Bladder Cancer

What is Bladder Cancer?

Bladder cancer develops when genetic changes in bladder cells lead to abnormal patterns of growth and division. Although several factors are associated with increased risk, the exact cause is not always known.

Risk Factors

• Aging
• Male sex
• Bladder birth defects
• Smoking
• Exposure to carcinogens
• Bladder stones
• Chronic bladder infections and irritation
• Schistosomiasis
• Lynch syndrome
• Cowden disease
• Prior chemotherapy and/or radiation therapy
• Personal or family history of bladder cancer
• Use of the drug Pioglitazone (Actos)
• Low fluid intake

How Is Bladder Cancer Detected?

Clinicians typically review medical, surgical, social, and family history, order laboratory tests, and assess imaging studies to make a diagnosis and guide care.

If bladder cancer is suspected, common tests include:

Urine cytology

Examines a urine sample for tumor cells.

Cystoscopy

Uses a thin, flexible scope to visualize the bladder interior.

Imaging studies

CT (Computed Tomography)—X-ray based 3D images;
PET (Positron Emission Tomography)—radioactive tracer highlights metabolically active cells;
PET-CT—combines PET and CT information;
MRI (Magnetic Resonance Imaging)—magnetic fields create detailed images;
Ultrasound—sound waves produce images of organs and tissues.

If results show a mass suspicious for bladder cancer, a biopsy is typically ordered to confirm the diagnosis and plan treatment.

Signs and Symptoms

The following may suggest bladder cancer, but can also occur with other conditions:

• Blood in the urine (hematuria)
• Frequent and/or painful urination
• Burning sensation when urinating
• Waking at night to urinate (nocturia)
• Sensation of needing to urinate without being able to pass urine
• Lower abdominal and/or back pain
• Darkening of the urine

Report new or concerning symptoms to a healthcare professional so the cause can be evaluated and treated if needed.

Stages of Bladder Cancer (AJCC)

Stage 0a

Cancer involves only the surface of the bladder’s inner lining.

Stage 0is

Cancer is confined to the inner lining (carcinoma in situ).

Stage I

Cancer has grown through the inner lining into connective tissue beneath it.

Stage II

Cancer has invaded the muscular wall of the bladder.

Stage III

Cancer extends through the muscular wall into surrounding fatty tissue, and may involve adjacent organs (e.g., prostate in men; uterus/vagina in women).

Stage IV

Either the primary tumor involves the pelvic or abdominal wall; or cancer has spread to nearby lymph nodes; or there are distant metastases.

How Is Bladder Cancer Treated?

Management depends on stage and type, and may include chemotherapy, immunotherapy, radiation therapy, and/or surgery. Treatments can be used alone or in combination.

Factors to Discuss When Choosing a Treatment Plan

• Age, overall health, and lifestyle
• Cancer stage and pathologic features
• Other significant medical conditions
• Whether immediate treatment is recommended
• Expected benefits and goals of therapy
• Potential side effects of each option

Ask questions and review options with your care team to balance potential benefits and risks and select the plan that fits your needs.