Bladder Cancer: The Basics
Bladder cancer is caused by bladder cells growing out of control. As the number of cells grow, they form into a tumor. There are two types of bladder cancer:
- Transitional cell or urothelial cell bladder tumors start in either the innermost lining of the bladder.
- Adenocarcinomas, squamous cell carcinomas or small cell carcinomas start in other parts of the bladder.
Bladder cancer that has spread from the bladder to another part of the body is called metastatic cancer.
Bladder cancer affects more men than women and is more common in those over the age of 65. The largest risk factor for developing bladder cancer is smoking (currently or in the past). Other risk factors include:
- Family history.
- Genetic mutations.
- Occupational exposure to chemicals.
- Previous exposure to certain chemotherapy medications.
- Radiation to the pelvis.
- Exposure to arsenic in well water.
- Aristolochic (a Chinese herb).
- Bladder infections caused by schistosoma haematobium.
- Neurogenic bladder and the overuse of indwelling catheters.
There are no standard screening tests available.
Signs & Symptoms of Bladder Cancer
The most common sign of bladder cancer is hematuria (blood in the urine). Other symptoms are the result of irritation to the bladder wall caused by the tumor.
- Increased frequency of urination.
- Nocturia (waking up at night to urinate).
- Pain or burning with urination.
- Feeling of incomplete emptying of bladder.
Advanced cases of bladder cancer can be caused by the tumor blocking urine going in or out of the bladder. Advanced bladder cancer can cause:
- Flank pain (pain in upper back, abdomen or sides of these areas).
- Kidney Damage.
Diagnosis of Bladder Cancer
If you have blood in your urine, your healthcare provider will have your urine examined under a microscope. This can find bladder cancer cells. However, this test can miss a cancer diagnosis. You may also have:
- X-ray of the upper urinary tract.
- CT scan.
- Intravenous pyelogram (dye is put into a vein, which travels through the kidneys and bladder and can be seen on an x-ray).
- Cystoscopy with biopsy (camera placed through the urethra and into the bladder to see inside the bladder). A pathology report summarizes the results of the biopsy and is sent to your healthcare provider. This report is an important part of planning your treatment. You can request a copy of your report for your records.
- If the biopsy result shows cancer, a second cystoscopy with a resection (also called a transurethral resection or TUR) is done to further evaluate or remove the tumor.
Staging Bladder Cancer
To guide treatment, bladder cancer is "staged." The stage is based on:
- Size and location of the tumor.
- Whether cancer cells are found in the lymph nodes.
- Whether cancer cells are found in other areas of the body.
Stages range from stage 0 to stage IV. The stage and type of bladder cancer will help determine a treatment plan.
Treatment for bladder cancer depends on the type of bladder cancer you have and the stage.
Superficial Bladder Cancer
This type of cancer has not invaded the muscle. Treatments include:
- Transurethral resection or TUR. The goal of the TUR is to completely remove the cancer.
- After a TUR, the patient will receive intravesicular chemotherapy, which is chemotherapy that is infused directly into the bladder to kill any remaining cancer cells.
Muscle Invading Bladder Cancer
Bladder cancer that has invaded the muscle wall requires more extensive treatment. Treatment can include:
- Removal of the bladder (called cystectomy).
- Chemotherapy may be used either before or after surgery to shrink the tumor to make surgery easier, or to prevent recurrence.
- Radiation, chemotherapy and TUR may be used to avoid cystectomy.
For patients with advanced or metastatic disease that can not receive chemotherapy, immunotherapy may be a treatment option. There are many options that can be used to treat muscle invading bladder cancer and each case is unique. Speak to your provider about which course of treatment is right for you.
This article is a basic guide to bladder cancer. You can learn more about bladder cancer and treatment by using the links below.
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Bladder Cancer Treatment (PDQ ®). PDQ Cancer Information Summaries. National Cancer Institute. 01 Oct 2015.
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National Cancer Institute Surveillance, Epidemiology, and End Results Program. SEER Stat Fact Sheets: Bladder Cancer. 2015. Found at: http://seer.cancer.gov/statfacts/html/urinb.html
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National Cancer Institute. FDA Approves Immunotherapy Drugs for Patients with Bladder Cancer. 2017. Found at: https://www.cancer.gov/news-events/cancer-currents-blog/2017/approvals-fda-checkpoint-bladder
National Comprehensive Cancer Center Network. Bladder Cancer. Version 5.2017. Found at: https://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf
National Institutes of Health. Smoking and Bladder Cancer. 2011. Found at: https://www.nih.gov/news-events/nih-research-matters/smoking-bladder-cancer
Nguyen, D. P., & Thalmann, G. N. (2017). Contemporary update on neoadjuvant therapy for bladder cancer. Nature Reviews Urology, 14(6), 348.
Park, S., Reuter, V. E., & Hansel, D. E. (2019). Non‐urothelial carcinomas of the bladder. Histopathology, 74(1), 97-111.