Bladder Cancer: The Basics

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Bladder cancer is the sixth most common form of cancer in the United States. In 2019, the American Cancer Society estimates, nearly 62,000 men and 19,000 women will develop the disease, and approximately 13,000 men and 4,800 women will die from it. The risk of bladder cancer rises with age.

Men are three to four times more likely to get bladder cancer than women; however, by the time most women are diagnosed, their tumors often are more advanced. Bladder cancer is more challenging to treat when it’s advanced, but it’s also an increasingly manageable condition.

Types of Bladder Cancer

Urothelial carcinoma (aka transitional cell carcinoma) is by far the most common type of bladder cancer in the U.S. With this type, the cancer begins in the urothelium, the cells lining the inside surface of the bladder, which is a hollow, balloon-shaped organ that stores urine until it’s ready to pass from the body. The urothelium protects bladder tissues from toxins or infection that may be in the urine.

Other types of bladder cancer include:

  • squamous cell carcinoma, which typically forms as a result of chronic inflammation and irritation of the bladder;
  • adenocarcinoma, which is extremely rare and originates in cells that make up mucus-secreting glands in the bladder;
  • small cell carcinoma, which is rare and may involve neuroendocrine cells in the bladder; and
  • sarcoma, which arises in the bladder’s connective tissue or muscle.

Most bladder cancer is superficial, meaning it is located on the bladder’s surface. Often referred to as non-muscle-invasive bladder cancer, it can be treated with a type of surgery called a transurethral resection of bladder tumor (TURBT). After surgery, the urologist may treat further with chemotherapy or BCG, a type of bacteria that stimulates the immune system and is delivered right into the bladder to prevent the cancer from recurring or invading more deeply.

By contrast, muscle-invasive bladder cancer is more serious and accounts for about 30 percent of cases. Generally, people develop advanced bladder cancer if treatment for earlier stages doesn’t work or if the cancer is not caught until it’s far along, says Byron Lee, M.D., Ph.D., a urologic oncologist at the Cleveland Clinic in Ohio. “The most common symptom is blood in the urine. However, not all individuals are alarmed by blood in the urine because it can come and go, it might be attributed to other causes, or it might be pale pink so they don’t even notice it.”

Risk Factors

With bladder cancer, certain cells in the bladder become abnormal and start to multiply in an out-of-control fashion. Exactly why this happens is the subject of intense investigation, but certain risk factors have been identified. Far and away, the biggest risk factor is tobacco use. Cigarette smokers are at least three times more likely to develop bladder cancer than nonsmokers. “The toxins from cigarettes are filtered through the kidneys and bladder and can cause cancer in those areas,” says Elizabeth Plimack, M.D., chief of the division of genitourinary medical oncology at Fox Chase Cancer Center in Philadelphia.

Exposure to certain chemicals, such as rubber, leather, textiles, and paint dyes, has been linked to the development of this cancer. The combination of smoking and working with cancer-promoting chemicals can increase a person’s chances of developing bladder cancer even more. Exposure to arsenic in drinking water (such as well water) also has been linked with an increased risk.

“The development of bladder cancer is often the result of many decades of exposure to cancer-causing agents,” Dr. Lee points out. A history of cancer in the lining of any part of the urinary tract—such as the kidneys, ureters, or urethra—also elevates the risk, even if the first tumor was removed completely.

In most cases, blood in the urine is the first sign of bladder cancer, though needing to urinate more often, experiencing pain or burning during urination, or having a weak urine stream also can occur. With advanced bladder cancer, you might have trouble urinating even when you feel like your bladder is full, Dr. Lee says, and “you can develop an obstruction of the ureters where urine backs up in the kidney, which leads to pain in the flank.”

Loss of appetite, unintentional weight loss, weakness, increased fatigue, shortness of breath, and bone pain also can occur with advanced bladder cancer.

Recent Advances

While the prognosis for those with advanced bladder cancer is not as rosy as patients and doctors would like, hope is on the horizon. In the last few years, five new immunotherapy drugs and one targeted therapy drug have been approved—and many new protocols are being clinically tested. In the meantime, treatment advances currently available can slow the cancer’s progression, ease symptoms, and extend survival.