Bladder cancer occurs when cells in the bladder develop changes in their DNA, causing them to grow and divide uncontrollably. It is often diagnosed early because in many cases it causes obvious symptoms, such as blood in the urine (hematuria). While some risk factors for bladder cancer can be mitigated by behavior (e.g., smoking cessation), others cannot (e.g., age or gender). Treatment options for bladder cancer include surgery, chemotherapy, radiation, immunotherapy and targeted therapy.
According to the American Cancer Society, there will be roughly 83,730 new cases of bladder cancer in the United States this year. It is the fourth most common cancer in men, but it is less common in women. Bladder cancer is most often diagnosed in individuals who are ages 55 and older.
Find out what you need to know about detection, diagnosis and treatment here. Our experts keep you informed about the latest treatment options, research updates and advice on living with bladder cancer.
- What is Bladder Cancer?
- Types of Bladder Cancer
- Bladder Cancer Symptoms
- Bladder Cancer Causes
- Bladder Cancer Risk Factors
- Bladder Cancer Diagnosis
- Bladder Cancer Stages
- Bladder Cancer Treatment
- Bladder Cancer Survival
Bladder cancer occurs when cells in the bladder develop changes in their DNA, causing them to grow and divide abnormally. Instead of dying off like healthy cells, the cancer cells multiply rapidly, in some cases spreading and invading other tissues.
Urothelial carcinoma is the most common type of bladder cancer in the United States, accounting for approximately 90% of all cases. It usually starts in the urothelial cells that line the inside of the bladder, but it can be found in other parts of the urinary tract, too, such as the urethra.
Other types of bladder cancer include squamous cell carcinoma, which is linked to chronic bladder infections; adenocarcinoma, which begins in the cells that make up the mucus-secreting glands in the bladder; and small cell carcinoma, which starts in the neuroendocrine cells and is rare but aggressive.
Bladder cancer is often diagnosed early because it causes obvious symptoms, like blood in the urine (hematuria), that prompt patients to seek medical help.
Bladder cancer symptoms include:
- discolored urine (pink, rust-colored or bright red)
- pain during urination
- the urge to urinate frequently
- lower back pain
The symptoms of bladder cancer are similar to those of other medical conditions, such as infections or kidney disease. If you have questions or concerns about your health, please consult a healthcare professional.
While the exact cause of bladder cancer is not yet fully understood, scientists believe that most bladder cancer cases result from acquired mutations, rather than inherited ones.
- Acquired mutations are changes to the DNA that occur sometime during your lifetime and are not passed on from generation to generation. They are often a result of exposure to certain chemicals, like tobacco smoke, that end up in the urine and damage the bladder cells. Sometimes, however, there is no clear explanation for why cells become cancerous.
- Inherited mutations refer to genetic changes that are passed down from your parents. While some people are more sensitive to the effects of chemicals than others, which could be an inherited trait, bladder cancer is not considered to be an inherited disease.
While some risk factors for bladder cancer can be reduced by behavior (e.g., smoking cessation), others cannot (e.g., age or gender). Understanding the risks of bladder cancer will tell you if you are at risk for developing the disease.
According to the American Cancer Society, people who smoke are at least three times as likely to get bladder cancer as non-smokers. While smoking is most often associated with lung cancer, the chemicals damage the lining of the bladder as they are processed and excreted in urine, making smoking a significant risk factor for bladder cancer.
The risk for developing bladder cancer increases with age. Most people diagnosed with bladder cancer are over the age of 55.
Bladder cancer is more common in men than in women.
Exposure to Certain Chemicals
Frequent exposure to arsenic, paints, dyes, metals and petroleum products increases your risk of developing bladder cancer, as does drinking water that has been treated with chlorine.
Chronic Bladder Inflammation
Irritation caused by repeated urinary infections and long-term use of urinary catheters has been linked to bladder cancer.
Previous Cancer Treatment
If you have been treated with radiation therapy to the pelvis or have taken certain chemotherapy drugs (e.g., cyclophosphamide), you may be at increased risk of developing bladder cancer.
Personal History of Cancer
If you have had bladder cancer once, you are more likely to develop it a second time.
Family History of Cancer
Although bladder cancer is not considered hereditary, meaning it is not directly passed down by a parent, if one of your immediate relatives — a parent, sibling or child — has had bladder cancer, your risk of developing the disease may be higher.
There are several tests used to diagnose bladder cancer. Here is a list of what you might experience.
- Physical exam: Your doctor will likely start with a physical exam, which usually includes questions about your family medical history, pre-existing conditions and overall health. They will then look for any physical signs of cancer, which will most likely rely on an internal exam. During this test a doctor will (with gloves and lubrication) insert a finger into your rectum and/or vagina to check for any growths or lumps that are indicative of the disease.
- Urinalysis: If bladder cancer is suspected, your doctor will likely order a urinalysis, which is a test of your urine to assess its color and contents. The presence of red blood cells and white blood cells may indicate cancer.
- Urine Cytology: This is a test in which a urine sample is analyzed under a microscope to check for abnormal cells.
- Urine Culture: This is a test to rule out a urinary tract infection, which produces some of the same symptoms as bladder cancer.
- Cystoscopy: A cystoscope is a long, thin, flexible tube-like instrument with a light and a lens for viewing. A urologist inserts this tool through the urethra and uses it to look inside the bladder and urethra to check for abnormalities. During this procedure, they may also use the cystoscope to remove tissue samples, which are then checked under a microscope for signs of cancer.
