Bladder cancer usually starts in the lining of your bladder, the organ that holds your urine. These bladder cells are called urothelial cells. If they grow out of control, the cancer that forms in your bladder is called urothelial carcinoma.
Other cancers that start in the bladder aren't as common, including adenocarcinoma and squamous cell carcinoma. But not all bladder cancers are the same. Some bladder tumors grow very slowly and aren't life-threatening, and others are more aggressive and need intense treatment.
"In the last year to two years, the treatments for bladder cancer have improved remarkably," says Farshid Sadeghi, MD, a urologic oncology surgeon at City of Hope Cancer Center Phoenix. "It's the most curable it has ever been."
Learning about what causes bladder cancer, your specific tumor stage, and outlook can help you understand your diagnosis. It can help you feel more empowered and prepared to take part in decision making with your care team.
What Causes Bladder Cancer?
Experts don't know exactly what causes bladder cancer, but it starts with DNA changes inside the cells. The DNA changes can cause the cells in your bladder to:
- Multiply uncontrollably (make copies)
- Form a tumor
- Cause the tumor to grow bigger
Certain risk factors might raise your chances of DNA damage inside bladder cells. Because these factors only raise your risk, just having certain factors doesn't mean you'll automatically develop bladder cancer.
Who's at risk of bladder cancer?
The number one risk factor for bladder cancer is smoking. It can raise your risk of bladder cancer more than three times that of people who don't. Smoking can also raise your chances of the cancer progressing quickly and coming back after treatment.
Men are also at a higher risk of bladder cancer, as are adults over 55, and White adults. Your risk of bladder cancer can go up if you:
- Work as a painter, machinist, printer, firefighter, hairstylist, or truck driver
- Have chronic urinary tract infections (UTIs), kidney stones, a long-term catheter, or a parasite (schistosomiasis)
- Get radiation treatment to your pelvic area or take a cyclophosphamidechemotherapy
- Take certain medicines such as pioglitazone or aristolochic acid
- Have certain gene changes such as Lynch syndrome, Cowden disease, or retinoblastoma
- Were born with bladder problems
What Are Symptoms of Bladder Cancer?
Although symptoms can be different for everyone, some bladder cancer signs tend to happen in most people.
"The most common symptom is blood in the urine, but it's usually painless blood in the urine," says Sadeghi.
Knowing the signs can help you speak up and get tested for bladder cancer earlier.
How Doctors Diagnose Bladder Cancer
Depending on your symptoms, your doctor will likely order tests to confirm your bladder cancer diagnosis.
After a bladder biopsy, you and your doctor will review your pathology report. It can tell you the tumor stage, which is how big your tumor is and how far it's spread in your body.
What Bladder Cancer Stages Mean
Staging on your pathology report can help predict how your tumor may behave and which treatment is likely to have the most effect.
"Pathology tells us if it's low grade or high grade – which means slow growing or more rapid growing – invasive or non-invasive," says Sadeghi.
That's because staging tells you whether your tumor has:
- Invaded the muscle wall of your bladder, also called muscle invasive bladder cancer
- Not invaded the muscle wall, also called non-muscle invasive bladder cancer
In general, the higher your stage, the more intense your treatment will need to be. Ask your doctor to go over your specific stage of bladder cancer with you. It can sometimes be complex.
No matter which stage you have, bladder cancer is very treatable, says Sadeghi.
Stage IV is not considered curable, but you can manage it as a chronic condition. "The only thing you are worried about in your lifetime is the cancer coming back in the bladder and requiring further treatment," says Sadeghi.
Bladder cancer treatment has changed dramatically in recent years. Sadeghi says major advances in immunotherapy and targeted treatments can now help muscle invasive, and even metastatic disease.
How Bladder Cancer Treatment Options Have Changed
Today, treatment for bladder cancer can depend on many things, such as whether your cancer is muscle invasive or if your tumor has spread beyond your bladder.
Surgery
Surgery is often the first treatment doctors suggest after a bladder cancer diagnosis. You may get a procedure called a transurethral resection of bladder tumor (TURBT).
This procedure removes your tumor through your urethra without needing a cut in your stomach, and a TURBT can:
- Diagnose your cancer
- Determine the bladder tumor stage
- Often remove all visible disease
If your cancer is more advanced, your doctor may suggest a cystectomy. This procedure removes all or part of your bladder. With muscle invasive bladder cancer, this surgery may help if other treatments aren't working.
