What causes bladder cancer is not always clear, but the risk of developing bladder cancer can be increased by smoking, getting older, long term bladder problems and unsafe exposure to aniline dyes which are used in some industries. Bladder tumours usually form in cells lining the bladder. Once a tumour begins to enlarge, it may stay in the lining or grow into the wall of the bladder. If untreated, the tumour may then grow into other structures such as lymph nodes. If the cancer enters the bloodstream it may spread to other areas of the body (metastasis). Often the first symptom noticed is blood in the urine, other symptoms such as needing to pass urine more often or feeling as if you need to go but can’t affect about 1/3 of people with early bladder cancer. As the tumour grows these symptoms affect more people. The first test to diagnose bladder cancer is usually a urine sample. Sometimes a tube will be inserted through the urethra and the bladder will be washed with liquid to try to wash out some cancer cells for diagnosis. If cancer is suspected, the next step is usually a cytoscopy (a tube to allow the doctor to look inside the bladder). If there is to be a tumour the doctor can take a small sample (biopsy) for testing. CT or MRI scans are also used to scan the body to see if the cancer has spread to other areas. Treatment depends on the size of the tumour and how much it has grown into the bladder wall. Surgery may be considered especially if the tumour is still small. The surgeon can insert a cytoscope through the urethra and cut out the tumour or burn it away. If the tumour has grown more deeply the surgeon may cut open the abdomen and remove some or the entire bladder (a partial or full cystectomy). If the whole bladder is removed an artificial bladder will be created on the inside or a urostomy bag on the outside. Radiotherapy (an x-ray beam) can be used as the main treatment in some people and in others may be used after surgery to remove any remaining cancer cells. In early cancer, drugs (chemotherapy) or another treatment called BCG may be placed directly into the bladder to kill cancer cells (intravesical treatment). Usually though, chemotherapy is used in the later stages where it can attack cancer cells throughout the body (not just the bladder) and help stop the cancer spreading.