Raising Awareness of Bladder Cancer Symptoms and Tests

Bladder cancer occurs when there is a growth of abnormal tissue, known as a tumour, which develops the bladder lining. In some cases, the tumour spreads into the bladder muscle. The risk of developing men is 1 in 29 and lower in women at 1 in 89. Smoking is the biggest risk factor in developing bladder cancer. Other factors that increase its likelihood include:

• Exposure to chemicals, especially in jobs involving textiles, dyes, tanning, rubber, paints or plastics.

• Previous cancer treatments such as chemotherapy or radiotherapy.

• Having a catheter for a long time.

• Long-term or repetitive UTI (urinary tract infections).

• Long-term bladder stones.

Early detection of bladder cancer is extremely important as it significantly increases the chance of survival. If a bladder cancer is found early (at Stage 1) the survival rate is high, with around 8 in 10 people surviving 5 years or more.

Medical Negligence Case Study: Rosina Blower’s Story

Rosina Blower was born in 1933 and lived all her life in Warsop. She was a very charismatic and social person. She was married to George Johnson for 58 happy years, and they had a family. George described their wedding as a very full house surrounded by many family and friends.

Rosina sadly passed away on the 24th of March in 2017 as a result of bladder cancer that had gone undiagnosed for 9 years. Rosina started having stress incontinence urinary symptoms in 1996 and was being seen by her GP and the local Gynaecology Unit. At that time, a cystoscopy and histology were undertaken, which reported evidence of “keratinising squamous metaplasia” which is known to have a high risk of developing bladder cancer. Unfortunately, those treating her had failed to recognise the significance of this finding, which should have resulted in her being referred to a Urology Specialist for regular check-ups and monitoring.

Four years later, in 2000, she was experiencing difficulties emptying her bladder and was told to use a self-catheter (referred to as ISC). This caused her to suffer recurring urinary tract infections. Eight years later, in 2008, her symptoms worsened and now included bladder pain. Another cystoscopy was performed, which reported widespread metaplastic changes stating that her whole bladder was covered with extensive squamous metaplasia. Her doctor wrote to her stating, “I am pleased to report your histology report shows keratinised squamous metaplasia, which is secondary to intermittent self-catheterisation and some acute inflammation, so no great worries”. And she was again not referred to a Urologist for further cancer monitoring.

Over the next 8 years, Rosina was periodically treated with DSMO, or Dimethyl Sulfoxide, which is a powerful anti-inflammatory, to address her bladder pain and antibiotics for intermittent UTIs. In the spring of 2016, she highlighted new and worsening difficulties and became incontinent when her bladder became distended (or full). At this time, a permanent catheter was fitted. Shortly after Rosina started experiencing increasingly frequent bladder pain and a new pelvic pain.

6 months later, in the winter of 2016, she was admitted to the hospital with even more deteriorating symptoms, including vulval pain and urinary incontinence upon standing. She was only treated for a UTI, was discharged and sent home without further testing.

The following month, in January 2017, Rosina returned to her GP with systemic symptoms of vomiting, poor appetite, weight loss and mobility issues. In general, she felt very unwell. Tests reported she had elevated inflammatory markers. She was admitted to the hospital for an ultrasound, which identified a tumour in her bladder. Two months later, in March 2017, she had

another cystoscopy, which confirmed the tumour was a metastatic bladder carcinoma with bone involvement. Rosina’s tissue examination under microscope test results reported transitional cell carcinoma with extensive squamous differentiation, her test results also showed a fracture of the pelvis caused by disease rather than trauma.

At this stage, radiotherapy was not a viable option for Rosina, and she was given palliative care. She died later that month in March 2017.

Medical Negligence and Missed Opportunities for Early Diagnosis

A year after Rosina’s death, her husband, George, contacted Hopkins Solicitors to investigate if there was any medical negligence involved in her care. It was determined by investigation that the treating doctors had not appreciated any of the red flags in her initial histology reports back in 2008, and that Rosina should have been told by her doctor that there was a future risk that it could turn into cancer. She should have been referred to a Urology Specialist for annual monitoring and testing. If the monitoring had taken place, it is highly likely that Rosina’s bladder cancer would have been diagnosed in its early stages, and treatment could have been given to extend and improve her quality of life. Her husband’s medical negligence

claim was successful in 2024. Like many bereaved spouses, George’s main purpose for the claim was not to receive money, but to ensure those involved in her care admitted liability and to ensure the Medical Trust’s involved were aware, hopefully ensuring other patients in the future wouldn’t experience the same mistakes.

Bladder Cancer Awareness

Early Detection is extremely important, as treatment can significantly extend your life expectancy and reduce or eliminate the life-changing symptoms associated with bladder cancer.

If you or a loved one is experiencing any of the symptoms listed above, ensure you seek medical investigations.

If you feel you or a loved one have had a delayed diagnosed of bladder cancer, our trusted and experience Medical negligence team can investigate if you have a valid negligence claim or pursue a complaint process, to ensure the Trusts involved in your care are aware there are errors in their diagnosing process so they can improve them for future patients.

If you do and say nothing, the trust may not know it needs to take steps to improve and prevent future mistakes.