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02 September 2014

NICE developing a new guideline to end the postcode lottery for treating bladder cancer

NICE is developing its first guideline on treating bladder cancer to address the wide variation in the treatment options available to people with the disease.

Bladder cancer is the seventh most common cancer in the UK. Due to the number of people with the disease, the intensive treatment and prolonged hospital stays needed1, it is thought to be one of the most expensive cancers for the NHS, but there is a wide variation across the country in terms of the treatments offered

This is the first NICE guideline to look at how best to diagnose and manage bladder cancer and its aim is to help ensure patients are diagnosed quickly and accurately and receive the best possible care.

Commenting on the new draft recommendations, Professor Mark Baker, Centre for Clinical Practice director at NICE, said: “The majority of people are diagnosed with bladder cancer after a visit to their GP because they’ve noticed blood in their urine. But for many a diagnosis is only made when they are admitted to hospital in an emergency – in these cases prognosis can be poor, which is why it is so important that people are aware of the warning signs. Blood in the urine is the most common sign, but other symptoms may include a need to visit the toilet on a more frequent basis or a burning sensation when passing urine.

“Around 10,000 people are diagnosed 2 and 5,0003 people die as a result of bladder cancer in the UK each year. There are effective treatments available, but we know that there is a wide variation across the country in how well the disease is diagnosed and the care available locally.

“Due to the location of the tumours and the nature of the treatments which can affect bowel, bladder and sexual function, bladder cancer can also have a profound impact on someone’s psychological wellbeing as well as their physical health. Recommendations made in this new draft guideline emphasise the importance of ensuring patients have all the information they need, to enable them to make better informed decisions about their care, improving their quality of life during and after treatment.”

There are two main types of bladder cancer – non-invasive bladder cancer is only in the inner lining of the bladder and invasive bladder cancer is cancer that has spread into the deeper walls of the bladder.

Draft recommendations include:

Information and support for people with bladder cancer: A holistic needs assessment should be used to identify an individualised package of information and support for people with bladder cancer and, if they wish, their partners, families or carers, at key points in their care such as:

  • when they are first diagnosed
  • after they have had their first treatment
  • if their bladder cancer recurs or progresses
  • if their treatment is changed
  • if palliative or end of life care is being discussed.

Diagnosing bladder cancer: A CT or MRI staging should be considered before surgery to remove the tumour (transurethral resection of bladder tumour, TURBT) if muscle-invasive bladder cancer is suspected at cystoscopy.

Managing high-risk non-muscle invasive bladder cancer: The choice of intravesical BCG (Bacille Calmette-Guérin, a variant of the BCG vaccine) or cystectomy (surgical removal of part or all of the bladder) should be offered to people with high-risk non-muscle-invasive bladder cancer, and base the choice on a full discussion with the person, the clinical nurse specialist and a urologist who performs both intravesical BCG and cystectomy.

Managing muscle-invasive bladder cancer: A choice of cystectomy or chemoradiotherapy should be offered to people with muscle-invasive bladder cancer for whom radical therapy is suitable. The choice should be based on a full discussion between the person and a urologist who performs cystectomy, a clinical oncologist and a clinical nurse specialist.

The new draft guideline will be available on the NICE website from Wednesday 3 September; publication of the final recommendations is expected in February 2015 

Notes to Editors


  1. The intensive treatment needed for muscle-invasive bladder cancer and the prolonged hospital stay needed for nonmuscle-invasive bladder cancer mean that bladder cancer is one of the most expensive cancers to treat.
  2. CRUK (2013a). Bladder cancer incidence statistics. (Online).  Available from:
  3. CRUK (2013b). Bladder cancer mortality statistics. (Online).  Available from:
  4. The draft guidance will be available from 3 September 2014. Embargoed copies of the draft guidance are available from the NICE press office on request.
  5. Clinical guidelines are applicable in England and Wales, but they are also usually disseminated in Northern Ireland after review

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