Bladder cancer occurs when cancerous cells form in the tissues of the bladder, the hollow organ in your abdomen that stores urine. The bladder has several layers, and cancer cells can form in any layer.
There are about 83,000 new cases of bladder cancer in the United States each year. It accounts for about 4% of all new U.S. cancer cases.
Bladder cancer symptoms can vary and may include painful urination and blood in your urine. Treatment options depend on how advanced the cancer is. Depending on the type of bladder cancer, it may be curable.
There are several types of bladder cancer. Healthcare providers classify them based on the types of cells involved and whether the muscle tissue has been affected.
Based on Cell Type
Types of bladder cancer based on cells include:
Urothelial carcinoma: Also known as transitional cell carcinoma, this type of bladder cancer starts in the urothelial cells (cells that line the bladder and other urinary system organs). This is the most common type of bladder cancer. Squamous cell carcinoma: Squamous cell carcinoma starts in the squamous cells (cells that line the inside of the bladder). Adenocarcinoma: This type of cancer starts in the glandular cells (cells that line the bladder and make mucus). Small cell carcinoma: This type of bladder cancer starts in the neuroendocrine cells in the bladder (nerve-like cells that release hormones).
Based on Muscle Involvement
Bladder cancer is categorized based on whether the cancer cells have impacted muscle tissue.
Non-muscle-invasive bladder cancer occurs when cancer cells have not reached the muscle wall of the bladder. Muscle-invasive bladder cancer is less common, occurring when cancer cells spread to the muscular wall and beyond.
Bladder cancer causes symptoms in the early stages, which can help you and your healthcare providers recognize there’s a problem and begin early treatment. Bladder cancer affects your urinary system, and the earliest sign of bladder cancer is usually blood in the urine.
Possible early symptoms of bladder cancer include:
Blood in your urine Frequent urinationPain or burning with urinationAn urgent need to urinateInability to fully empty the bladder Incontinence, which is when urine leaks
Many of these symptoms could be caused by a less serious condition, such as a urinary tract infection (UTI). It’s important to see your healthcare provider if you develop any new urinary symptoms for the proper testing and diagnosis.
As bladder cancer progresses, it may affect other areas of the body. Possible symptoms of advanced bladder cancer include:
Abdominal pain Inability to urinate Lower back pain, especially on only one side FatigueWeaknessUnintended weight loss Bone pain
Bladder cancer occurs when the cells in the lining of your bladder mutate and begin to grow and multiply out of control. Researchers aren’t certain what causes the cells to grow uncontrollably but have determined several risk factors that increase the chances of developing bladder cancer.
Risk Factors
Known risk factors for bladder cancer include:
Tobacco smoke: Smoking or being exposed to cigarette smoke significantly increases the risk of bladder cancer. Healthcare providers estimate that approximately half of all cases are linked to smoking.
Chemical exposures: Exposure to certain chemicals has been linked to an increased risk of bladder cancer. People who work in industries that produce dyes, rubber, aluminum, and leather may be at risk.
Family history: Having a close family member, such as a parent or sibling, with bladder cancer increases your risk.
Bladder infection: People who experience frequent or long-term bladder infections may be at increased risk.
Cancer treatments: Chemotherapy and radiation therapy may increase the risk of bladder cancer.
Ethnicity: White people are twice as likely to be diagnosed with bladder cancer as those who are African American or Hispanic. Asian Americans tend to have a lower risk.
Age: Older adults are at increased risk for bladder cancer. Most people diagnosed with this type of cancer are over age 55.
Sex: People assigned male at birth are more at risk than people assigned female at birth.
If your healthcare provider suspects you could have bladder cancer, they will likely refer you to an oncologist for testing. Oncologists are medical doctors who specialize in diagnosing and treating cancer.
Your healthcare provider will ask about your symptoms, urinary habits, health history, and overall health. They will also likely perform a thorough physical exam to look for signs of bladder cancer. Internal exams, like a digital rectal or pelvic exam, may be recommended so your healthcare provider can feel for a tumor in your bladder.
Diagnostic tests for bladder cancer include:
Urinalysis: A healthcare provider looks for blood, protein, bacteria, and other substances in a urine sample.
Urine cytology: A pathologist (a medical doctor who specializes in diagnosing diseases) examines a urine sample under a microscope to look for cancer cells. This provider may also be able to detect tumor markers.
Urine culture: This urine test involves culturing a urine sample to see if bacteria grow. It’s usually done to rule out a UTI.
