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When we feel good, most of us take our health for granted. We often overlook daily functions like walking, breathing, and using the restroom—activities that seem simple, but really, our body is hard at work. It isn’t until something goes wrong, that we notice the power and complexity of these everyday tasks.
The bladder is just as vulnerable as any other part of the body, and unfortunately, bladder cancer is among the 10 most common cancers in the world. The good news is that most bladder cancers are caught early and can be treated with surgery and chemotherapy.
What is bladder cancer?
Bladder cancer is a cancer of the bladder, a hollow pouch-like organ in the pelvis. The bladder serves to store urine passed from the kidneys through hollow tubes called ureters. The inner lining of the bladder is a thin membrane of skin-like cells (urothelial cells) surrounded by a more dense layer of connective tissue (the lamina propria). Around these two layers is a thick layer of muscle that is responsible for pushing urine out of the bladder when it is time to urinate.
About 90% of bladder cancers start in the inner urothelial lining of the bladder (urothelial cancer or transitional cell cancer). The initial tumor can be flat (urothelial carcinoma in situ) or have little projections or hairs growing from it (papillary carcinoma). Both carcinoma in situ (CIS) and Papillary carcinoma are low-grade and usually carry only a small risk of spreading. If the tumor does not start in the urothelial cells, it can start in flat cells (squamous cell carcinoma) in the bladder lining or gland cells in the bladder (adenocarcinoma).
Bladder cancer is the seventh most common form of cancer worldwide. The American Cancer Society estimates that around 80,000 people in the United States will get bladder cancer in 2020. About 17,000 people in the U.S. will die of bladder cancer in the same year. It is more common in men and seniors. Nine out of ten patients are over the age of 55, and the average age when bladder cancer is diagnosed is 73.
Bladder cancer is always graded and staged. Grading determines how likely the cancer will spread, and staging describes how far cancer has spread.
Low-grade cancer cells look a lot like normal cells and have a low risk of spreading. High-grade cancer cells are very different from normal cells and have a high risk of spreading or returning.
Stages of bladder cancer represent how far cancer has grown:
- Stage 0 cancer has just started growing and is located in a clearly defined group on the bladder wall.
- Stage I bladder cancer has grown into the lamina propria, the connective tissue below the bladder lining.
- Stage 0 and Stage I bladder cancers are called “early stage” and “non-muscle invasive” bladder (NMIBC) cancers because the tumor has not yet spread to the muscle layers in the bladder.
- Stage II bladder cancer has grown into the muscle layer of the bladder. Stage II to IV bladder cancer is called “muscle-invasive” bladder cancer (MIBC) and is always considered high-grade high-risk cancer.
- Stage III bladder cancer has spread to the fat surrounding the bladder. The cancer now sheds cancer cells into the fluid (lymph) that surrounds tissues in the bladder. Lymph collects in nearby lymph nodes where the tumor cells start growing there.
- Stage IV or metastatic bladder cancer has spread to local organs such as the prostate in men and uterus or vagina in women, as well as other parts of the body.
Treatment will depend on the grade and the stage the cancer has reached when the diagnosis is made.
How is bladder cancer diagnosed?
Bladder cancer is primarily diagnosed by identifying the tumor, imaging the tumor’s location, and lab tests. Patients will initially see a general practitioner, but the final diagnosis will be made by a urologist or oncologist (cancer doctor).
Although bladder cancer is not diagnosed by the symptoms, it’s a good idea to know when it’s time to see a doctor. Symptoms of bladder cancer include blood in the urine or urinary obstruction. Other less common symptoms include painful urination, frequent urination, fatigue, and weight loss.
People should also be aware of symptoms if they are at risk of bladder cancer. At the top of the risk list is smoking, a habit that increases the likelihood of bladder cancer six-fold. Other bladder cancer risk factors include schistosomiasis infection (rare in the developed world), exposure to certain paint, dyes, or petroleum products, advanced age, and male gender.
The gold standard for bladder cancer diagnosis is identifying the tumor directly using cystoscopy. A physician inserts a narrow tube, called a cystoscope, through the urethra into the bladder to view the bladder lining. The physician will note what the tumor looks like and the number of tumors.
