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Understanding Bladder Cancer: Symptoms, Causes, & Treatments - Bladder Health Awareness Month

A person holds a paper cutout of a bladder.

Kara Miller |

November is Bladder Health Awareness Month, a month dedicated to helping people find resources on bladder health. Each week, The Urology Care Foundation will be highlighting a bladder condition to focus on. This week’s topic is Bladder Cancer. 

Bladder cancer, though often overshadowed by other medical conditions, demands our attention and understanding. This blog serves as a comprehensive guide to this condition. We will systematically explore the essential aspects of bladder cancer, including its symptoms, causes, and the various treatment options available. Whether you are a patient, caregiver, or someone seeking reliable information, this blog equips you with the knowledge required to recognize the signs, understand the underlying factors, and discover the range of management strategies for bladder cancer. 

A man holds his pelvic region in pain.

What is Bladder Cancer? – An Overview

Recognizing the Symptoms of Bladder Cancer

Understanding the symptoms of bladder cancer is paramount in its early detection and treatment. Bladder cancer often manifests with signs that, although subtle, should not be ignored. While some of these symptoms may be indicative of various other conditions, it is essential to consult a healthcare professional if they persist or worsen. Vigilance in recognizing these warning signs is crucial for a timely response, as early diagnosis significantly enhances the chances of successful treatment. 

Danger Signs: When to See a Doctor

  1. Blood in the Urine (Hematuria): If you notice blood in your urine (hematuria), even if it's only once, it is a significant red flag. Hematuria can be a visible sign of bladder cancer, and it is essential to consult a doctor promptly.
  2. Changes in Urinary Habits: Sudden changes in your urinary habits, such as increased frequency, urgency, or pain during urination, could indicate a bladder issue, including bladder cancer. If these changes persist for an extended period, seek medical evaluation.
  3. Unexplained Back or Pelvic Pain: Chronic or persistent back or pelvic pain without an apparent cause should not be disregarded. Such discomfort can be associated with advanced bladder cancer and necessitates a medical assessment.
  4. Unexplained Weight Loss: If you experience unexplained weight loss, especially if it's rapid and not due to changes in diet or exercise, it may be a sign of various health issues, including bladder cancer. Consult a healthcare professional for a thorough evaluation.
  5. Fatigue: Excessive fatigue or weakness that persists and isn't related to other lifestyle factors can be a symptom of advanced bladder cancer. Fatigue often occurs due to the body's response to the disease, and it warrants medical attention to determine its underlying cause.

What causes bladder cancer?

Understanding the causes of bladder cancer is essential in addressing this complex disease. Although pinpointing a single, definitive cause can be challenging, several risk factors are associated with an increased likelihood of developing bladder cancer. 

Smoking is one of the most prominent risk factors, as tobacco exposure releases carcinogens into the body, which are filtered through the urine and can affect the bladder lining. 

Occupational exposure to certain chemicals and dyes, such as those found in the textile, chemical, and rubber industries, is another notable risk. 

Furthermore, age, gender, family history, and chronic bladder inflammation can contribute to the development of bladder cancer. 

While these factors are not guarantees of the disease, they highlight the importance of understanding the role of risk factors and the need for preventive measures and vigilant monitoring for those at higher risk.

Types of Bladder Cancer

Bladder cancer is not a one-size-fits-all condition; rather, it manifests in various forms, each with its unique characteristics and implications. Exploring the types of bladder cancer is crucial in understanding the nuances of this disease, as it guides treatment decisions, prognosis, and patient care. In this section, we delve into the different types of bladder cancer and their distinct attributes.

Transitional Cell Carcinoma - The Most Common Type of Bladder Cancer

Transitional Cell Carcinoma, also known as urothelial carcinoma, stands as the most prevalent type of bladder cancer, accounting for the majority of cases diagnosed. Accounting for around 95% of bladder cancers, this form of cancer originates in the urothelial cells that line the inside of the bladder. Transitional Cell Carcinoma is marked by its potential to not only affect the bladder but also the upper urinary tract, including the ureters and renal pelvis. It is often categorized into two subtypes: non-invasive and invasive. 

Non-invasive transitional cell carcinoma is confined to the lining of the bladder and is typically associated with a favorable prognosis if detected early. In contrast, invasive transitional cell carcinoma penetrates the bladder wall, presenting a more challenging clinical scenario. Understanding the characteristics and behavior of this common bladder cancer type is pivotal in guiding treatment strategies and therapeutic decisions.

Squamous Cell Carcinoma and Adenocarcinoma

Squamous Cell Carcinoma and Adenocarcinoma are two less common but significant subtypes of bladder cancer. Squamous Cell Carcinoma, which accounts for around 1% to 2% of bladder cancers, typically originates in the squamous cells that can develop in response to chronic irritation and inflammation of the bladder, often associated with conditions such as recurrent urinary infections or long-term catheter use. This subtype is more likely to be invasive when diagnosed, necessitating comprehensive treatment. 

