What Is Bladder Cancer?

Bladder cancer is a type of cancer that starts in the cells of the bladder—the hollow organ in the lower abdomen that stores urine before it leaves the body. It is one of the most common cancers worldwide, especially in older adults. In the United States alone, more than 80,000 new cases are diagnosed each year.

The good news is that many bladder cancers are found early, when they are easier to treat. Early detection can make a big difference in survival and quality of life. However, bladder cancer has a tendency to return even after successful treatment, which means long-term follow-up care is very important.

What Are the Types of Bladder Cancer?

There are several subtypes of bladder cancer. Understanding the differences helps doctors choose the best treatment plan.

• Urothelial carcinoma (transitional cell carcinoma): The most common type (around 90% of all cases). Begins in the urothelial cells that line the bladder.
• Squamous cell carcinoma: Linked to long-term irritation of the bladder, sometimes due to chronic infections or long-term catheter use. Less common but can be aggressive.
• Adenocarcinoma: Very rare (about 1–2% of cases). Begins in glandular cells in the bladder lining.
• Small cell carcinoma: Extremely rare. Grows quickly and is usually treated with chemotherapy and radiation.
• Sarcoma: Rarest form. Starts in the muscle cells of the bladder.

What Are the Causes of Bladder Cancer?

Cancer develops when DNA inside bladder cells changes (mutates), causing cells to grow uncontrollably. While the exact cause is not always clear, several factors can contribute:

• Tobacco use: Smoking is the single biggest cause. Chemicals in tobacco smoke enter the bloodstream, get filtered by the kidneys, and end up in urine, directly damaging bladder cells.
• Chemical exposure: Long-term contact with certain industrial chemicals, especially dyes and solvents, may increase risk.
• Chronic bladder irritation: Ongoing infections, bladder stones, or repeated catheter use can sometimes lead to cancer.
• Genetic mutations: Some inherited or acquired mutations increase cancer risk.

What Are the Risk Factors for Bladder Cancer?

You may be at higher risk of bladder cancer if you have:

• Lifestyle factors:
  • Smoking (cigarettes, cigars, pipes).
  • High exposure to certain workplace chemicals (e.g., in rubber, leather, printing, or paint industries).
• Medical history:
  • Past bladder cancer (high recurrence risk).
  • Long-term urinary infections or stones.
  • Past chemotherapy or pelvic radiation.
• Age and gender:
  • Most patients are over 55.
  • Men are about 3–4 times more likely to develop bladder cancer than women.
• Family history: Having close relatives with bladder cancer slightly raises risk.
• Drinking water factors: Long-term arsenic exposure in drinking water has been linked to bladder cancer in some regions.

What Are the Symptoms of Bladder Cancer?

Bladder cancer often shows early warning signs. If you notice them, it’s important to see a doctor right away.

Early symptoms:

• Blood in the urine (hematuria) – may appear pink, red, or brown.
• Frequent urination.
• Pain or burning while urinating.
• Urgency (strong, sudden need to urinate).

Advanced symptoms:

• Back or pelvic pain.
• Inability to urinate.
• Unexplained weight loss.
• Fatigue or weakness.
• Swelling in the legs.

Because many of these symptoms can also be caused by urinary infections or kidney stones, medical evaluation is crucial.

How Is Bladder Cancer Diagnosed?

Doctors use a series of tests to confirm bladder cancer:

• Cystoscopy: A doctor inserts a thin, tube-like instrument called a cystoscope through the urethra into the bladder to directly view the bladder lining. Fluid is used to fill the bladder, allowing the doctor to see abnormal areas.
• Biopsy: If suspicious areas are found during a cystoscopy, tissue samples (biopsies) are taken. These samples are then examined under a microscope by a pathologist to confirm the presence of cancer cells.
• Urine Cytology: A sample of urine is examined under a microscope to check for any abnormal or cancerous cells.
• Imaging tests: CT Urogram uses X-rays and a contrast dye to create detailed pictures of the bladder and other urinary tract structures, helping to identify the cancer’s size and location. MRI and ultrasound provide detailed views of the urinary tract.
• Retrograde Pyelogram: An imaging test where a dye is injected into the urinary tract to make the structures more visible on X-rays.