Cystoscopy: A urologist (a medical doctor who specializes in diagnosing and treating urinary tract conditions) uses a long, thin tube with a camera on the end (called a cystoscope) to examine the inside of your bladder and take tissue samples for biopsy.
Transurethral resection of the bladder (TURB): After a cystoscopy, the urologist may recommend a TURB, which can remove any bladder tumors and surrounding tissue.
Biopsy: During a cystoscopy, the urologist may take a tissue sample from the bladder and send it to the lab for a pathologist to examine under a microscope.
Computed tomography (CT) scan: A CT scan provides several X-ray images of the bladder and surrounding organs to look for a tumor.
Magnetic resonance imaging (MRI): An MRI can provide images of soft tissues in the body. This test can determine if cancer has spread beyond your bladder.
Intravenous pyelogram (IVP): This test provides an X-ray of your urinary system using special dyes that pass through your kidneys and bladder.
Stages of Bladder Cancer
If you’re diagnosed with bladder cancer, your healthcare team will recommend further testing to stage the disease. Staging involves determining how advanced the cancer is and which areas of the body are affected.
Bladder cancer is staged using the TNM system, which uses the following factors:
T (tumor): Determines how far the primary tumor has grown through the bladder wall or to nearby tissuesN (nodes): Determines if cancer cells have spread to the lymph nodes near your bladderM (metastasis): Determines if the cancer has metastasized (spread) to distant areas in the body such as your lungs, liver, or bone
Bladder cancer stages include:
Stage 0: Cancer cells are present in the lining of the bladder but not the bladder wallStage 1: Cancer cells are present in the innermost lining of the bladder, known as the urothelium, as well as the next connective tissue layerStage 2: Cancer cells have grown through the bladder lining and are present in the muscular wall (muscle-invasive cancer)Stage 3: Cancer cells are present in the fatty tissue surrounding the bladder and may have spread to a nearby lymph nodeStage 4: Cancer cells have spread to other areas of the body, such as your abdominal wall, bones, liver, or lungs
Bladder cancer is treatable with several options. Surgery is the main treatment used for bladder cancer. Additional treatments may be necessary if the cancer is advanced.
Surgeries used to treat bladder cancer include:
Transurethral resection (TUR) with fulguration: The surgeon inserts a cystoscope into your bladder through your urethra (the hole urine comes out) to remove or burn away the tumor. Partial cystectomy: The surgeon removes part of your bladder. This type of surgery is used for a low-grade tumor that has started to invade the wall of the bladder. Radical cystectomy with a urinary diversion: The surgeon removes your entire bladder and any affected lymph nodes. They then create a new way for urine to exit your body through your colon or an opening in your abdomen.
Other treatment options for bladder cancer include:
Radiation: This treatment uses high-energy beams to kill cancer cells or keep them from growing.
Chemotherapy: This is treatment with drugs used to stop the growth of cancer cells. Systemic chemotherapy is administered intravenously (into a vein, IV) and travels through your bloodstream. Intravesical chemotherapy is placed directly into the bladder.
Immunotherapy: This is a drug treatment used to boost a person’s immune system response to cancer. Immunotherapy drugs can be given through an IV or placed in the bladder.
Targeted therapy: Targeted therapy involves using drugs or other substances to block the action of specific enzymes, proteins, and other molecules involved in the growth and spread of cancer cells.
A treatment’s effectiveness depends on whether the cancer has spread to the bladder’s muscle wall. Non-muscle-invasive bladder cancer is often curable.
You can lower your risk of bladder cancer by avoiding tobacco smoke. If you smoke and are ready to quit, talk with your healthcare provider about how to stop successfully. If your workplace contains chemicals linked to cancer, talk with your employer about how to protect yourself.
It’s not always possible to prevent bladder cancer. Some people develop bladder cancer even without any risk factors.
As bladder cancer progresses, it may impact other organs and cause complications, including:
Anemia: Because bladder cancer causes blood loss through the urine, it may lead to anemia (a lack of red blood cells).
Urinary incontinence: Untreated bladder cancer can lead to an inability to control the flow of urine.
Sexual dysfunction: Painful intercourse and erectile dysfunction are possible.
Starting bladder cancer treatment in the early stages may help prevent complications.
Going through bladder cancer diagnosis and treatment can be overwhelming. You may feel a range of emotions and worries. Talk with your healthcare team about meeting with a therapist or support group to discuss your experience and learn coping skills.
After completing bladder cancer treatment, you will continue to meet with your healthcare team for monitoring and follow-up care. Your provider may recommend regular blood and urine tests to monitor for cancer and complications. They may also recommend regular imaging studies.