During the cystoscopy, a physician will remove a part of the tumor to be analyzed in the lab (biopsy). A pathologist will study the tumor sample and look for tumor cells in a urine sample (urine cytology) to make the definitive diagnosis.
The physician will order a CT scan or X-ray of the urinary tract to determine how far the tumor has grown into the bladder tissues or if it has spread to other areas. Additional imaging tests, such as a PET scan , chest X-ray, bone scan, or MRI (magnetic resonance imaging) may be used to discover how far cancer has spread in the body.
Bladder cancer treatment options
Bladder cancer treatment depends on the stage of cancer.
Non-muscle invasive bladder cancer (NMIBC)
Standard treatment for non-muscle invasive bladder cancer (stage 0 and stage I) involves surgical removal of the tumor followed by injecting medications directly into the bladder to prevent the cancer’s return. The tumor will be removed by inserting an electric wire or laser through the cystoscope to burn away the tumor in a procedure called transurethral resection of bladder tumor, or TURBT.
TURBT will be followed by preventive medications. Drugs are injected through a tube directly into the bladder and remain in the bladder for one or two hours, a procedure known as intravesical therapy. The drugs work against any cancer cells they come in contact with. Because the drugs don’t enter the body’s tissues, side effects are mild.
Muscle invasive bladder cancer (MIBC)
Advanced bladder cancer is treated by surgically removing the entire bladder followed by a course of chemotherapy to prevent the cancer’s return.
The surgical removal of the bladder, a procedure called a radical cystectomy, will also involve removing the prostate gland in men and the uterus, cervix, ovaries, and upper vagina in a woman. Lymph nodes around the region of the urinary tract will also be removed.
If possible, the surgeon will create a new bladder from part of the small intestine called a neobladder, that will allow for near-normal urination. If a neobladder is not possible, the surgeon will create a urinary diversion. One option is for the surgeon to create an ileal conduit, a tube from a segment of intestinal tissue that directs urine from the ureters through a hole out of the abdomen to collect in a bag outside the body. The other option is to create a pouch in the body made from large intestine tissue. The urine collects in the pouch and is drained several times a day out of a hole in the abdomen using a catheter.
Surgery will be followed by intravenous chemotherapy for several months to prevent a recurrence.
Trimodality therapy
Some patients with muscle-invasive bladder cancer may be candidates for treatment that preserves the bladder. Called multi-modality or trimodality therapy, this procedure involves surgically removing the tumor (TURBT) followed by both radiation and chemotherapy.
Follow-up treatment
Once the cancer has been cleared, patients are put on a lifelong schedule of follow-up surveillance to ensure the cancer does not return. Regular cystoscopic examinations, urine cytology, and blood tests will occur every few months to once a year. A urogram (a CT imaging of the urinary tract) will be performed once a year. People with a urinary diversion will also be checked for infection and urination problems.
Bladder cancer medications
Medications for bladder cancer are prescribed based on the cancer’s stage and risk for spreading.
Intravesical BCG
Stage 0 and stage I bladder cancer involves surgical removal of the tumor and the intravesical (into the bladder) injection of BCG (bacillus Calmette-Guerin), a live but attenutaed form of Mycobacterium bovis, which at one time was used as a tuberculosis vaccine. The inactive bacteria in BCG activate the immune system in the bladder which then targets and destroys cancer cells on the bladder wall. BCG is administered directly into the bladder through a urethral catheter once a week for the first six weeks after surgery followed by maintenance doses for up to one to three years.
Intravesical chemotherapy
Intravesical chemotherapy is also used for early-stage bladder cancer both before and after surgery, but usually when BCG does not work or can’t be used. Anticancer drugs such as mitomycin, doxorubicin, valrubicin, epirubicin, or gemcitabine are injected through the urethra directly into the bladder. These drugs are then absorbed directly into the upper layers of bladder tissue where they stop the growth of cancer cells. The first dose is given within 24 hours of the surgical removal of the tumor and additional doses are given each week for four to six weeks. For higher-risk tumors, maintenance doses may go on for a year.
Mitomycin, doxorubicin, valrubicin, and epirubicin are all types of antibiotics that are used solely against cancer rather than bacteria. They all interfere with the ability of tumor cells to use their genetic information to produce new tumor cells. Gemcitabine belongs to a class of anticancer drugs called antimetabolites. These drugs stop tumor growth by interfering with enzymes that the tumor cells need to produce copies of their genetic information.
