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Bladder Cancer

Last updated March 18, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Dr. Bob describes the symptoms of bladder cancer and explains the treatment options for this condition.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Cancer of the Bladder
  • Malignant Tumor of Urinary Bladder
  • Urinary Bladder Cancer 

What is Bladder Cancer? (Definition/Background Information)

  • Bladder Cancer is a general term for cancer that originates in the urinary bladder (hence, it is also known as Urinary Bladder Cancer). There are different types of Bladder Cancer.
  • The exact cause of this malignancy is unknown, but there are many factors, such as smoking, exposure to chemicals, previous history of cancer, etc. that are thought to play a role in its development.
  • A majority of different Bladder Cancer types are detected and diagnosed at an early stage and most of them in adult men, who are higher prone to the condition than women (3:1 male-female ratio).
  • The prognosis and treatment depends on the type of Bladder Cancer.
  • Early Bladder Cancer treatment has a high rate for success, since the prognosis of the condition is better, with early-stage, lower-grade cancers.
  • However, even if the condition is diagnosed early, there is a high probability of cancer remission. Therefore, a Bladder Cancer survivor usually undergoes multiple tests, in order to be vigilant for any signs of cancer recurrence. Individuals may continue to undergo screening tests for many years, after first diagnosis.

The type of bladder cell that transforms to malignant cells, determines the type of Bladder Cancer one is affected with. The type of Bladder Cancer one is diagnosed with, determines the appropriate treatment for that type of cancer. Bladder Cancers are classified as:

  • Transitional Cell Carcinoma of Bladder: It is cancer that usually occurs in the urinary system lining, such as the kidney, urinary bladder, and accessory organs. Transitional Cell Carcinoma is the most common type of Bladder Cancer, comprising approximately 95% of all such cancers. This type of cancer is also called as Urothelial Cancer
  • Squamous Cell Carcinoma of Bladder: Squamous cells are thin, flattened cells found in tissues that cover the skin exterior, lining of the digestive tract, lungs, and other areas of the body. These types of cells can become cancerous over time. This type of Bladder Cancer is frequently observed in certain parts of the world (rare in the US), where a parasitic infection (known as schistosomiasis) is common. Squamous Cell Carcinomas comprises approximately 1-2% of all Bladder Cancers
  • Adenocarcinoma of Bladder: Adenocarcinoma starts in the cells that produce mucus, which occurs in the mucus-secreting glands of the bladder. Adenocarcinoma is a rare form of Bladder Cancer and accounts for approximately, only 1% of the cases 

Who gets Bladder Cancer? (Age and Sex Distribution)

  • Normally, Bladder Cancer (in general) affects individuals, over the age of 55 years. However, individuals of any age group may be affected
  • Both males and females are affected by this cancer, though it is 3-times more likely to develop in males, than females
  • Urinary Bladder Cancer is 2-times more likely to develop in Caucasians, than African-Americans 

What are the Risk Factors for Bladder Cancer? (Predisposing Factors)

The underlying cause of Bladder Cancer is unknown at this time, although it is believed that certain factors may increase one’s risk for the condition. These risk factors include:

  • Advancing age: Elderly adults have a higher risk; the risk increasing with age
  • Smoking: Smoking cigarettes, cigars, or pipes, increase one’s risk, due to the damaging effect of chemicals accumulating in one’s body
  • Gender: Men are 3-times more likely to develop Bladder Cancer than women. This may be attributed to the high rate of male smokers in comparison to female smokers
  • Exposure to various chemicals, due to one’s nature of occupation, place of residence: It is believed that being around or associating oneself with certain harmful chemicals may increase the risk
  • Race: Caucasians are found to have a higher risk, than any other race or ethnic group
  • Previous cancer treatment: Individuals, previously treated for cancer with cyclophosphamide, an anti-cancer drug, may have an increased risk for Urinary Bladder Cancer
  • Previous radiation therapy treatment for cancer: Radiotherapy targeted at the pelvis for a prior cancer may also elevate the risk
  • Excessive consumption of nitrates, which are found in fatty foods and meats
  • Personal history: Individuals, who have had a history of Bladder Cancer, are at an increased risk for cancer recurrence in different parts of the bladder
  • Family history: Individuals, with one or more (immediate) family members or relatives with a history of Urinary Bladder Cancer, may have an increased risk of the condition
  • Fluid consumption: Individuals, who do not drink adequate amounts of fluids for optimal hydration each day, have an increased risk
  • Chronic bladder inflammation: Although urinary infections, kidney stones, and bladder stones, do not directly cause Bladder Cancer, these conditions cause constant inflammation in the bladder, resulting in irritation of the bladder lining. Increased irritation of the bladder lining has been linked to Bladder Cancer
  • Type II diabetes: Individuals with type II diabetes, are thought to have a 40 % increased risk of developing this condition

