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Bladder Cancer - Information Overview
Last reviewed: 12.07.2025
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Bladder cancer is most often transitional cell. Symptoms include hematuria; later, urinary retention may be accompanied by pain. Diagnosis is confirmed by imaging or cystoscopy and biopsy. Treatment options include surgery, destruction of tumor tissue, intravesical instillations, or chemotherapy.
Much less common are other histological types of bladder cancer, which have epithelial (adenocarcinoma, squamous cell carcinoma of the bladder, mixed tumors, carcinosarcoma, melanoma) and non-epithelial (pheochromocytoma, lymphoma, choriocarcinoma, mesenchymal tumors) origin.
The bladder can also be affected as a result of direct growth of malignant neoplasms from neighboring organs (prostate, cervix, rectum) or distant metastasis (melanoma, lymphoma, malignant tumors of the stomach, mammary gland, kidneys, lungs).
ICD-10 codes
- C67. Malignant neoplasm;
- D30. Benign neoplasms of urinary organs.
What causes bladder cancer?
In the United States, there are more than 60,000 new cases of bladder cancer and approximately 12,700 deaths each year. Bladder cancer is the fourth most common cancer in men and the least common cancer in women; the male to female ratio is 3:1. Bladder cancer is more common in whites than in African Americans, and its incidence increases with age. More than 40% of patients experience recurrence in the same or another site, especially if the tumor is large, poorly differentiated, or multiple. Expression of the p53 gene in tumor cells may be associated with progression.
Smoking is the most common risk factor, causing more than 50% of new cases. The risk is also increased by excessive use of phenacetin (analgesic abuse), long-term use of cyclophosphamide, chronic irritation (particularly from schistosomiasis, stones), contact with hydrocarbons, tryptophan metabolites or industrial chemicals, especially aromatic amines (aniline dyes, such as naphthylamine used in industrial painting) and chemicals used in the rubber, electrical, cable, dye and textile industries.
More than 90% of bladder cancers are transitional cell. Most are papillary bladder cancers, which tend to exophytic growth and a highly differentiated structure. Infiltrating tumors are more insidious, they tend to invade and metastasize early. The squamous cell variant is less common, usually found in patients with parasitic invasion or chronic irritation of the mucous membrane. Adenocarcinoma can occur as a primary tumor, but can also be a metastasis of malignant tumors of the rectum, which must be excluded. Bladder cancer tends to metastasize to the lymph nodes, lungs, liver, and bones. In the bladder, carcinoma in situ is highly differentiated but noninvasive, usually multifocal, and tends to recur.
Symptoms of Bladder Cancer
Most patients have unexplained hematuria (macro or microscopic). Some patients have anemia. Hematuria is detected during examination. Irritative symptoms of bladder cancer - urination disorders (dysuria, burning, frequency) and pyuria are also common at presentation. Pelvic pain occurs in the common variant, when space-occupying lesions are palpated in the pelvic cavity.
Where does it hurt?
Diagnosis of bladder cancer
Bladder cancer is suspected clinically. Excretory urography and cystoscopy with biopsy of abnormal areas are usually performed immediately because these tests are necessary even if urine cytology, which can detect malignant cells, is negative. The role of urinary antigens and genetic markers has not been definitively established.
For apparently superficial tumors (70-80% of all tumors), cystoscopy with biopsy is sufficient for staging. For other tumors, computed tomography (CT) of the pelvic and abdominal organs and chest X-ray are performed to determine the extent of the tumor and to detect metastases.
Bimanual examination under anesthesia and magnetic resonance imaging (MRI) may be helpful. The standard TNM staging system is used.
Symptoms and Diagnosis of Bladder Cancer
[ What do need to examine?
How to examine?
What tests are needed?
Who to contact?
Bladder cancer treatment
Early superficial bladder cancer, including initial muscle invasion, may be completely removed by transurethral resection or tissue destruction (fulguration). Repeated intravesical instillations of chemotherapeutic agents, such as doxorubicin, mitomycin, or thiotepa (rarely used), may reduce the risk of recurrence. Instillation of BCG (Bacillus Calmette Gurin) vaccine after transurethral resection is generally more effective than instillation of chemotherapeutic agents for carcinoma in situ and other high-grade, superficial, transitional cell variants. Even when the tumor cannot be completely removed, some patients may benefit from instillation. Intravesical BCG plus interferon therapy may be effective in some patients who have recurred after BCG alone.
Tumors that invade deeply into or beyond the wall usually require radical cystectomy (removal of the organ and adjacent structures) with concomitant urinary diversion; resection is possible in less than 5% of patients. Cystectomy is increasingly being performed after initial chemotherapy in patients with locally advanced disease.
Urinary diversion traditionally involves diversion into an isolated ileal loop brought out to the anterior abdominal wall and collection of urine in an external drainage bag. Alternatives such as an orthotopic neobladder or cutaneous diversion are very common and are acceptable to many, if not most, patients. In both cases, an internal reservoir is constructed from bowel. With an orthotopic neobladder, the reservoir is connected to the urethra. Patients empty the reservoir by relaxing the pelvic floor muscles and increasing abdominal pressure so that urine flows through the urethra in a nearly natural manner. Most patients achieve urinary control during the day, but some incontinence may occur at night. With a subcutaneous reservoir (a "dry" stoma), patients empty the reservoir by self-catheterization throughout the day as needed.
If surgery is contraindicated or the patient objects, radiation therapy alone or in combination with chemotherapy can provide 5-year survival rates of about 20-40%. Radiation therapy may cause radiation cystitis or proctitis or cervical stenosis. Patients should be monitored every 36 months to detect progression or recurrence.
The detection of metastases requires the administration of chemotherapy, which is often effective but rarely radical, except in cases where metastases are limited to the lymph nodes.
Treatment of recurrent bladder cancer depends on the clinical stage, site of recurrence, and previous treatment. Recurrence after transurethral resection of superficial or superficially invasive tumors is treated with repeat resection or tissue destruction. Combination chemotherapy may prolong survival in patients with metastases.
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What is the prognosis for bladder cancer?
Superficial bladder cancer is rarely fatal compared to invasive bladder cancer. For patients with deep muscle invasion, the 5-year survival rate is approximately 50%, but adjuvant chemotherapy can improve these results. Overall, the prognosis for patients with progressive or recurrent invasive bladder cancer is poor. The prognosis for patients with squamous cell bladder cancer is also poor, as it is usually highly invasive and is only detected at an advanced stage.