- Biopsy: Cells and tissue samples are collected (often during a cystoscopy) and examined under a microscope by a pathologist for signs of bladder cancer. In some cases, this procedure, which is also called transurethral resection of bladder tumor (TURBT) can be used as a treatment method to remove the tumor.
- Intravenous Pyelogram (IVP): A contrast dye is injected into a vein. As the dye moves through the urinary system (kidneys, ureters and bladder) x-rays are taken to check for tumors, which are made visible by the dye.
If bladder cancer is discovered, your physician may recommend additional tests to determine whether the cancer has spread and how far. These tests include CT scan, magnetic resonance imaging (MRI), positron emission tomography (PET), bone scan and chest x-ray.
I’ve Been Diagnosed with Bladder Cancer, Now What?
Bladder cancer is highly treatable. A urologist (a doctor who specializes in the urinary system) can help you determine the best immediate course of action. Ask what stage of the disease you have, what treatment your care team recommends and why. This discussion will help guide you in making informed decisions about your treatment.
Staging is a process doctors use to determine if the bladder cancer has spread, and if so, how far. The staging system that is most commonly used for bladder cancer is the American Joint Committee on Cancer TNM system, which uses three metrics for classification:
T: refers to the size and extent of the tumor.
N: determines if the cancer has spread to nearby lymph nodes.
M: determines if the cancer has spread (metastasized) to other parts of the body.
The system has five stages: 0, I, II, III, IV. Stage 0 is the lowest stage and is assigned to cancers that have not spread beyond the bladder. Stage IV is the highest stage and indicates that the cancer has spread beyond the bladder to lymph nodes and/or other organs.
To learn more about bladder cancer staging, speak with your doctor. They can answer your questions and help you better understand your stage and prognosis.
What Is High Grade Bladder Cancer?
In addition to assigning a stage, your doctor may also give the bladder cancer a grade. A high-grade bladder cancer tends to be more aggressive and is more likely to spread. A low-grade bladder cancer usually grows slowly and is less likely to spread. The grade is based on the cell structure and appearance when examined through a microscope.
There are several ways to treat bladder cancer, and treatment options are sometimes used in combination. Your treatment plan will depend on the type, stage and grade of the cancer you have, as well as your overall health and personal preferences. These are the standard treatment approaches your care team may recommend:
- Surgery: This is the most common treatment for bladder cancer, especially if the disease has not spread beyond the bladder. There is more than one approach to bladder cancer surgery:
- Transurethral resection of bladder tumor (TURBT): This procedure is often used to diagnose bladder cancer, but it can also be used as a treatment option if the cancer has not yet spread. During the TURBT procedure, a surgeon inserts a cutting tool or an electric wire loop through a cystoscope and into the bladder to cut away or burn away the cancer. In some cases, a high-energy laser may be used.
- Cystectomy: This procedure removes all (radical cystectomy) or part (partial cystectomy) of the bladder, depending on the extent of the cancer. In women, a radical cystectomy may also include removal of the uterus, ovaries and part of the vagina. A cystectomy is often combined with chemotherapy.
- Reconstructive Surgery: After a radical cystectomy, which involves removing the entire bladder, you will need reconstructive surgery to allow your body to store and pass urine. Options for reconstructive surgery include: neobladder reconstruction, ileal conduit and continent urinary reservoir.
- Chemotherapy: For some types of cancer, chemotherapy drugs are administered individually. For bladder cancer, however, two or more drugs are often used in combination. Chemotherapy can be administered directly into the bladder (intravesical chemotherapy) or through a vein or muscle (systemic chemotherapy). Examples of chemotherapy drugs used to treat bladder cancer include mitomycin (Mitosol), a combination of gemcitabine (Gemzar) and cisplatin, or a combination of cisplatin, methotrexate, and vinblastine (CMV).
- Radiation therapy: This can be used as a primary treatment for early-stage bladder cancer, or in combination with surgery and/or chemotherapy for more advanced cases. For bladder cancer, radiation therapy is most often delivered from outside of the body (external beam radiation), directing high-energy beams at specific points to kill cancer cells.
- Immunotherapy: Immunotherapy drugs are used to help your body recognize and defend against cancer cells. They can be administered directly into the bladder (intravesical therapy) or through a vein (intravenous therapy). Checkpoint inhibitors used to help the immune system fight bladder cancer include atezolizumab (Tecentriq), durvalumab (Imfinzi), avelumab (Bavencio), nivolumab (Opdivo) and pembrolizumab (Keytruda).
- Targeted therapy: These drugs are used to identify and attack cancer cells, which causes less harm to your normal cells. They may be used to treat bladder cancer after the disease hasn’t responded other treatments.
Here are a few questions to ask when discussing treatment options with your doctor:
- What type of bladder cancer do I have?
- What stage is it and what does that mean?
- What grade is the cancer?
- Do I need to start treatment right away?
- Which treatment option(s) do you recommend, and why?
- How long will the treatment last?
- What are the risks and side effects?
- How will we know the treatment is working?
Survival rates for bladder cancer are high overall. According to Surveillance, Epidemiology, and End Results (SEER) data published by the National Cancer Institute, the relative five-year survival rate from 2010 to 2016 was 77%. This means that the majority of individuals diagnosed with bladder cancer were still alive five years after their diagnosis.
When the disease is in situ (meaning it hasn’t spread) the 5-year survival rate is 96%. When it is localized or regional, it is 69% and 37%, respectively. For distant stages of the disease, the 5-year survival rate is 6%, but these types of bladder cancer are less common. Even if you are diagnosed with a more aggressive stage of the disease, it is important to recognize that there is hope — regular medical advancements are making progress.