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Bladder Cancer? (Etiology)

Presently, the direct cause of Urinary Bladder Cancer is not entirely known; although, medical researchers believe that certain factors may be responsible for the disease. These include:

  • Smoking: Smoking cigarettes, cigars, or pipes, increase one’s risk for Bladder Cancer, due to the accumulation of harmful/damaging chemicals in urine. When cigarette smoke is inhaled, the body absorbs many of the chemicals into the bloodstream. This is filtered by the kidney and it gets collected in urine. These harmful chemicals can damage the bladder insides, increasing the risk of developing Bladder Cancer
  • Exposure to various chemicals: Kidneys are vital to filtering dangerous chemicals from the bloodstream, which then get collected in the urinary bladder. Researchers/physicians believe that associating oneself with certain harmful chemicals may increase one’s risk
  • Parasitic infection: Certain parasitic infections, such as schistosomiasis, have been linked to Squamous Cell Carcinoma type of Bladder Cancer 

What are the Signs and Symptoms of Bladder Cancer?

The most common sign of early-stage Bladder Cancer is hematuria (blood in urine). However, hematuria may occasionally be difficult to detect. It can also be the primary sign of additional disorders, such as kidney or bladder stones, urinary tract infection, etc. Many overlapping signs and symptoms may cause a delayed diagnosis of Bladder Cancer, in some cases.

The signs and symptoms associated with Bladder Cancer include:

  • Hematuria (blood in urine)
  • Frequent and painful urination
  • Urinary tract infection
  • Abdominal pain
  • Back pain
  • Weight loss 

How is Bladder Cancer Diagnosed?

There are a variety of tests that a healthcare provider may use, to detect, locate, and diagnose Bladder Cancer; and to also check, if it has potentially spread to other regions. These tests and exams include:

  • Physical examination and medical history evaluation: A thorough physical examination and evaluation of the individual’s medical history can aid in arriving at a definitive diagnosis. Physical examination may include rectal examination, prostate examination, and pelvic examination (in women)
  • Urine cytology: Urine cytology is used to analyze urine samples under a microscope, in order to check for the presence of any cancerous cells
  • Urine culture and urine analysis
  • Cystoscopy: During cystoscopy, a narrow tube called a cystoscope is inserted to look directly into the bladder. A local anesthetic is usually administered, in order to make the examination more comfortable
  • Bladder biopsy: During cystoscopy, a special biopsy forceps is passed through the urinary bladder, to collect small tissue samples of the tumor. A pathologist will then examine these samples under a microscope, after the tissue sample is suitably processed in an anatomic pathology laboratory. A biopsy (usually performed by an urologist) is the only test a physician relies on to make a definitive diagnosis of Urinary Bladder Cancer

However, if the physician is unable to perform a bladder biopsy, due to the risk of damaging vital organs, then additional tests may be recommended. These may include radiological imaging studies for Bladder Cancer, such as:

  • Intravenous pyelogram (IVP): Intravenous pyelogram is a technique using x-rays, to examine the kidneys, bladder, and ureters (the tubes that transport urine from the kidneys to the bladder), by using a dye to highlight the duct systems. Any signs of abnormalities can be visualized using an IVP
  • Computerized tomography (CT) scan of the urinary tract: Also known as CAT scan, with this radiological procedure, detailed three-dimensional images of the structures inside the body are created. CT scans may be helpful in detecting recurrences, or if Bladder Cancer has metastasized to other organs
  • Ultrasound study of various organs to determine the presence of metastasis
  • MRI study, to determine the spread of the tumor
  • X-ray of chest
  • Whole body bone scan
  • PET scan

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Bladder Cancer?

If Urinary Bladder Cancer is detected late, then it can spread into the surrounding organs, making it difficult to successfully treat the condition, using surgical interventions. Complications of Bladder Cancer may include:

  • Cancer that has metastasized (spread) may travel to the pelvic lymph nodes, and/or to the liver, lungs, and bones, as foci of metastasis
  • Recurrence of the tumor, after its surgical removal
  • Anemia due to bleeding
  • Urinary incontinence
  • Hydronephrosis - swelling of the ureters, due to obstruction. Severe hydronephrosis can cause kidney damage 

How is Bladder Cancer Treated?

The treatment of Bladder Cancer depends on a number of factors, including the histological type of the cancer, stage of the cancer, overall health condition of the individual, and treatment preferences of the individual.

