Bladder cancer is a malignancy of the organ in the lower abdomen that stores urine and is the sixth most common cancer in the U.S. Bladder cancer frequently starts in the cells lining the bladder (urothelial cells); however, it can also occur in other types of bladder cells as well as include more than one type of cell. Three types of bladder cancer that begin in the cells lining the bladder (urothelial cells) are 1) urothelial carcinoma, which is also called transitional cell carcinoma; 2) squamous cell carcinoma; and 3) adenocarcinoma. Urothelial carcinoma (Transitional cell carcinoma) – Urothelial carcinoma, which is the most common type of bladder cancer in the U.S., is found in the cells lining the inside of the bladder (urothelial), which expand when the bladder is full and contract when it is empty. Squamous cell carcinoma – Squamous cell carcinoma can occur from chronic bladder irritation, such as frequent bladder infections or long-term catheterization. While rare in the U.S., this cancer is common in other countries where parasite infections called schistosomiasis cause frequent bladder infections. Adenocarcinoma – Adenocarcinoma occurs in the glands of the bladder that secrete mucus and is rare in the U.S. Bladder cancer is further classified as either non-muscle invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC). Non-muscle invasive bladder cancer (NMIBC) – Non-muscle invasive bladder cancer is the most common type of bladder cancer, and usually does not spread (metastasize); however, it frequently recurs after treatment. Muscle-invasive bladder cancer (MIBC) – Muscle-invasive bladder cancer spreads to the muscle wall of the bladder and can be life-threatening. Bladder cancer is also categorized by the following stages: Stage 0 (0a and Ois) – Non-invasive papillary carcinoma or carcinoma in situ, with abnormal cells that may become cancerous and spread (metastasize). Stage I – Cancer has spread to the connective beyond the inner lining of the bladder (urothelial cells). Stage II – Cancer has spread to the muscle layers of the bladder. Stage III (IIIA and IIIB) – Cancer has spread to the fat outside the bladder, and possibly the reproductive organs, such as uterus, vagina, prostate, or seminal vesicles; or cancer has spread to one pelvic lymph node. Stage IV (IVA an IVB) – Cancer has spread from bladder to the lining of the abdomen (peritoneum) or pelvis; or cancer has spread to lymph nodes above common iliac arteries. Cancer has spread (metastasized) to other parts of the body, such as liver, lung, and bone. Bladder cancers are further categorized based on the appearance of cells, as either a low-grade bladder tumor or high-grade bladder tumor. Low-grade bladder tumor – Low-grade bladder tumor has cells that look more like normal cells, grows slowly, and is usually non-invasive (does not spread). High-grade bladder tumor – High-grade bladder tumor has cells that look abnormal, is more aggressive, and is usually invasive (spreads). The stage and grade of bladder cancer determines its treatment and outcome (prognosis).

Alternative names for bladder cancer include bladder tumor, bladder neoplasm, transitional cell carcinoma, urinary carcinoma, urothelial carcinoma, and urothelial bladder cancer.

Bladder cancer occurs when genetic (somatic) mutations or chromosome 9 deletions occur that are acquired during a person’s lifetime (are not inherited) and that damage DNA in bladder cells, leading to abnormal cells that form a tumor. Several risk factors can also increase the chances of developing bladder cancer, such as chronic irritation of the bladder from recurrent bladder infections or long-term catherization, smoking, exposure to radiation or industrial chemicals such as arsenic, dyes, leather, rubber,  paint, and petroleum in the workplace, drinking water that has been treated with chlorine, and parasite infections (schistosomiasis). Other risk factors that increase chances of developing bladder cancer include being white, male, older than 40, previous cancer treatment, or having a family history of bladder cancer or hereditary nonpolyposis colorectal cancer (Lynch Syndrome).

While many individuals with bladder cancer have no symptoms, symptoms may include frequent urination, difficult urination, painful urination, pelvic pain, back pain, and blood in the urine (hematuria).

