Metastatic muscle invasive bladder cancer in pregnancy

We present the case of a woman in her 30s presenting in the second trimester with frank haematuria and left flank discomfort. MRI revealed a T3b bladder tumour with suspected peritoneal invasion. Chemotherapy was contraindicated due to teratogenicity. A coordinated obstetrics–urology MDT was undertaken at 33 weeks, an elective caesarean section was performed immediately followed by a transurethral resection of bladder for tumour debulking and histological assessment. A preterm but healthy infant was delivered and subsequently discharged from NICU. Histology revealed grade 2 bladder adenocarcinoma, in keeping with urachal origin. The patient progressed to metastatic T4 disease with pulmonary metastases and peritoneal involvement, requiring palliative chemotherapy. This case underscores the importance of a multidisciplinary approach in managing advanced bladder cancer during pregnancy, balancing maternal and foetal safety, respecting patient preferences and optimising oncological outcomes while highlighting the diagnostic and therapeutic challenges of cancer diagnosis in pregnancy.