A new standard: Combined therapy for muscle invasive bladder cancer
Chemotherapy before surgery may help you live longer with muscle invasive bladder cancer instead of surgery alone. Adding treatments together may also improve results even further.
Now, researchers are seeing promising results using antibody-drug conjugates (ADCs). These medicines combine an antibody with a drug to directly target and kill bladder cancer cells.
"Now we're questioning if we have to do bladder removal in many patients because this combination is so effective," says Sadeghi.
Stage IV bladder cancer isn't usually curable, but with newer treatments, people are going into long-term remission. "I've seen it cure patients who had metastatic bladder cancer," says Sadeghi.
Treatments put directly into your bladder (intravesical therapy)
Immunotherapy called Bacillus Calmette-Guérin (BCG) or chemotherapy can go inside your bladder. This puts the medication in the same place as the cancer cells, which may help protect the rest of your body (or system).
"The chemotherapy in the bladder only bathes the bladder," says Sadeghi. "[The chemo] doesn't go into your body, so it doesn't have systemic side effects."
Even though chemotherapy can cause severe side effects, intravesical therapy can help treatment be gentler on the rest of your body.
Radiation therapy
Not everyone with bladder cancer needs radiation therapy. It uses high-energy beams to destroy cancer cells. But radiation can be an important option alongside other treatments with muscle invasive disease.
Clinical trials
If you are diagnosed with high-risk, muscle invasive, or advanced bladder cancer, ask your doctor whether you might qualify for a clinical trial. There are many promising new therapies, and clinical trials can:
- Give you access to treatments that are not yet widely available
- Help researchers continue improving bladder cancer treatments
Life without a bladder
Sadeghi says although it's common to have your bladder removed, life without a bladder is very manageable. After your surgeon takes your bladder out, they can make a new way for pee to be stored and leave your body.
Your surgeon will either:
- Make a hole (stoma) to the outside of your body for pee to be collected in an external bag, called a conduit
- Use part of your intestine to collect pee, called a neobladder
"I have hundreds and hundreds of patients with a neobladder or a conduit who maintain their quality of life," syas Sadeghi. "They realize they can do everything they did before they lost their bladder."
Your Bladder Cancer Care Team
Your bladder cancer care team can include many different medical doctors. Sadeghi recommends seeking care at a comprehensive cancer center.
"If your cancer is invasive, you need a lot of input," says Sadeghi. "You need a urologic oncologist, medical oncologist, and radiation oncologist, because you could also get radiation treatment."
The center also offers access to other specialists who have experience treating various aspects of bladder cancer.
All the members of your care team work together. They'll help you consider all the available treatment options and support your quality of life after your bladder cancer diagnosis.
Finding Support
A bladder cancer diagnosis can impact more than your physical health. It can create emotional stress, financial concerns, and uncertainty about the future.
Organizations like Bladder Cancer Advocacy Network (BCAN) can offer:
- Educational materials
- Support groups
- Patient stories
- Opportunities to connect with survivors
"There are thousands of bladder cancer survivors who are part of it. They volunteer information about what it's like to go through bladder cancer," says Sadeghi. "I find that it offers a lot of reassurance and comfort, often more than anything I can tell my patients."
Questions to Ask Your Doctor
Here are some questions that you may find helpful as you gather and digest all the information that comes with a bladder cancer diagnosis.
The more you understand your diagnosis, the better prepared you'll be to take part in treatment decisions.
Show Sources
Photo Credit: DigitalVision/Getty Images
SOURCES:
Farshid Sadeghi, MD, urologic oncology surgeon, City of Hope Cancer Center Phoenix.
National Cancer Institute: "Bladder Cancer."
American Institute for Cancer Research: Bladder Cancer."
MD Anderson Cancer Center: "Bladder Cancer."
National Foundation for Cancer Research: "Bladder Cancer Awareness Month."
Cleveland Clinic: "TURBT: Transurethral Resection of Bladder Tumor."
UpToDate: "Pathology of Bladder Neoplasms."
American Cancer Society: "What Is Bladder Cancer?" "Bladder Cancer Causes, Risk Factors, and Prevention."
