Bladder Cancer

Bladder cancer is a common type of cancer that begins in the cells of the bladder—a hollow, muscular organ located in the lower abdomen that stores urine. Most bladder cancers start in the urothelial cells, which line the inner surface of the bladder.

These cells are also found in the kidneys and ureters, which means urothelial cancers can occur there as well, though they are far more common in the bladder.

Bladder cancer is often diagnosed at an early stage, making it highly treatable. However, even early-stage bladder cancers may recur after successful treatment. Because of this, long-term follow-up and regular check-ups are essential.

Symptoms

Bladder cancer may cause the following signs and symptoms:

  • Blood in urine (hematuria) — urine may appear bright red, cola-colored, or may look normal with microscopic blood detected on tests
  • Frequent urination
  • Painful urination
  • Back pain

Causes

Bladder cancer begins when bladder cells develop DNA mutations. These genetic changes cause the cells to grow rapidly and survive longer than normal cells. Over time, the abnormal cells form a tumor capable of invading surrounding tissues and potentially spreading (metastasizing) to other parts of the body.

Types of Bladder Cancer

The type of bladder cancer depends on the cell in which the cancer originates. This helps doctors choose the most appropriate treatment.

  1. Urothelial Carcinoma (Transitional Cell Carcinoma)

The most common type. It begins in the cells lining the inside of the bladder, ureters, and urethra. These cells stretch when the bladder fills and shrink when it empties.

  1. Squamous Cell Carcinoma

Linked to chronic bladder irritation or infections, long-term catheter use, or parasitic infections such as schistosomiasis in certain regions.

  1. Adenocarcinoma

A very rare form that begins in mucus-secreting glandular cells of the bladder. Some bladder cancers may contain more than one type of cell.

Risk Factors

Factors that may increase the risk of bladder cancer include:

  1. Smoking

Smoking cigarettes, cigars, or pipes exposes the bladder to harmful chemicals filtered by the kidneys and stored in urine. This significantly increases bladder cancer risk.

  1. Increasing Age

The risk rises with age. Most cases occur after age 55.

  1. Male Gender

Men are more likely to develop bladder cancer than women.

  1. Chemical Exposure

Long-term exposure to certain industrial chemicals increases risk. These include chemicals used in manufacturing dyes, rubber, leather, textiles, and paint products, as well as arsenic.

  1. Previous Cancer Treatment
    • Chemotherapy with cyclophosphamide
    • Radiation therapy directed at the pelvis These may increase future bladder cancer risk.
  2. Chronic Bladder Inflammation

Repeated urinary infections, long-term catheter use, or chronic irritation can raise the risk of squamous cell carcinoma. In some regions, parasitic infections like schistosomiasis contribute significantly.

  1. Personal or Family History

People with previous bladder cancer have a higher risk of recurrence. A family history of bladder cancer is rare but may slightly increase risk.Conditions like Lynch syndrome (HNPCC) also increase the risk of urinary tract cancers

Treatment Options for Bladder Cancer

1.⁠ ⁠Non–Muscle-Invasive Bladder Cancer (NMIBC)

This is when the cancer is limited to the inner lining and has not invaded the muscle wall.

  • A. Transurethral Resection of Bladder Tumor (TURBT)
    • First-line treatment for diagnosis and removal.
    • Performed with a scope through the urethra (no incision).
  • B. Intravesical Therapy (medicine placed directly into the bladder)
    • 1.⁠ ⁠BCG (Bacillus Calmette–Guérin)
      • Most common and effective for high-risk NMIBC.
      • Helps the immune system attack cancer cells.
    • 2.⁠ ⁠Intravesical Chemotherapy
      • Often mitomycin C, gemcitabine, or epirubicin.
      • Used after TURBT or when BCG isn’t suitable.

2.⁠ ⁠Muscle-Invasive Bladder Cancer (MIBC)

When cancer has invaded the bladder’s muscle layer.

  • A. Radical Cystectomy
    • Removal of the bladder.
    • May involve urinary diversion, such as:
    • Ileal conduit (urostomy)
    • Neobladder reconstruction
    • Continent catheterizable pouch