Bladder Cancer Explained: Symptoms, Risk Factors, Diagnosis and Treatment Options

Bladder cancer is the sixth most common cancer in the United States, with more than 80,000 new cases expected in 2025, and about 75 percent of these cases occur in men. The good news? In recent years, the rates of new bladder cancer diagnoses have been decreasing by about one percent each year due to a decrease in the rates of smoking.

What Is Bladder Cancer?

Bladder cancer happens when the cells lining the bladder - the organ that holds urine - start to grow uncontrollably. It usually begins in the inner lining but can spread deeper into the bladder wall or to nearby organs and other parts of the body over time.

There are different types of bladder cancer. The most common type is called urothelial carcinoma (also known as transitional cell carcinoma). Urothelial carcinoma makes up over 90 percent of all bladder cancer cases. Other less common types include squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcoma.

Signs and Symptoms

Bladder cancer is often detected early because it tends to cause noticeable symptoms that prompt people to see a doctor. Symptoms often include:

• Blood in the urine, which may turn it orange, pink or red. However, sometimes the amount of blood is too small to change the color.
• Changes in bladder habits, like more frequent urination, pain or burning while urinating or a strong urge to urinate even when the bladder isn’t full.

In more advanced cases, symptoms can include unexplained weight loss, loss of appetite, extreme tiredness and persistent lower back or bone pain.

Diagnosis and Staging

Doctors use several tests to diagnose bladder cancer and find out how far it has spread. These tests include:

• Urinalysis and urine cytology: Tests that check for blood and cancer cells in the urine.
• Cystoscopy: A thin, flexible tube with a camera is inserted through the urethra to look directly inside the bladder.
• Biopsy: During a cystoscopy, a small tissue sample may be taken to confirm if cancer cells are present.
• Imaging tests: CT scans, MRI scans and ultrasounds help show if the cancer has spread beyond the bladder and help determine its stage.

Treatment

Bladder cancer treatment is personalized based on several factors, including how far the cancer has spread (the stage), how aggressive the cancer cells look (the grade) and the patient's overall health and personal goals.

Early-Stage Bladder Cancer (Non-Muscle-Invasive)

When bladder cancer is still on the surface and hasn't grown into the muscle wall, about 70–75 percent of cases, treatment usually includes:

• TURBT (Transurethral Resection of Bladder Tumor): Doctors remove the tumor using a thin tube with a camera, which is inserted through the urethra. No external cuts are needed.
• Intravesical therapy: After TURBT, medicines may be placed directly into the bladder to kill any remaining cancer cells and lower the chance of cancer coming back. This can include:
  • BCG therapy: A type of immunotherapy that uses weakened bacteria to boost the body's natural defenses against cancer.
  • Intravesical chemotherapy: Anti-cancer drugs like gemcitabine or mitomycin C are used.

Early-Stage Muscle-Invasive Bladder Cancer

If cancer has grown into the muscle layer, stronger treatments are needed. Treatments may include:

• Radical cystectomy: Surgery to remove the entire bladder and sometimes nearby organs, such as the prostate in men or the uterus in women. After surgery, new ways for urine to leave the body are created, such as:
  • Ileal conduit: A small piece of intestine used to direct urine to an opening on the skin.
  • Neobladder: A new bladder made from part of the intestine.
  • Continent urinary reservoir: An internal pouch connected to a small opening on the skin.
• Neoadjuvant chemotherapy: Given before surgery to shrink the tumor and improve survival odds.
• Bladder preservation therapy: Some patients may choose a combination of chemotherapy and radiation to treat cancer while keeping the bladder intact.

Advanced Metastatic Bladder Cancer

When bladder cancer spreads to other organs, like the liver, lungs or bones, the focus is on controlling the disease, easing symptoms and improving quality of life. Treatment options include:

• Chemotherapy: Typically a combination like cisplatin and gemcitabine. If cisplatin isn't safe, other options can be used.
• Immunotherapy: Medicines like pembrolizumab and nivolumab help the immune system attack cancer, cells, especially if chemotherapy doesn't work.
• Targeted therapy: Special drugs, like erdafitinib, are used if the cancer has specific genetic changes.
• Antibody-drug conjugates (ADCs): New treatments like enfortumab vedotin deliver chemotherapy directly to cancer cells, causing less harm to healthy tissue.

Exceptional Cancer Care

If you're diagnosed with cancer, trust Southwest Michigan's most preferred healthcare system. With locations in Battle Creek and Kalamazoo, Bronson Cancer Center offers comprehensive care, combining expert medical teams, advanced technology and supportive resources at every stage of your cancer journey. Learn more about Bronson's regional cancer program.