The odds are fairly good that you or someone you know may be diagnosed with bladder cancer. For men, it’s the fourth most common site where cancer develops. For women, it’s less common but not rare — nearly 20,000 women in the U.S. will be diagnosed with it in 2025. The average age of diagnosis is 73.
Now, for some better news: Most people who have bladder cancer can live active lives thanks to treatments that tend to work quite well. More than three-quarters of people with bladder cancer live at least five years past the diagnosis.
Treatment often requires surgery or other measures that can affect your quality of life in the short and long term. And even early-stage bladder cancer is likely to return, so follow-up exams are typically continued for years.
How bladder cancer develops
The bladder is a hollow, muscular organ about the size of a pear. It stores urine until it’s passed out of the body through a narrow tube called the urethra. The wall of the bladder consists of multiple tissue layers.
Most bladder cancers are urothelial carcinomas. This type of cancer starts when the cells that line the inside of the bladder are damaged and multiply out of control.
Bladder cancer risk factors
Black men have the highest incidence of bladder cancer. A history of smoking also is a major risk factor. Smokers are three times more likely to develop bladder cancer than nonsmokers.
Another major risk factor is being around arsenic and chemicals used in making dyes, rubber, textiles, leather and paint products.
Other risk factors include:
- Past treatment with chemotherapy or radiation therapy.
- Use of certain diabetes drugs for a long time.
Early signs and symptoms of bladder cancer
In the early stages, you may not have symptoms. Signs of bladder cancer include blood in your urine, either enough that you can see it when you urinate or a small amount only found during a routine urine test.
Blood in urine — whatever the cause — should always be checked out by a healthcare professional.
Other symptoms of bladder cancer include:
- Pain with urination.
- Changes in bladder habits, such as having to go more frequently or not being able to urinate despite the urge to do so.
- Pelvic pain or back pain.
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How is bladder cancer diagnosed?
A number of procedures can be used to test for — and in some cases treat — bladder cancer:
- Cystoscopy — This is the gold standard test for bladder cancer. With a cystoscopy, a doctor inserts a hollow tube, called a cystoscope, through the urethra. The cystoscope has a lens that lets the doctor see inside the urethra and bladder. Cystoscopy is typically done using local anesthesia to make it more comfortable.
- Transurethral resection of bladder tumor (TURBT) — During a cystoscopy, the doctor may pass a tool through the scope and into the bladder to collect a cell sample for testing. TURBT also can be used to treat bladder cancer.
- Urine cytology — This test analyzes a sample of urine under a microscope to check for the presence of cancer cells.
- Imaging tests — A computerized tomography (CT) urogram combines CT imaging and injection of a contrast agent into a vein to highlight the structures of the urinary tract. Another option is a retrograde pyelogram, which combines X-ray imaging and delivery of a contrast agent using a catheter threaded through the urethra into the bladder.
Stages of bladder cancer
Bladder cancer is assigned a stage based on how far the cancer has grown into bladder tissue layers or has moved beyond the bladder. Bladder cancer may be:
- Nonmuscle invasive — This early form of bladder cancer involves only the superficial surface layer of the bladder. About three-quarters of diagnosed bladder tumors are confined to the bladder’s surface. At this stage, treatment is highly successful, though the cancer can still return (recur) or progress to a more invasive form.
- Muscle invasive — At this stage, tumor cells are growing in the bladder wall’s muscle layer. Once the cancer invades the muscle layer, your care team will likely recommend surgery to remove your bladder. Your care team may also recommend chemotherapy before or after your bladder is removed.
- Metastatic — At this stage, cancer has spread beyond the bladder. It may have invaded nearby structures or distant organs such as the lungs or liver. People with metastatic bladder cancer typically have chemotherapy but may have radiation or surgery. It may be necessary to remove the bladder if other treatments can’t control a person’s symptoms.
Treatment options for bladder cancer
As with other cancers, treatments for bladder cancer are tailored to the type of tumor and its stage. The cancer’s grade — how abnormal the cells look — also will drive treatment decisions.
A low-grade tumor is less likely to return or spread, while a high-grade tumor is more likely to come back or spread. Age and general health are factors in a treatment plan as well. Studies indicate that older people, including those into their 80s, can handle surgery and other treatments. And researchers are investigating promising new treatments.
TURBT procedure and immunotherapy for bladder cancer
When a biopsy finds nonmuscle invasive bladder cancer, doctors likely will use the TURBT procedure described earlier to remove cancerous tumors. A small wire loop may be passed through the cystoscope to remove the cancer and burn away any remaining cancer cells with an electric current.
The procedure requires general anesthesia but usually doesn’t require an overnight hospital stay. In a week or so after the procedure, you’ll likely use a catheter to urinate so that your bladder can heal and regain pumping strength. You may need to have TURBT repeated a month or so after the initial procedure to make sure all the cancerous cells have been removed.
Some people may get immunotherapy after a nonmuscle invasive cancer is removed. Immunotherapy helps reduce risk of the cancer coming back. This therapy activates your body’s immune system to help fight cancer cells. You get it through a catheter placed into your bladder through the urethra.
Radical cystectomy: Surgical removal of the bladder
Surgical removal of the entire bladder and other nearby tissues, called radical cystectomy, is the standard of care once cancer is in the bladder’s muscle layer.
Rarely, if a single small tumor with specific features is found in the dome of the bladder, doctors may remove a portion of the bladder if possible to not harm bladder function.
What happens after bladder removal
After bladder removal, your body needs a new route to get rid of urine. There are several options to consider with your surgeon — all involve using a piece of your intestine.
Options include:
- Using a segment of small intestine to create a tube that diverts urine from your kidneys to an opening created on the skin’s surface. The opening is called a stoma. A bag can be attached to the stoma to collect urine.
- Creating a small reservoir for urine under the skin of your abdomen. A channel is connected to a hole in the skin so that you can use a catheter to drain the collected urine.
- Creating a bladderlike reservoir inside the body that’s attached to the urethra. This may allow for more-typical urination.
You may also get chemotherapy in a vein or delivered directly to the bladder through the urethra. Your care team may use chemotherapy before surgery to shrink a tumor, or after to kill any remaining cancer cells.
Your care team may recommend radiation therapy after surgery if some cancer remains. Radiation also may be used if surgery is not an option or if the cancer has spread to other areas.
What happens after treatment for bladder cancer
Tumors that are confined to the bladder may come back after treatment. It’s important to have regular medical exams, including follow-up cystoscopy and imaging, throughout life.
This article originally appeared in the Mayo Clinic Health Letter.
