About 74,000 new cases of bladder cancer will be diagnosed this year, predominantly in people older than age 55, according to the American Cancer Society. Half of these patients will have bladder cancer that is still confined to the inner layer of the bladder, 35% will have cancer in deeper layers but which is still confined, and the remaining patients will have cancer that has spread to tissues outside the bladder.
Bladder cancer is diagnosed in whites almost twice as often as in African Americans, although the disease may be more advanced at diagnosis in minorities. Men are far more likely than women to develop bladder cancer; it is the fourth most common cancer in men.
Transitional cell carcinoma, or urothelial carcinoma, is the most common type of bladder cancer. It is divided into papillary carcinoma, in which tumors grown in slender, finger-like projections from the inner surface of the bladder toward its hollow center, and flat carcinoma, which exists only in the inner layer of bladder cells.
Squamous cell carcinoma, more commonly seen in sun-exposed areas of the skin, may very rarely occur in the bladder but often invades surrounding tissues.
Adenocarcinoma occurs in 1% of bladder cancers, but also is associated with invasive cancer.
Small cell carcinoma occurs in less than 1% of bladder cancers, beginning in neuroendocrine cells that grow quickly.
Bladder cancer is rare, so there is no regular recommended screening, such as a colonoscopy to detect signs of colon cancer. However, doctors may suggest bladder cancer screening for people with signs or symptoms, or increased risk from certain bladder birth defects, work-related exposure to specific chemicals, or a previous history of the disease.
Diagnosis may begin with a urinalysis, or collection of urine for examination. Different urine tests may indicate blood in the urine, the presence of cancer cells, or tumor markers that could indicate bladder cancer. Often, the presence of a small amount of blood in the urine is caused by infection, kidney or bladder stones, or benign kidney disease. Urinary changes, such as frequency, burning, pain, or urgency, may also be caused by noncancerous conditions. However, any urinary change, especially being unable to urinate, should be immediately evaluated by a physician.
Imaging studies are a critical component of diagnosing, staging, and planning appropriate treatment for bladder cancer. Computed tomography (CT) and magnetic resonance imaging (MRI) are already widely used, and some physicians are exploring the potential role of positron-emitted tomography (PET)-CT using intravenous tracing dyes to guide medical management about where and how bladder cancer develops.
Surgical techniques to treat bladder cancer range from passing an instrument up the urethra to remove tumors or abnormal tissue, known as transurethral resection of the bladder tumor or TURBT or cystectomy (removal of all or part of the bladder and sometimes parts of sexual organs). Reconstructive surgery is necessary if the entire bladder is removed. Surgery does involve the risk of side effects, including the potential for pain, infection, bleeding, urinary side effects, and sexual dysfunction.
Chemotherapy and radiation may be used alone or in conjunction with other interventions. For noninvasive or minimally invasive cancers, intravesical therapy, where a liquid drug is inserted directly into the bladder through a catheter, is sometimes used. Chemotherapy drugs that destroy cancer cells or immunotherapy drugs that cause the body’s own immune system to attack cancer cells may be used in intravesical therapy. Intravesical therapy may help spare healthy tissues, but may cause pain or burning in the bladder or have side effects similar to intravenous chemotherapy, such as pain, weakness, aches, fatigue, nausea, vomiting, and an inability to concentrate.
In 2015, a study published in Nature reported that a clinical trial of MPDL3280A, an immunotherapy drug for patients with advanced bladder cancer, showed such promise that the U.S. Food and Drug Administration granted it “breakthrough therapy designation status.” Among patients who were positive for the PD-L1 protein, 43% showed tumor shrinkage at 6 weeks, and 52% showed tumor shrinkage at 12 weeks. In patients who were negative for the PD-L1 protein, more than 10% responded to treatment. The drug is also being investigated for other hard-to-treat cancers, including lung, kidney, colon, and head and neck cancers.
More than 500,000 people in the United States are bladder cancer survivors. Learn more about diagnosis, treatment, and clinical research from the American Cancer Society.