Staging of Bladder Cancer

After diagnosis, doctors determine how advanced the cancer is. This helps guide treatment decisions.

Staging

• Stage 0: Cancer only in the bladder lining.
• Stage I: Spread into the connective tissue beneath the lining.
• Stage II: Reached bladder muscle.
• Stage III: Spread to surrounding fat or nearby organs.
• Stage IV: Spread to lymph nodes, bones, or distant organs.

Grading

• Low-grade tumors: Cells look more like normal cells; usually slower growing.
• High-grade tumors: Cells look very abnormal and are more likely to spread.

Treatment Options for Bladder Cancer

Surgery:

• Transurethral Resection of Bladder Tumor (TURBT): For superficial cancers, a TURBT is performed to remove the tumor by scraping it from the bladder wall, sometimes followed by fulguration to burn the remaining tissue.
• Partial or Radical Cystectomy: For high-grade, non-muscle-invasive, or invasive cancers, a partial or radical cystectomy (removal of part or all of the bladder) may be necessary. A urinary diversion is performed to create a new way for urine to leave the body after a radical cystectomy.

Medical Treatments:

• Intravesical Chemotherapy: Given directly into the bladder for non-invasive bladder cancers to reduce recurrence risk.
• Systemic Chemotherapy: Given through a vein for invasive cancers, often before surgery to shrink the tumor or as part of a combination with radiation therapy.
• Immunotherapy: Boosts the immune system to fight cancer. Bacillus Calmette-Guérin (BCG) is an immunotherapy agent commonly used for non-muscle-invasive bladder cancer to reduce recurrence. Systemic drugs like pembrolizumab and nivolumab may be used to treat advanced bladder cancer or to prevent recurrence after surgery.
• Radiation Therapy: High-energy rays destroy cancer cells. Often used when surgery is not possible or to shrink tumors before surgery.

Proton Therapy: When Is It Applicable?

Proton therapy is a type of radiation that uses proton beams instead of X-rays. For the treatment of bladder cancer, this technique offers the potential for better bladder preservation, enhanced local control, and reduced side effects compared to conventional photon (X-ray) radiation, making it particularly beneficial for patients with invasive bladder cancer who are ineligible for surgery. May be useful in certain cases to limit damage to surrounding organs, though it’s not the standard first-line treatment for bladder cancer.

What Is the Prognosis for Bladder Cancer?

Bladder cancer survival depends on stage, grade, and overall health.

• Early-stage cancers (Stage 0 and I): High survival rates with proper treatment.
• Stage II and III: Chances of cure are lower but still possible with aggressive treatment.
• Stage IV: More difficult to treat, but modern therapies can extend life and improve quality of life.

On average, the 5-year survival rate for bladder cancer in the U.S. is around 77%, but this varies widely by stage.

Screening and Prevention of Bladder Cancer

There is no routine screening test for bladder cancer in the general population. However, people at high risk may benefit from regular urine tests or cystoscopy.

Prevention tips:

• Quit smoking.
• Limit workplace chemical exposure.
• Drink plenty of fluids (dilutes harmful substances in urine).
• Treat bladder infections promptly.

For International Patients

People from around the world come to Apollo Hospitals for the treatment of bladder cancer. Our international patient services team will guide you all the way from seeking the first virtual connect all the way to treatment in India and then returning home post treatment.

Services include:

• Medical opinions and scheduling
• Pre-arrival medical review of reports and imaging.
• Travel and logistics
• Assistance with visa invitation letters, airport transfers, and nearby accommodation options.
• Dedicated international patient coordinators to guide through each step.
• Language and cultural support
• Interpreter services in multiple languages.
• Clear, simple explanations at every stage with written care plans.
• Financial coordination
• Transparent treatment estimates and packages when possible.
• Support with international payment methods and insurance coordination.
• Continuity of care
• Shared records, imaging, and treatment summaries for home doctors.
• Telemedicine follow-ups for convenience after returning home.