Surgery for early-stage Bladder Cancer: If the cancer is small and has not invaded the urinary bladder wall, the surgical treatments a physician may recommend include:

  • Transurethral resection of bladder tumor: Transurethral resection of bladder tumor (TURBT) is a procedure that is frequently used to remove Bladder Cancers restricted to the inner layers of the bladder. During this procedure, a small wire loop is used to pass through the urethra and into the bladder. This loop uses an electric current (fulguration) to burn away the cancer cells. However, following this procedure, there may be painful or bloody urination
  • Segmental cystectomy: During a segmental cystectomy (also known as partial cystectomy), the part of the bladder that contains the cancer cells is removed by a surgeon. If the cancer is confined to a certain area of the bladder, segmental cystectomy may be an option and part of the bladder can be removed without damaging bladder function

Surgery for advanced Bladder Cancer: If the cancer has invaded deep into the layers of the urinary bladder wall, surgical treatments a physician may recommend include:

  • Radical cystectomy (removal of the entire bladder): If the cancer has invaded into the muscle layers, the surgeon may remove the entire bladder, nearby lymph nodes, and a part of the urethra
    • The surgery usually includes removal of the prostate and seminal vesicles in men
    • In women, radical cystectomy involves the removal of the uterus, ovaries, and part of the vagina

After surgical treatment, the attending physician may discuss the details of the cancer, further treatment measures required, and the post-operative care, with the individual.

Chemotherapy:

  • Chemotherapy is a treatment that uses drugs to kill cancer cells. In this treatment, a combination of two or more chemotherapy drugs are usually used
  • These drugs may be administered intravenously (through a vein in the arm), or directly into the bladder (intravesical therapy), by passing a tube through the urethra
  • Chemotherapy may be recommended for individuals with advanced Urinary Bladder Cancers that has spread to other body regions

Radiation therapy:

  • Radiation therapy attempts to destroy cancer cells by aiming high-energy beams at the cancer cells
  • Radiation therapy can be administered either by a machine placed outside the body (external beam radiation), or internally, by a device positioned directly at, or close to the malignant tumor. In women, the device is placed inside the vagina (brachytherapy)
  • This technique may be used before surgery, to decrease the size of a tumor, thus allowing for its easy removal; or after surgery, to kill the remaining cancer cells
  • Radiation therapy and chemotherapy are sometimes used as a combination tool 

How can Bladder Cancer be Prevented?

Currently, there is no known and available method to prevent Urinary Bladder Cancer. However, various steps that may be taken to help decrease the incidence of the condition are:

  • Smoking cessation: When an individual quits smoking, they reduce their risk for Bladder Cancer by 33% after 10 years, even if they were smoking for several years. At 15 years, individuals who quit smoking may ultimately have the same reduced risk as a non-smoker. A smoker’s risk of Bladder Cancer is 2-3 times higher, when compared to the same risk in a non-smoker
  • Avoiding exposure to certain chemicals: Individuals, who work with certain harmful chemicals, can lessen their exposure to the chemicals, by following proper usage principles and occupational safety instructions. Prolonged exposure to asbestos and other harmful chemicals (such as arsenic, chromium, nickel, and tar) may increase the risk of Bladder Cancer. This risk is multiplied in smokers, who are exposed to these harmful chemicals
  • Proper fluid hydration: Drinking appropriate amounts of liquids every day, especially water, can dilute toxic substances that concentrate in the urine and decrease one’s risk of cancer
  • Adequate consumption of fruits and vegetables: A healthy diet, low in saturated fats and rich in fruits and vegetables, may help decrease one’s risk for Bladder Cancer. Regular consumption of soy-based foods, incorporated into one’s diet, can also decrease the risk 

What is the Prognosis of Bladder Cancer? (Outcomes/Resolutions)

  • The prognosis for Bladder Cancer depends on many factors, such as:
    • The individual’s age
    • Physical health of the individual
    • Location of the cancer
    • Stage, grade, and type of cancer
  • Almost all individuals diagnosed and treated for Stage 0 cancer; survive for 5 years, post-diagnosis (5-year survival rate of 98%). This number steadily drops with cancer stage progression. Less than 20% individuals with stage IV disease, survive for 5 years, following diagnosis and treatment
  • Earlier the stage and lower the grade of cancer, better is the prognosis. A pathologist’s report helps in assessing the prognosis of the tumor
  • Although, the risk of Bladder Cancer recurrence is high, a majority of such recurrences can be surgically removed and the condition cured. Hence, regular follow-up and periodic exams are necessary 

Additional and Relevant Useful Information for Bladder Cancer:

  • Urinary bladder removal surgical procedure (also known as cystectomy) is commonly performed to treat cancer of the urinary bladder 

The following article link will help you understand urinary bladder removal surgical procedure.
http://www.dovemed.com/common-procedures/procedures-surgical/urinary-bladder-removal-for-urinary-bladder-cancer/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Aug. 28, 2014
Last updated: March 18, 2018