Adenocarcinoma, on the other hand, begins in the glandular cells that produce mucus. It's rarer, only occurring in about 1% of bladder cancers, and often found in the urachus, a structure that connects the bladder to the umbilical cord during fetal development. Adenocarcinoma often requires distinct treatment approaches due to its distinct characteristics. While both of these subtypes of bladder cancer are less frequent than transitional cell carcinoma, they underscore the importance of considering the diverse nature of this disease, demanding tailored strategies for diagnosis and treatment.

Small Cell Carcinoma

Small Cell Carcinoma of the bladder is an exceptionally rare and aggressive subtype of bladder cancer. Small Cell Carcinoma occurs in less than 1% of bladder cancers. Unlike the more common transitional cell carcinoma, which primarily arises from the bladder lining, small cell carcinoma originates in the neuroendocrine cells found in the bladder's inner layer. 

This subtype is characterized by its rapid growth and tendency to spread to other organs, often at the time of diagnosis. Due to its aggressiveness and less favorable prognosis, the management of small cell carcinoma typically involves a combination of chemotherapy and radiation therapy. While small cell carcinoma accounts for a small fraction of bladder cancer cases, it highlights the heterogeneity of this disease and the importance of considering alternative treatment strategies for less common subtypes. Early detection and prompt intervention are critical in addressing this challenging variant of bladder cancer.


Bladder sarcoma, a highly uncommon form of bladder cancer, is characterized by its origin in the mesenchymal tissues of the bladder, which include muscles, blood vessels, and connective tissues. 

The type of sarcoma most associated with the bladder is Rhabdomyosarcoma (RMS). RMS is a type of sarcoma which affects muscle cells. This form of cancer is much more common in children, but overall very rare. 

A graphic showing bacteria in the bladder.

Connections between UTI and Bladder Cancer

The Relationship between Frequent UTI and Bladder Cancer

The relationship between frequent urinary tract infections (UTIs) and bladder cancer is a subject of medical interest and study. While UTIs are common and typically benign, recurrent or chronic UTIs may be associated with an increased risk of bladder cancer, particularly in cases of long-standing inflammation. 

Chronic irritation and inflammation of the bladder caused by recurrent UTIs can potentially lead to genetic mutations in the bladder lining cells, which may contribute to the development of cancer over time. However, it's important to note that the majority of individuals with frequent UTIs do not develop bladder cancer. Still, this link underscores the significance of timely and effective management of UTIs to reduce the risk of potential complications, including the development of bladder cancer. 

Graphical images of a cystoscopy.

Diagnosing Bladder Cancer: Tests and Techniques

Diagnosing bladder cancer involves a series of tests and techniques designed to detect and characterize the disease accurately. The process typically begins with a thorough medical history and physical examination. 

To confirm the presence of bladder cancer, the gold standard diagnostic test is cystoscopy, during which a thin, flexible tube with a camera is inserted into the bladder to visualize its interior. To determine the specific type and stage of bladder cancer, a tissue sample (biopsy) is taken during cystoscopy and examined under a microscope.

Additionally, imaging tests like CT scans or MRIs may be used to assess the extent of cancer and its potential spread. 

Urine cytology, which involves the analysis of urine for cancer cells, can also provide valuable diagnostic information. Furthermore, various molecular tests are becoming increasingly useful in diagnosing and characterizing bladder cancer at a molecular level. Early and accurate diagnosis is critical for determining the most appropriate treatment plan, making these diagnostic tests and techniques essential in the management of bladder cancer. 

A man receives chemotherapy.

Treatment for Bladder Cancer: What are the Options?

When it comes to the treatment of bladder cancer in men and women, a range of options exists, each carefully tailored to the type and stage of the disease, as well as the individual's overall health. From non-invasive early-stage cases to more advanced and aggressive forms, the approach to managing bladder cancer can encompass surgery, radiation therapy, chemotherapy, immunotherapy, or a combination of these methods. The selection of the most suitable treatment plan is a collaborative effort between patients and their healthcare teams, with the goal of achieving the best possible outcome while preserving bladder function and overall quality of life. 

Bladder Surgery - What Does it Involve?

Bladder surgery, often a crucial component in the treatment of bladder cancer, can encompass various procedures aimed at removing cancerous tissue, managing the disease, and preserving urinary function. The specific type of bladder surgery undertaken depends on factors such as the stage of cancer, its location, and the overall health of the patient. 

For early-stage bladder cancer, transurethral resection is a common approach, where cancerous tissue is removed through the urethra using a thin tube with a camera and surgical instruments. In more advanced cases or when the bladder needs to be removed entirely (radical cystectomy), a portion of the intestine or the creation of a urinary diversion may be required. 

Bladder surgery can significantly impact a patient's quality of life, making the choice of procedure a carefully considered decision between the patient and their urologist and oncologist teams. Understanding the nature of these surgeries is essential in navigating the treatment journey for bladder cancer and making informed decisions about the most suitable approach.

Understanding the Efficacy of Chemotherapy for Bladder Cancer

Chemo for bladder cancer is a valuable and frequently used treatment approach, particularly in cases where the disease has advanced to a more aggressive stage or has spread to other parts of the body. 

