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Bladder cancer

Urinary system cancer that begins in the urinary bladder

  • 25 min read
  • 10 chapters
Transitional cell carcinoma of the bladder. The white in the bladder is contrast.
James Heilman, MD · CC BY-SA 4.0

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Through Bladder, Lymph node and Urethra

Those whose bladder tumors have not spread outside the bladder have the best prognoses. These tumors are typically surgically removed, and the person is treated with chemotherapy or one of several immune-stimulating therapies. Those whose tumors continue to grow, or whose tumors have penetrated the bladder muscle, often have their bladder surgically removed (radical cystectomy). People whose tumors have spread beyond the bladder have the worst prognoses; on average they survive a year from diagnosis. These people are treated with chemotherapy and immune checkpoint inhibitors, followed by enfortumab vedotin.

Around 500,000 people are diagnosed with bladder cancer each year, and 200,000 die of the disease. The risk of bladder cancer increases with age and the average age at diagnosis is 73. Tobacco smoking is the greatest contributor to bladder cancer risk, and causes around half of bladder cancer cases. Exposure to certain toxic chemicals or the tropical bladder infection schistosomiasis also increases the risk.

Signs and symptoms

The most common symptom of bladder cancer is visible blood in the urine (haematuria) despite painless urination. This affects around 75% of people eventually diagnosed with the disease. Some instead have "microscopic haematuria" – small amounts of blood in the urine that can only be seen under a microscope during urinalysis – pain while urinating, or no symptoms at all (their tumors are detected during unrelated medical imaging). Less commonly, a tumor can block the flow of urine into the bladder; backed up urine can cause the kidneys to swell resulting in pain along the flank of the body between the ribs and the hips. Most people with blood in the urine do not have bladder cancer; up to 22% of those with visible haematuria and 5% with microscopic haematuria are diagnosed with the disease. Women with bladder cancer and haematuria are often misdiagnosed with urinary tract infections, delaying appropriate diagnosis and treatment.

Around 3% of people with bladder cancer have tumors that have already spread (metastasized) outside the bladder at the time of diagnosis. Bladder cancer most commonly spreads to the bones, lungs, liver, and nearby lymph nodes. Tumors cause different symptoms in each location. People whose cancer has metastasized to the bones most often experience bone pain or bone weakness that increases the risk of fractures. Lung tumors can cause persistent cough, coughing up blood, breathlessness, or recurrent chest infections. Cancer that has spread to the liver can cause general malaise, loss of appetite, weight loss, abdominal pain or swelling, jaundice (yellowing of the skin and eyes), and skin itch. Spreading to nearby lymph nodes can cause pain and swelling around the affected lymph nodes, typically in the abdomen or groin.

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