Treatments for bladder cancer depend on the type, stage, and grade of the cancer, in addition to a patient’s overall health and may include surgery, transurethral resection of bladder tumor (TURBT), cystectomy (partial or complete bladder removal), bladder reconstruction, continental urinary reservoir (new pouch for holding urine), intravesical (in the bladder) chemotherapy, systemic (whole body) chemotherapy, radiation therapy, chemotherapy combined with radiation therapy (chemoradiation), bladder preservation trimodal therapy, and immunotherapy (biological therapy or biologics). Surgery – Surgery for bladder cancer can include surgery to remove the bladder tumor and any surrounding cancerous tissue, transurethral resection of bladder tumor (TURBT), which is where the surgeon inserts a cautery or laser device through the urethra into the bladder to burn out the cancer, cystectomy, which involves either partial or full removal (radical cystectomy) of the bladder, and bladder reconstruction, which creates a new way for urine to be excreted, such as the creation of a continental urinary reservoir (new pouch for holding urine) through the use of a small portion of the small intestine. Chemotherapy – Chemotherapy for bladder cancer can be administered in different ways, such as intravesical chemotherapy (used for high-grade or recurrent bladder cancers), which is when cancer drugs are administered directly into the bladder, systemic (whole body) chemotherapy, which is used when the cancer cannot be surgically removed (unresectable) and is administered via a pill or intravenously (IV), or chemotherapy combined with radiation therapy (chemoradiation). Chemotherapy may be used before surgery to reduce the tumor size, or after surgery to kill any remaining cancer cells.  Radiation Therapy – Radiation therapy uses directed, high-energy X-rays or protons or other types of radiation to kill bladder cancer cells. Trimodality Therapy (Bladder preservation)– Trimodality therapy uses a combination of chemotherapy, radiation therapy, and transurethral resection of bladder tumor (TURBT) in an effort to preserve as much of the bladder as possible. Immunotherapy (Biological therapy or biologics) – Immunotherapy is when the body’s immune system is used to fight cancer cells and is administered either directly into the bladder (intravesical) or systemically through pills or an IV (intravenously).  Common immunotherapy drugs administered for bladder cancer are Bacillus Calmette-Guerin (BCG), which is a tuberculosis vaccine, interferon (interferon alfa-2b ), and atexolizumab (Tecentriq), which is used for locally advanced or metastatic bladder cancer that was unresponsive to chemotherapy. Some patients may also want to consider participating in clinical trials for bladder cancer to gain access to new, experimental treatments.

There are a variety of support groups for bladder cancer: American Bladder Cancer Society - https://bladdercancersupport.org/ Bladder Cancer Advocacy Network - https://bcan.org/in-person-support-group/ CancerCare - https://www.cancercare.org/diagnosis/bladder_cancer Cancer Support Community - https://www.cancersupportcommunity.org/bladder-cancer

If you experience any symptoms such as frequent urination, difficult urination, painful urination, pelvic pain, back pain, or blood in the urine (hematuria), contact your doctor as soon as possible. If abnormal bladder cancer cells are found after testing, you will be referred to specialists in urinary surgery and cancer treatment called urologists and oncologists.

Possible complications of bladder cancer include urinary incontinence (leaking of urine), swelling in the ureters (hydronephrosis), ureteral narrowing (stricture), sexual problems (erectile dysfunction or narrowing of the vagina), and anemia.  Some patients may have to wear a urostomy bag, either temporarily or permanently, after bladder cancer surgery, which is emptied a few times a day. Cancer treatment-related complications may also occur, such as weakness and fatigue, skin and nail changes, hair loss, and others, for which treatment is an essential part of cancer care.

If you experience any symptoms such as frequent urination, difficult urination, painful urination, pelvic pain, back pain, or blood in the urine (hematuria), contact your doctor as soon as possible. If abnormal bladder cancer cells are found after testing, you will be referred to specialists in urinary surgery and cancer treatment called urologists and oncologists.

While there is no known way to prevent bladder cancer, the risk of developing this cancer can be reduced by not smoking, drinking adequate amounts of water each day, avoiding exposure to industrial chemicals in the workplace, and regularly eating a variety of fruit and vegetables. Any bladder infection should be treated as soon as possible, as any lingering or frequent bladder infections can increase the risk of developing bladder cancer. If you have a family history of bladder cancer or a family history of hereditary nonpolyposis colorectal cancer (Lynch Syndrome), it is important to speak with your doctor about being screened for bladder cancer. Bladder cancer that is diagnosed and treated in the early stages has a good chance of being cured.