Bladder Cancer

Bladder cancer is a tumor that starts in the lining of your bladder. This is the small, hollow organ that holds your pee. It usually happens when urothelial cells — the ones that shrink and swell so your bladder can store and release pee — become abnormal. This same kind of cell lines part of your kidneys and ureters (the tubes that carry pee to your bladder). If you have bladder cancer, your healthcare provider will check for cancer cells there, too.

Providers have many ways to treat bladder cancer. This includes surgery, radiation and medicines. But even when providers find and treat tumors before they spread, they often come back.

You’ll work closely with your urologist, oncologist and/or radiation oncologist to keep an eye on your health. That way, you can get treatment as soon as you need it.

Types

There are different types of bladder cancer. Each gets its name from the cells where the cancer starts. Types include:

• Urothelial carcinoma: The most common type, it accounts for about 9 out of 10 bladder cancers in the U.S. 
• Squamous cell carcinoma: Squamous cells (like those in your skin) are also in your bladder lining. This type typically affects people who’ve had long bouts of bladder irritation.
• Adenocarcinoma: This rare type starts in the glands that line your bladder.

There are several rarer types and subtypes, too.

Providers also describe bladder cancers based on the extent of tumor growth. From least to most advanced, they are:

• Non-muscle-invasive (NMIBC): The cancer is in your bladder lining. It hasn’t spread to your bladder’s muscle wall. About 3 out of 4 bladder cancers are this type. 
• Muscle-invasive (MIBC): Cancer cells have grown into bladder wall muscle.
• Metastatic: This kind has spread to organs outside of your bladder, like your bones, lungs or liver.

Symptoms of bladder cancer

Symptoms include:

• Blood in your pee
• Pain when you pee
• Needing to pee a lot
• Having trouble peeing

More common conditions can cause these symptoms, too. So, having them isn’t a sure sign of bladder cancer. But you should still contact a healthcare provider if you have one or more of them.

Bladder cancer causes

This condition happens when cells in your bladder lining mutate, or change. They become abnormal cells that multiply and form tumors. Left untreated, tumors may grow through your bladder wall. They can spread to nearby lymph nodes and then other parts of your body. At this point, the cancer is most advanced or metastatic.

Experts don’t know why these changes happen. But they’ve found factors that increase the chance of having bladder cancer.

Risk factors

Risk factors include:

• Age and sex: Most people diagnosed are men aged 55 or older. It’s the fourth most common cancer in men living in the U.S.
• Cigarette smoke: Smoking cigarettes more than triples your risk of developing bladder cancer. Smoking pipes and cigars, using smokeless tobacco and exposure to secondhand smoke may also increase your risk.
• Exposure to chemicals: People who work with certain chemicals used in dyes, rubber, leather, paint, some textiles and hairdressing supplies may have an increased risk. Toxic chemicals in drinking water and swimming pools are also risk factors.
• Past cancer treatments: The chemotherapy drug cyclophosphamide and previous radiation therapy directed at your pelvis are risk factors.
• Chronic bladder inflammation: Frequent bladder or urinary tract infections can increase your risk. So can long-term catheter use.

How to lower your risk

You can’t always prevent bladder cancer. But you can greatly lower your risk by choosing not to smoke or use tobacco. If you already do, your healthcare provider can connect you with resources to help you quit.

Most people know that lung cancer is the most common cause of deaths related to smoking. But bladder cancer is the second most common.

How doctors diagnose bladder cancer

Healthcare providers often do tests on a urine (pee) sample to check for signs of cancer. Some tests help rule out other conditions that may be causing your symptoms. For example, a urinalysis can rule out urinary tract infection (UTI).

You’ll need procedures to diagnose this condition, including:

• Cystoscopy: This is the main test to diagnose bladder cancer. Providers use a flexible lighted tube to view the inside of your bladder. They may take tissue or fluid samples for testing during the procedure.
• Transurethral resection of bladder tumor (TURBT): This procedure removes bladder tumors. Then, a provider tests the cancer cells to learn more about the diagnosis. TURBT procedures may also be a treatment.

If the results show bladder cancer, you’ll need more tests to help your provider know how advanced it is. Tests include:

• A CT scan or MRI to check for cancer in your kidneys and ureters, as well as your lymph nodes, lungs and bones
• An intravenous pyelogram (IVP) or CT urogram to look for cancer cells in your kidneys and ureters
• A chest X-ray to check for cancer spread in your lungs
• A bone scan to see if cancer has spread to your bones

Staging and grading

Healthcare providers use what they learn about the cancer to stage and grade the disease. Staging shows how advanced the cancer is, based on the size and location of tumors. Grading shows how aggressive it is, based on how abnormal the cancer cells look.

