Bladder Cancer: Symptoms, Causes & Treatment

Bladder cancer is a tumor that can cause a frequent urge to urinate, lower abdominal pain, blood in the urine, excessive tiredness, and unexplained weight loss. Blood in the urine is one of the most common warning signs of bladder cancer.

Bladder cancer can affect anyone, but it is more common in people who smoke and in those who are frequently exposed to certain chemicals, such as dyes, pesticides, or arsenic. These substances can accumulate in the bladder over time and damage the tissue, which may lead to cancerous changes.

If bladder cancer is suspected, it is important to see your primary care provider or a urologist as soon as possible for diagnosis and treatment. Early evaluation helps identify the cause of your symptoms and determine the most appropriate next steps.

Bladder cancer symptoms

The main symptoms of bladder cancer are:

• Blood in the urine, usually detected only on a urine test

• Pain or a burning sensation when urinating

• Lower abdominal pain

• Needing to urinate more often

• A sudden urge to urinate

• Urinary incontinence

• Fatigue

• Loss of appetite

• Unexplained weight loss

Bladder cancer symptoms can also occur with other urinary tract conditions, such as prostate cancer, urinary tract infections, kidney stones, or urinary incontinence.

According to the National Cancer Institute, blood in the urine is the most common symptom of bladder cancer and should be evaluated as soon as possible.

Because of this, it is important to see a primary care provider or urologist to identify the cause of your symptoms and discuss the most appropriate treatment.

Main causes

Bladder cancer happens when malignant cells begin to grow in the bladder. This may be related to genetic factors or to frequent or long-term exposure to toxic substances.

Toxic substances may be found in cigarettes, pesticides, dyes, and medications such as cyclophosphamide. These substances can enter the body through food, breathing, or skin contact and may contribute to the development of cancer cells.

Confirming a diagnosis

Bladder cancer is usually diagnosed by a urologist based on a person’s symptoms, medical history, and physical exam. To confirm the diagnosis, the doctor may order tests such as a urine test, ultrasound of the urinary tract, MRI or CT scan, and cystoscopy.

Cystoscopy is done by passing a thin tube through the urethra to look inside the bladder. If cancer is suspected, the doctor may also order a biopsy, which removes a small sample from the abnormal area of the bladder for lab analysis and is often done during cystoscopy.

Cancer staging

Based on imaging tests, the stages of bladder cancer are:

• Stage 0: no evidence of a tumor, or the tumor is found only in the lining of the bladder

• Stage 1: the tumor has grown through the lining of the bladder but has not reached the muscle layer

• Stage 2: the tumor has reached the muscle layer of the bladder

• Stage 3: the tumor has gone beyond the muscle layer of the bladder and reached nearby tissues

• Stage 4: the tumor has spread to lymph nodes and nearby organs, or to distant parts of the body

Cancer staging helps determine how advanced the disease is and which treatment is most appropriate. Since the stage is related to how far the cancer has progressed, early diagnosis and early treatment are very important.

Bladder cancer treatment

Depending on the stage of the disease and the person’s overall health, treatment may include:

1. Surgery

Surgery is the most commonly used treatment for bladder cancer. It tends to work best when the tumor is found early and is still localized.

Some surgical procedures that may be used are:

• Transurethral resection: this involves scraping, removing, or burning the tumor when it is small and located on the surface of the bladder

• Partial cystectomy: this involves removing the part of the bladder affected by the tumor

• Radical cystectomy: this is used in more advanced stages of the disease and involves removing the entire bladder

When the whole bladder is removed, lymph nodes or other nearby organs that may contain cancer cells may also be removed. In men, this may include the prostate, seminal vesicles, and part of the vas deferens, while in women it may include the uterus, ovaries, fallopian tubes, and part of the vagina.

2. BCG immunotherapy

Immunotherapy uses medicines that help the immune system attack cancer cells. It is most often used for superficial (non-muscle-invasive) bladder cancer or to help prevent the cancer from coming back after surgery.

The most commonly used form of immunotherapy is BCG, a solution containing live, weakened bacteria that is placed into the bladder through a catheter and works by stimulating the immune system to attack cancer cells. According to the National Cancer Institute, BCG is used to help lower the risk of the cancer coming back after surgery.

The person usually needs to keep the BCG solution in the bladder for about 2 hours, and treatment is generally given once a week for 6 weeks, although the schedule may vary based on medical guidance. Other immunotherapy agents may also be recommended depending on the case.

3. Radiation therapy

Radiation therapy uses radiation to destroy cancer cells. It may be used before surgery to shrink the tumor, instead of surgery in people who cannot have surgery, or after surgery to destroy cancer cells that may still remain.

It can be given externally, using a machine that directs radiation at the bladder area, or internally, by placing a device in the bladder that releases radioactive material. Treatment is usually given several times a week for several weeks, depending on the stage of the tumor.

4. Chemotherapy and immunotherapy

Chemotherapy for bladder cancer uses medicines to destroy cancer cells in the bladder and, in some cases, elsewhere in the body. Treatment may involve one medicine or a combination of medicines, and immunotherapy may also be recommended depending on the characteristics of the tumor.

In people with superficial (non-muscle-invasive) bladder cancer, the doctor may use intravesical chemotherapy, in which the medicine is placed directly into the bladder through a catheter and left there for several hours. This treatment is usually given once a week for several weeks.

Is bladder cancer curable?

The chances of curing bladder cancer are higher when the tumor is found in the early stages of the disease. At that point, the tumor is usually less advanced and may respond better to the treatment recommended by the doctor.