Platinum-based chemotherapy
Stage III (muscle-invasive) bladder cancer is usually treated with bladder removal (cystectomy) and an intravenous platinum-based anticancer agent (cisplatin) or, to preserve the bladder, radiation and cisplatin. Platinum-based drugs, which include cisplatin, carboplatin, and oxaliplatin, attach to DNA in cancer cells and prevent the cell from producing more cancer cells.
Platinum-based chemotherapy combination
Stage IV (metastatic) bladder cancer is treated with intravenous chemotherapy medications including cisplatin. Carboplatin or oxaliplatin, also platinum-based drugs, will be used for patients who cannot be given cisplatin. Chemotherapy is administered before (referred to as neoadjuvent therapy) and after surgery (adjuvent therapy) and can go on for several months. The first-line treatment for stage IV bladder cancer is DD-MVAC: dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin. If this doesn’t work, the most common second-line treatment is gemcitabine and cisplatin, but bladder cancer treatment protocols involve several other drug combinations depending on the situation. Platinum-combination therapy is given in cycles. Different drugs are administered in heavy doses over two days followed by a rest period. A cycle can last anywhere from 14 to 28 days and be repeated several times.
Methotrexate, like cisplatin and gemcitabine, is an antimetabolite cancer drug. Vinblastine is an alkaloid or microtubule-targeting agent (MTA). It interferes with one of the most important metabolic processes in cells, microtubule formation, and so prevents tumor cells from dividing and kills them.
Checkpoint inhibitors
When platinum-based chemotherapy combinations fail to stop the growth of cancer, intravenous injections of checkpoint inhibitors are the next line of attack. These include Keytruda (pembrolizumab), Opdivo (nivolumab), Libtayo (cemiplimab), and Tecentriq (atezolizumab). These drugs are monoclonal antibodies that attach to the “off” switch, called a checkpoint, on immune cells. By blocking the chemical off switch, these drugs fire up the immune system to kill cancer cells.
Targeted therapy
The last line of attack against stage IV bladder cancer is targeted therapy. Drugs such as Padcev (enfortumab vedotin) attach a chemotherapy molecule to an antibody specific to cancer cells. The antibody attaches to a tumor cell and “delivers” the chemotherapy drug to kill that cell.
Colony-stimulating factors
Platinum-based chemotherapy, antitumor antibiotics, and antimetabolites such as gemcitabine diminish the ability of bone marrow to generate white blood cells, called myelosuppression. White blood cells are the first line of defense against infection, so patients are much more vulnerable to potentially serious infections. To counter myelosuppression, patients will often be given granulocyte-colony stimulating factors (G-CSF) such as Neupogen (filgrastim), Neulasta (pegfilgrastim), or Granocyte (lenograstim) to stimulate white blood cell growth in the bone marrow. A subcutaneous G-CSF injection is usually given one or two days after any of these anticancer drugs are given.
What is the best medication for bladder cancer?
Appropriate bladder cancer medications are determined by the cancer stage, how the cancer has responded to therapy, and the patient’s tolerance of side effects. There is no “best” medication for bladder cancer, just the most appropriate drug or combination of drugs for the medical situation.
| Best medications for bladder cancer | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Tice BCG (Bacillus Calmette-Guerin) | Biological response modifier | Intravesical | One vial injected into the bladder per week for six weeks and once per month for six to twelve months afterward | Painful urination, flu-like symptoms, frequent urination |
| Mutamycin (mitomycin) | Anthracenedione antibiotic | Intravesical | 20 mg injected into the bladder once weekly for six weeks followed by 20 mg once per month for one to three years | Fever, loss of appetite, nausea |
| Valstar (valrubicin) | Anthracycline antibiotic | Intravesical | 800 mg injected into the bladder once per week for six weeks | Painful urination, frequent urination, urinary urgency |
| Adriamycin (doxorubicin) | Anthracycline antibiotic | Intravesical or infusion | Dose depends on method of administration and body surface area | Hair loss, nausea, vomiting |
| Infugem (gemcitabine) | Antimetabolite | Intravesical or injection | Dose depends on method of administration and body surface area | Nausea, anemia, liver problems |
| Cisplatin | Platinum-containing antimetabolite | Infusion | Dose depends on body surface area | Kidney damage, nausea, peripheral nerve pain |
| Methotrexate | Antimetabolite | Injection | Dose depends on body surface area | Dizziness, headache, hair loss |
| Vinblastine | Alkaloid | Infusion | Dose depends on body surface area | Low white blood cell counts, hair loss, pain |
| Keytruda (pembrolizumab) | Checkpoint inhibitor | Infusion | Eight ml of 100 mg/4 ml every three weeks | Fatigue, pain, lowered appetite |
| Neulasta (pegfilgrastim) | Colony-stimulating factor | Injection | 0.6 ml of 6 mg/0.6 ml injected beneath the skin | Bone pain, pain in the extremities, nausea |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of bladder cancer medication?
