Bladder Cancer

Everything about the causes, symptoms, treatments, and prognosis of tumor cell development in the bladder.

Symptoms and causes

Bladder cancer, or vesical cancer, is one of the most common types of oncologic disease, with a higher incidence in males. It occurs when bladder cells begin to grow uncontrollably, eventually forming a malignant tumor.

The main type of bladder cancer is transitional cell carcinoma, originating in the cells lining the interior of the urinary bladder, although it can also appear in other areas of the urinary tract (ureters and urethra).
It can be classified into different types. Based on how far the cancer cells have spread, it is described as:

Non-invasive bladder cancer: the tumor remains in the inner cell layer.
Invasive bladder cancer: tumor cells grow into the deeper layers of the urothelium—the tissue lining the interior of the bladder—and may reach the muscle.

The prognosis of bladder cancer depends on the stage at diagnosis and the extent of spread. When detected early and in less aggressive forms, the 5-year survival rate is approximately 90%.

Symptoms

The most characteristic symptoms of bladder cancer include:

Increased urinary frequency
Hematuria: presence of blood in the urine
Dysuria: pain or burning sensation during urination
Weight loss
Weakness
Fatigue

Causes

The exact causes of bladder cancer are unknown, although it is associated with the following factors:

Changes in the DNA of bladder cells leading to activation of oncogenes (promoting cell growth) or inactivation of tumor suppressor genes
Acquired genetic mutations due to exposure to chemicals or radiation
Inherited genetic mutations, which are rare

Different types of bladder cancer exist depending on the originally affected tissue:

Urothelial or transitional cell carcinoma: the most common type. It arises in the urothelial cells lining the bladder, renal pelvis, ureters, and urethra.
Squamous cell carcinoma: rare. Caused by a transformation of bladder cells into flat, squamous cells due to irritation or inflammation.
Small cell carcinoma: uncommon but highly aggressive. Originates in neuroendocrine cells and rapidly invades the bladder muscle.
Adenocarcinoma: very rare. Arises in glandular cells.
Sarcoma: infrequent and difficult to treat. Begins in the soft tissues of the bladder (muscle, blood vessels).

Risk Factors

Bladder cancer risk is higher in the following situations:

Sex: more common in men
Age: typically detected from 50–55 years onward
Smoking: the main risk factor, accounting for about 50% of diagnosed cases and increasing risk fourfold
Chronic inflammatory diseases of the bladder or urinary tract
Recurrent bladder infections
Prolonged exposure to radiation or chemicals
Personal or family history of cancer
Previous treatment with anticancer drugs

Complications

The most frequent complications of bladder cancer include:

Metastasis: often spreading to the lungs, liver, or bones
Urinary incontinence
Hydronephrosis: inflammation of the ureters
Urethral stricture
Complete urinary obstruction
Persistent bleeding leading to anemia

Prevention

There is no guaranteed way to prevent bladder cancer, although the following measures can reduce the risk:

Avoid smoking—the most effective preventive measure
Maintain a healthy diet rich in fruits and vegetables
Engage in regular physical activity
Limit exposure to toxic substances
Protect against radiation

Which Specialist Treats Bladder Cancer?

Bladder cancer is diagnosed and treated within urology and medical oncology, with radiation oncology involvement in most cases.

Diagnosis

When symptoms and patient history suggest bladder cancer, the following tests are used for confirmation:

Cystoscopy: insertion of a flexible tube with a camera to examine the bladder and urethra
Biopsy: tissue samples taken during cystoscopy to detect tumor cells in the laboratory
Urine culture: detects tumor markers
Urine cytology: microscopic examination of urine for cancer cells
CT urography: CT scan with contrast for detailed imaging of the urinary tract and assessment of its function

Once diagnosed, an MRI is performed to determine the cancer stage:

Stage 0: cancer cells present in the urothelium but not in the bladder wall
Stage 1: tumor cells arise from the bladder lining and spread to connective tissue without reaching the muscle
Stage 2: tumor reaches the bladder muscle
Stage 3: subdivided into:

Stage 3a:

Invasion of muscle tissue, bladder wall, surrounding fat, and in some cases, prostate, seminal vesicles, uterus, or vagina
Invasion of a pelvic lymph node distant from major pelvic arteries

Stage 3b: malignant cells reach multiple lymph nodes distant from arteries or one near the iliac arteries

Stage 4: subdivided into:

Stage 4a:

Invasion of the pelvic or abdominal wall
Lymph nodes above the iliac arteries

Stage 4b: cancer spreads to other organs, usually lungs, bones, or liver

Treatment

Bladder cancer treatment is personalized, considering patient characteristics and disease stage. In most cases, multimodal therapy is applied to achieve optimal outcomes:

Surgery: several types are possible:

Transurethral tumor resection: for superficial or early-stage cancers
Partial cystectomy: removal of part of the bladder when the tumor is localized and has invaded only part of the muscle
Radical cystectomy: complete bladder removal along with nearby lymph nodes affected by cancer

Chemotherapy: drugs to slow the growth of malignant cells

Intravesical chemotherapy: delivered directly into the bladder via a catheter
Systemic chemotherapy: affects the entire body, used preoperatively to reduce tumor size or when surgery is not feasible