• Early-stage tumors are confined to the lining of your bladder. They may be in the connective tissue just below the lining. They’re not in your muscle wall. 
• Invasive bladder tumors have spread to the muscle wall. Tumors at more advanced stages may have spread to nearby organs or tissue.
• Metastatic bladder cancer has spread to distant organs.

All muscle-invasive bladder cancers (MIBC) are high-grade. This means they’re fast-growing. Non-muscle-invasive bladder cancers (NMIBC) are either high-grade or low-grade.

These classifications impact the treatments you’ll need.

How is it treated?

There are several types of treatment.

Surgery

Surgery is a common treatment. Providers choose the type of surgery based on the cancer stage and grade.

Many times, TURBT — the procedure used to diagnose bladder cancer — can treat bladder cancer that hasn’t invaded your bladder’s muscle wall. Your provider may remove the tumor or use high-energy electricity to burn it away.

Radical cystectomy is the most common treatment for muscle-invasive bladder cancer. It also treats high-grade (aggressive) bladder cancers. This surgery removes your bladder and surrounding organs. This includes the prostate and seminal vesicles in males. It includes the ovaries, uterus and part of the vagina in females. Providers do surgery known as urinary diversion so you can still pass pee.

Often, providers give medicines, like chemotherapy and immunotherapy, before and/or after surgery.

Chemotherapy

These are cancer-killing drugs. Providers may deliver chemotherapy drugs directly to your bladder via a tube inserted into your urethra. This is called intravesical therapy. It targets cancer without damaging healthy tissue. 

You may also get chemotherapy that travels throughout your body through an IV.

Radiation therapy

Radiation therapy may be an alternative to bladder removal surgery. Sometimes, healthcare providers combine radiation therapy with TURBT and chemotherapy. This is called trimodal therapy. It fights cancer while allowing people to keep their bladders. 

Your healthcare provider can help you weigh the pros and cons of this treatment versus surgery if it’s an option.

Immunotherapy

Immunotherapy uses your immune system to attack cancer cells. Your provider might recommend Bacillus Calmette-Guérin (BCG) to treat early-stage bladder cancer. Like intravesical chemotherapy, this treatment sends drugs directly to your bladder. 

Other treatments include PD-1 or PD-L1 inhibitor immunotherapies. You get them through a vein (IV).

Antibody-drug conjugates

Antibody drug conjugates (ADCs) seek out cancer cells and then deliver powerful medicine to destroy them. These drugs can target cancer cells directly, sparing healthy cells. 

Targeted therapy

Targeted therapy attacks the weaknesses in cancer cells. For instance, drugs called FGFR gene inhibitors disrupt processes that cancer cells use to grow. 

When should I see my healthcare provider?

Even when the cancer goes away, you’ll still need to see your provider for regular checkups. This is because bladder cancer may come back. Usually, checkups are most frequent in the first year or two after treatment. If you remain cancer-free in that time, you may need follow-ups less often.

Contact your provider any time you have symptoms that might mean the cancer has returned.

What can I expect if I have this condition?

Early detection and treatment increase the chance of living longer with bladder cancer. Most people have early-stage disease that’s relatively easy to treat. It can be curable when surgery or radiation removes all traces of the cancer cells. But it can come back if any cancer cells remain. This is why you’ll need regular checkups after treatment.

Cancer treatments for invasive bladder cancer can help you live longer with fewer symptoms.

What is the survival rate for bladder cancer?

About 7 in 10 people who receive treatment for bladder cancer confined to the bladder are alive five years after diagnosis. The survival rate drops to a little under 4 in 10 if the cancer has spread to nearby organs. 

Still, survival rates can only provide a general idea of life expectancy. There are lots of factors that go into your prognosis. They include the type of bladder cancer, the stage and grade, and other considerations your provider will discuss with you.

​Is there anything I can do to feel better?

You can take care of yourself by being vigilant about follow-up care. Take care by eating heart-healthy foods and getting enough exercise and sleep.

It’s crucial to have a support system for adjusting to changes that can follow treatment. Depending on your circumstances, treatment can impact your sex life and fertility. Changing the way you pee after bladder removal surgery is a major lifestyle change, too.

Your provider can offer resources that can help. It’s also a good idea to reach out to support groups, so you can connect with others who understand what you’re going through.