Bladder cancer is one of the most common cancers in the United States. It is especially frequent in older adults and people with a history of smoking or certain occupational exposures.
While incidence rates have decreased in recent years by about 1%, it remains one of the most common types of cancer both globally and in the U.S. According to the American Cancer Society, Bladder cancer is the 10th leading cause of death in the U.S., with a high survival rate for patients who seek timely treatment.
Bladder cancer is among the most frequently diagnosed cancers in the U.S. It occurs more often in:
- older adults (most patients are over age 55)
- men more than women
- people with a history of smoking
- individuals exposed to certain chemicals in dyes, rubber, leather, and other industries
Because it often presents with visible blood in the urine, many cases are detected at an early stage, when treatment can be very effective.
Estimate your risk for bladder cancer.
Types of bladder cancer
Most bladder cancers begin in the inner lining of the bladder. The three main types are:
Urothelial (transitional cell) carcinoma is by far the most common in the U.S. It arises from the urothelial cells lining the bladder. These tumors are classified as non–muscle-invasive, when they are confined to the inner lining or just below it, or muscle-invasive, when they grow into the bladder’s muscular wall. This distinction is crucial because non–muscle-invasive disease is often managed with bladder-sparing procedures and intravesical therapies, while muscle-invasive disease usually requires more aggressive treatment, often including removal of the bladder.
Squamous cell carcinoma is less common and is linked to chronic irritation and inflammation of the bladder, such as long-term catheter use or certain infections. It is often more aggressive and frequently diagnosed at a more advanced stage.
Adenocarcinoma is rare and develops from glandular cells in the bladder lining. It is also associated with chronic inflammation or congenital abnormalities. Surgery is typically central to treatment, often in combination with chemotherapy or other systemic therapies.
Symptoms, detection, and diagnosis
Common symptoms
The most frequent early symptom is a change in urination, especially blood in the urine. Key symptoms include:
- blood in the urine (hematuria), which may be visible (pink, red, or cola-colored urine) or detected only on urine testing
- frequent urination
- urgency (strong, sudden need to urinate)
- pain or burning with urination
- pelvic pain or lower back pain (often a later sign or linked to more advanced disease)
These symptoms can also be caused by infections, kidney stones, or other conditions, but they should never be ignored.
Detection and initial evaluation
Initial detection begins with a medical history, physical exam, and urine tests to look for blood, infection, and cancer cells. Persistent, unexplained blood in the urine should always prompt further workup.
The key diagnostic tool is cystoscopy, in which a thin scope with a camera is passed through the urethra into the bladder so the surgeon can directly examine the bladder lining. If abnormal areas are seen, a procedure called transurethral resection of bladder tumor (TURBT) is performed under anesthesia. During TURBT, the surgeon removes visible tumors and sends tissue to pathology to determine the cancer type, grade (how aggressive the cells look), and depth of invasion. Imaging studies such as CT or MRI scans are used to evaluate the urinary tract, lymph nodes, and other organs to see whether the cancer has spread.
Persistent or unexplained blood in the urine should always prompt further evaluation.
Risk factors
There is no standard population-wide screening test for bladder cancer like there is for colon or breast cancer. However, targeted evaluation is important for high-risk individuals. Factors that increase risk include:
- smoking (cigarettes, cigars, pipes, or smokeless tobacco)
- long-term exposure to certain industrial chemicals
- prior radiation therapy to the pelvis
- certain chemotherapy agents (for example, cyclophosphamide)
- chronic bladder inflammation or long-term catheter use
- family history or certain genetic syndromes
Major risk factors include smoking (the single most important preventable cause), long-term exposure to certain industrial chemicals, prior pelvic radiation, some chemotherapy drugs, chronic bladder inflammation or infections, and certain inherited conditions. For individuals with significant risk factors, clinicians may recommend regular urine testing and prompt evaluation of any urinary changes, particularly blood in the urine. In selected high-risk situations, periodic cystoscopy may also be considered.
Prevention focuses on modifying risk: quitting tobacco, using protective equipment when working with chemicals, treating chronic urinary symptoms or infections, staying well hydrated, and following up promptly when urinary changes occur.
Treatment options
At WashU Medicine, the specialist team tailors the treatment to the type, stage, and grade of the cancer, as well as the patient’s overall health and preferences.
For non–muscle-invasive bladder cancer, TURBT is the primary treatment to remove visible tumors. This is often followed by intravesical therapy, which involves placing medication directly into the bladder through a catheter. Common intravesical treatments include bacillus Calmette-Guérin (BCG) immunotherapy and intravesical chemotherapy agents such as mitomycin or gemcitabine. Because recurrence is common, patients need regular follow-up with cystoscopy, urine testing, and sometimes imaging.
When cancer has invaded the bladder muscle, treatment becomes more intensive. Standard options include radical cystectomy (removal of the bladder and nearby lymph nodes), often combined with chemotherapy given before surgery to improve outcomes. Some patients may be candidates for bladder-sparing “trimodal” therapy, which combines maximal TURBT with chemotherapy and radiation. The choice between cystectomy and bladder-sparing approaches depends on tumor features, overall health, kidney function, and patient goals.
For metastatic or advanced bladder cancer, treatment typically involves systemic therapies such as chemotherapy, immunotherapy (for example, checkpoint inhibitors), and targeted drugs for tumors with specific molecular changes. Radiation and surgery may be used for symptom control in selected situations.
Clinical expertise at WashU Medicine
The multidisciplinary team of specialists at WashU Medicine offers comprehensive, care for patients with bladder cancer, including advanced surgical options in collaboration with fellowship-trained urologic oncologists.
This collaborative approach ensures that each patient receives an individualized treatment plan that may combine surgery, chemotherapy, radiation, and novel therapies when appropriate. Emphasis is placed on both cancer control and quality of life, including urinary function, sexual health, and long-term follow-up.
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