Bladder Cancer

Risk Factors

• Tobacco smoking: Leading risk factor; smokers have 3–4 times higher risk.
• Chemical exposure: Workplace exposure to dyes, rubber, leather, or pesticides.
• Chronic urinary tract infections (UTIs): Repeated irritation can increase risk.
• Chronic catheter use: Long-term catheterization increases risk.
• Previous cancer treatment: Chemotherapy or pelvic radiation.
• Family history: Having a close relative with bladder cancer increases risk.
• Age: Risk increases significantly after age 55.

Symptoms and Diagnosis

Early signs often include:

• Blood in urine (hematuria)—visible or microscopic
• Pain or burning during urination
• Urinary urgency or frequency
• Pelvic pain (in advanced cases)

Any blood in urine should be evaluated by a doctor—it's always worth investigating.

Diagnosis involves:

• Urinalysis and urine cytology: Microscopic examination of urine for abnormal cells.
• Cystoscopy: A thin, camera-equipped tube inserted through the urethra to visualize the bladder.
• Biopsy: Tissue samples are taken during cystoscopy and examined.
• Imaging (CT, ultrasound): To check for spread to lymph nodes or other organs.

Staging

Bladder cancer is classified as:

• Non-muscle-invasive (Ta, T1, Tis): Cancer hasn't invaded the muscle layer. ~70% of newly diagnosed cases. Better prognosis but higher recurrence risk.
• Muscle-invasive (T2, T3, T4): Cancer has invaded the muscle layer or deeper. ~30% of newly diagnosed cases. More aggressive, higher risk of spread.

Five-year survival rates vary widely: stage 0/I ~95–98%, stage II ~63–77%, stage III ~45–57%, stage IV ~15–20%.

Treatment Options

Non-Muscle-Invasive Bladder Cancer

TURBT (Transurethral Resection of Bladder Tumor) is standard:

• A cystoscope with a resecting loop removes the tumor and surrounding tissue.
• Minimally invasive, preserves the bladder.

Intravesical Therapy (treatment directly into the bladder):

• BCG (Bacillus Calmette-Guérin): A weakened live bacterium that stimulates the immune system. Gold standard for high-risk NMIBC.
• Chemotherapy (mitomycin, doxorubicin): Medication instilled directly into the bladder to prevent recurrence.

Muscle-Invasive Bladder Cancer

Radical Cystectomy:

• Surgical removal of the bladder, prostate (in men), and/or uterus and ovaries (in women).
• Often combined with chemotherapy before or after surgery.
• Requires creation of an alternative way to store and drain urine (urinary diversion—ileal conduit, continent pouch, or neobladder).

Multimodal Therapy (Bladder Preservation):

• TURBT + chemotherapy + radiation, used when cystectomy is not possible or desired.
• Less invasive but requires close monitoring.

Immunotherapy:

• Checkpoint inhibitors (atezolizumab, durvalumab) for advanced or metastatic disease.
• Increasingly used as first-line treatment for advanced bladder cancer.

Advanced/Metastatic Disease

Systemic chemotherapy (cisplatin-based combinations) combined with immunotherapy or targeted approaches.

Common Side Effects and Management

• BCG side effects (intravesical): Dysuria (painful urination), urgency, frequency; usually temporary.
• Urinary symptoms (post-cystectomy): Adjusting to new urinary diversion; skin irritation around the stoma.
• Chemotherapy side effects: Nausea, vomiting, fatigue, hair loss (depending on the drug).
• Sexual dysfunction: May occur after cystectomy or radiation; discuss with your care team.
• Infertility: Chemotherapy and surgery can affect fertility; discuss fertility preservation options before treatment.