does it Look Like on MRI?

A bladder cancer MRI looks for contrasts in brightness between certain tissues and potential bladder tumours, rating them on a system of signal intensity, from low signal to high signal. These contrasts can then be used by a trained specialist to diagnose the presence or absence of bladder cancer.

Diagnosing Bladder Cancer

If you have blood in your urine, it doesn’t necessarily mean that you have bladder cancer but you should make an appointment to see your GP as soon as possible. They will then ask a few questions about your symptoms, and if necessary, refer you for more tests including the following:

Medical History and Symptom Review

Your doctor will ask you questions regarding your general health and wellbeing and your symptoms. They will also ask if you smoke or have ever smoked, and if you have a family history of bladder cancer.

Physical Examination

You will also have a physical examination - your doctor will feel around your abdomen and may also feel inside your vagina or rectum, as a bladder tumour may cause a lump that may push against these organs.

Urinalysis

You will be asked to provide a urine sample that will be sent to a laboratory to be tested for the presence of blood or signs of an infection.

Urine Cytology

Your urine sample will also be tested for the presence of abnormal cells that could indicate cancer.

Cystoscopy

If the tests performed so far indicate that you may have bladder cancer, you’ll be sent for a cystoscopy. During a cystoscopy, your specialist will pass a long, thin tube with a small camera and light on the end, called a cystoscope, through your urethra, into your bladder. They will look for abnormalities that may indicate cancer. The process takes around five minutes and a local anaesthetic gel will be applied to your urethral area beforehand so that you feel no pain.

Bladder Biopsy

If during a cystoscopy abnormalities are found, you will be referred for a procedure called a transurethral resection of a bladder tumour (TURBT). This is carried out under a general anaesthetic and involves your surgeon:

Taking a sample of bladder cells (a biopsy) to look for cancerous cells
Possibly taking a small piece of tissue from the detrusor muscle for testing if they suspect muscle invasive bladder cancer
If necessary, removing the tumours from the bladder lining

If necessary, you may have a second TURBT six weeks later to see if all of the cancer has been removed and to see if there has been any spread beyond the bladder wall into the muscle.

MRI

A bladder cancer MRI scan produces a black, white and grey image of the bladder - a trained specialist will be able to differentiate between normal bladder tissues and cancerous cells by looking at the contrast in brightness, or signal intensity on the MRI scan results.

CT Scan

A CT, or computed tomography, scan is sometimes used to diagnose bladder cancer, and can be useful if cancer that started in the bladder has spread to other parts of the body.

Ultrasound

An ultrasound scan is sometimes used to examine the whole urinary tract. It uses high-frequency soundwaves to create an image that specialists can use to look for bladder tumours and blockages in the ureter tubes that pass urine from the kidneys to the bladder.

PET Scan

A PET, or positron emission tomography, scan is sometimes used to help doctors stage bladder cancer, to see if it’s spread or to monitor the success of any treatment.

Differential Diagnosis

Urinary tract infections, or UTIs, have similar symptoms to bladder cancer, such as blood in the urine and pain or burning when passing urine. Other conditions that could display similar symptoms include kidney stones and prostate cancer. If you have any of the symptoms mentioned above, it’s best to get them checked out to give you peace of mind.

Causes of Bladder Cancer

Most cases of bladder cancer, in particular non muscle and muscle invasive transitional cell carcinomas (the most common forms), develop because the cells of the bladder wall have been exposed to certain chemicals. The most common of these chemicals are those found in tobacco smoke. Long-term smoking is thought to be responsible for more than a third of all bladder cancer cases and is considered the biggest risk factor.

Other groups of chemicals that are also linked to bladder cancer are:

Aromatic amines
Polycyclic aromatic hydrocarbons (PAH)

You may be exposed to these if you work or have worked in industries or manufacturing involving:

Textile dyeing
Leather tanning
Handling crude oil
Smelting
Paints
Plastics
Rubbers

Frequent exposure to diesel fumes, such as working as a taxi or bus driver, may also be linked to an increased risk of bladder cancer. There is also evidence that the following may also increase your risk:

A family history of bladder cancer
Being overweight or obese
Taking certain medications for type 2 diabetes
Long-term or frequent bladder infections or stones
Having had a long-term catheter
Having previously had radiotherapy near to the bladder, such as for bowel cancer
Having had an infection called schistosomiasis (bilharzia), although this is rare in the UK

Prognosis and Treatment

Your recovery from bladder cancer will depend on the type of cancer you had, the stage of the cancer and your overall health and fitness. Treatment options will also depend on these factors and range from the TURBT procedure mentioned above, to chemotherapy and radiotherapy, or a combination of treatments. Some bladder cancers require surgical treatment called a radical cystectomy, to remove the entire bladder, part of the urethra and the nearby lymph nodes. Your medical team will discuss your treatment options with you, and offer full physical and mental health support throughout.

Why an MRI Scan is a Good Option

A bladder cancer MRI can be used to definitively confirm or rule out bladder cancer, meaning that if necessary, you can begin treatment as soon as possible.

How an MRI Scan Detects Bladder Cancer

An MRI scan uses strong magnets and radio waves to create an image of the soft tissues inside the body. Due to its high diagnostic performance, it’s often the preferred scan to diagnose bladder cancer. It can differentiate between the bladder wall and muscle and any tumours present and is useful in determining how far a tumour might extend into the bladder wall or muscle.

A bladder cancer MRI is also used to detect any spread of the disease to the lymph nodes or to other parts of the body. If cancer is suspected in the kidneys, you may have a multiparametric MRI scan that combines numerous MRI scanning techniques to get a detailed view of the kidneys. A dynamic contrast enhanced MRI, or DCE-MRI may also be used, and involves injecting a dye into the bladder to further enhance MRI images. This allows doctors to diagnose and stage a bladder carcinoma with more accuracy, alongside computer programming called the Vesical Imaging Reporting and Data System (or VI-RADS).

Find an MRI Scan for Bladder Cancer

If you’ve experienced blood in your urine, even just once, it’s best to see your GP. Sometimes, waiting for an appointment can be frustrating - if you’re concerned and would like a bladder cancer MRI, book a private scan appointment today. If you’re unsure what scan is right for you, book an appointment to see one of our private consultants who can advise you.

References

Getting diagnosed with bladder cancer. (n.d.). Cancer Research UK. https://www.cancerresearchuk.org/about-cancer/bladder-cancer/getting-diagnosed

Oldham, R. (2024b, May 10). Understanding bladder cancer: symptoms, causes, and treatment. Cancer Support UK. https://cancersupportuk.org/understanding-bladder-cancer-symptoms-causes-and-treatment/

Sim, K. C., & Sung, D. J. (2020). Role of magnetic resonance imaging in tumor staging and follow-up for bladder cancer. Translational Andrology and Urology, 9(6), 2890–2907. https://doi.org/10.21037/tau-19-671

Website, N. (2023c, November 6). Treatment. nhs.uk. https://www.nhs.uk/conditions/bladder-cancer/treatment/

Can an MRI Scan Diagnose Bladder Cancer?

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