Chemotherapy employs powerful drugs to target and inhibit the growth of cancer cells, either before or after surgical intervention. The effectiveness of chemotherapy in bladder cancer treatment varies depending on several factors, including the specific type of chemotherapy drugs used, the stage and grade of the cancer, and the individual patient's response to the treatment. 

For some, chemotherapy can shrink bladder tumors, improve the chances of successful surgery, or help control the spread of cancer. In certain cases, it may be used as a neoadjuvant therapy before surgery or as adjuvant therapy after surgery. While chemotherapy can be associated with side effects, including fatigue, nausea, and immune system suppression, its potential benefits in slowing the progression of bladder cancer and increasing survival rates make it a valuable tool in the comprehensive treatment of this disease. Individualized treatment plans, in consultation with healthcare providers, are crucial in determining the most effective use of chemotherapy in the context of bladder cancer management.

The Emergence of Immunotherapy in Bladder Cancer Treatment

The emergence of immunotherapy has brought a revolutionary dimension to the treatment of bladder cancer. Immunotherapy harnesses the body's own immune system to recognize and combat cancer cells effectively. 

In the context of bladder cancer, drugs known as immune checkpoint inhibitors have shown remarkable promise. These medications, such as pembrolizumab, avelumab, and nivolumab, work by blocking specific proteins that cancer cells use to evade the immune system, thereby enhancing the immune response against the tumor. 

Immunotherapy has demonstrated significant success in treating advanced bladder cancer, particularly for patients who have not responded to traditional chemotherapy. This approach not only offers a viable option for those with limited treatment alternatives but also provides the potential for long-lasting responses. 

Bladder Cancer Prognosis: Stages and Survival Rates

Bladder cancer prognosis is intricately tied to the disease's stage at the time of diagnosis. The stages, ranging from 0 to IV, are determined by the extent of cancer's spread within the bladder and to nearby or distant organs. 

Generally, the earlier the stage, the more favorable the prognosis. For non-invasive, low-grade tumors, the prognosis is often excellent with a low risk of recurrence. However, once bladder cancer advances to muscle-invasive stages or spreads beyond the bladder, the prognosis becomes less optimistic. 

The 5-year relative survival rate for localized bladder cancer is 71%

The 5-year relative bladder cancer survival rates for different types of bladder cancer are:

  • Carcinoma in situ of the bladder alone (abnormal cells found in the tissue lining the inside of the bladder): 97% 
  • Localized bladder cancer: 71%
  • Regional bladder cancer (cancer has spread beyond the bladder to nearby lymph nodes or organs): 39%
  • Metastatic bladder cancer (cancer has spread beyond the bladder to a distant part of the body): 8%

Nevertheless, these statistics are general estimates and don't account for individual variations in factors such as treatment response and overall health. Thus, while stage plays a crucial role in predicting outcomes, a personalized approach to treatment and close monitoring can lead to improved survival rates and enhanced quality of life for bladder cancer patients.

Living with Bladder Cancer: Quality of Life and Care

Living with bladder cancer presents a unique set of challenges, both during and after treatment. Maintaining the best possible quality of life is a primary concern for patients and their healthcare teams. The impact of bladder cancer treatment on urinary function, emotional well-being, and daily life can be significant. Patients may experience changes in urinary habits, sexual function, and body image, which can have emotional and psychological effects. 

To address these concerns, a comprehensive approach to care often includes support from medical professionals, such as urologists, oncologists, and counselors, as well as the use of adaptive strategies like urinary diversion procedures. 

It's also essential for individuals with bladder cancer to build a strong support network, seek emotional support through counseling or support groups, and make lifestyle adjustments to improve their overall well-being. With appropriate care and management, many individuals can lead fulfilling lives, despite the challenges of living with bladder cancer.

Prevention Tips: How Can You Lower the Risk of Bladder Cancer?

While the exact causes of bladder cancer remain multifaceted and not entirely preventable, adopting certain lifestyle and environmental measures can help lower the risk of developing this disease. To reduce your risk of developing bladder cancer, these strategies may help:

  • Quit smoking or void tobacco altogether
  • Maintain a healthy diet
  • Get regular exercise
  • Maintain proper hydration
  • Minimize exposure to workplace chemicals
  • Schedule regular medical check ups

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American Cancer Society. (2022, Dec.). What Is Bladder Cancer?

American Cancer Society. (2018, Jul.). What Is Rhabdomyosarcoma?

Demarco, Cynthia. (2023, Mar 09.). Can Frequent UTIs Be a Sign of Bladder Cancer?

Dana-Farber Cancer Institute. (n.d.). Bladder Cancer Diagnosis.

Memorial Sloan Kettering Cancer Center. (n.d.). Surgery for Bladder Cancer.

National Cancer Institute. (2023, Feb. 16.). Bladder Cancer Treatment.

National Cancer Institute. (2023, Apr. 27.). Bladder Cancer Survival Rates.