Bladder Cancer

Usually first noticed as painless blood in the urine. Most cases are caught before invading the bladder wall.

How it presents

The most common first sign is painless blood in the urine, either visible or found on a urinalysis. Because it is painless and often intermittent, it is easy to dismiss — which is exactly why any blood in the urine deserves evaluation.

Less commonly, bladder cancer causes urinary frequency, urgency, or burning that mimics an infection but does not respond to antibiotics.

Risk factors

Smoking is by far the leading risk factor and accounts for roughly half of cases. Carcinogens are filtered by the kidneys and sit in contact with the bladder lining. Occupational exposure to aromatic amines — in dye, rubber, leather, paint, and some manufacturing settings — is next. Prior pelvic radiation, certain chemotherapy agents, and chronic bladder irritation also contribute.

Diagnosis and staging

Diagnosis involves cystoscopy to see the bladder lining directly, imaging of the upper tracts, and often a urine cytology. If a tumor is found, the next step is TURBT — transurethral resection of bladder tumor — performed under anesthesia, which both removes the visible tumor and provides the tissue needed to determine depth of invasion.

That depth is the central question. About three quarters of bladder cancers are non-muscle-invasive, confined to the inner layers. The remainder are muscle-invasive, and are treated far more aggressively.

Treatment

Non-muscle-invasive disease is treated by resection, often followed by medication instilled directly into the bladder — BCG immunotherapy or chemotherapy — to reduce recurrence. Because recurrence is common, surveillance cystoscopy at regular intervals becomes a long-term part of care. This surveillance is not a formality; it is what keeps the disease controlled.

Muscle-invasive disease is typically treated with chemotherapy followed by removal of the bladder (radical cystectomy) with urinary diversion, or in selected patients with a bladder-preserving combination of resection, chemotherapy, and radiation.