Side effects of bladder cancer medications will vary depending on the medication, the dose, and the patient’s other medical conditions. This is not a complete list.
Almost two in three patients that receive intravesical BCG will experience bladder irritation that includes pain, swelling, painful urination, and a frequent need to urinate. BCG is a live culture of a bacteria similar to tuberculosis, so the next most common side effects are reactions to this bacteria as if it were an infection. The most serious side effect is an actual infection that will require antibiotic treatment.
Bladder cancer chemotherapy drugs all reduce the ability of bone marrow to produce white blood cells. As a result, infections are a common side effect and could be serious enough to require hospitalization.
Antitumor antibiotics commonly cause nausea, vomiting, and hair loss, as well as possible heart damage.
Common side effects of gemcitabine include flu-like symptoms, fatigue, nausea, skin rash, and a decrease in white blood cells, red blood cells, and platelets. Lowered red blood cells, or anemia, can cause fatigue, tiredness, and shortness of breath. Platelets are responsible for blood clotting, so patients on gemcitabine may have bleeding or bruising problems.
Platinum-based chemotherapy and platinum-based combination chemotherapy (MVAC or gemcitabine-cisplatin) have several common side effects including hair loss, fatigue, mouth sores, peripheral nerve pain, tingling in the extremities, and kidney damage. The drug regimen also reduces the number of red blood cells (anemia) and platelets.
Checkpoint inhibitors cause gastrointestinal problems in almost half of patients, such as bloody diarrhea and colon swelling (colitis)—sometimes several months after the drug has been administered. Other side effects include liver damage (hepatitis), thyroid problems, overactive pituitary, adrenal insufficiency, joint pain, muscle pain, kidney problems, rashes, and itchiness. Among the most severe, but rare, side effects are kidney failure, type I diabetes, and severe and potentially life-threatening skin reactions.
Common side effects of granulocyte-colony stimulating factors include bone pain, pain in the extremities, nausea, fever, and low platelet counts, which can cause bleeding and bruising problems.
What is the best home remedy for bladder cancer?
There are no effective home or natural remedies for bladder cancer. However, self-care is an important component of minimizing the effects of surgery and chemotherapy.
Follow discharge instructions
After surgery, you will be given a detailed set of discharge instructions as well as medications to control pain or constipation. Follow these instructions carefully to speed healing and avoid complications.
Eat a nutritious diet
Loss of appetite, nausea, diarrhea, and weight loss are common effects of both cystectomy and chemotherapy. It is imperative to eat small nutritious meals rich in nutrients and spaced evenly throughout the day. Bland foods may be best tolerated.
Drink fluids
Diarrhea is a common effect of both radiation and chemotherapy, so be sure to drink fluids throughout the day. To avoid vomiting, don’t drink a lot of fluid all at once, but space out your drinking throughout the day.
Replace electrolytes
Vomiting and diarrhea deplete the body of electrolytes, so include electrolyte-rich foods such as bananas, broth, and other foods high in potassium or sodium.
Exercise
You cannot exercise hard after surgery, radiation, or chemotherapy, but it is important to move. Just a bit of daily walking or stretching will help you recover.
Practice safe hygiene
Many of the drugs used to treat bladder cancer leave a person vulnerable to infections. Wash your hands regularly, take a couple of short showers each day, and brush your teeth. Above all, avoid any people sick with infections.
Have hard candy on hand
Radiation therapy and chemotherapy can cause dry mouth and painful mouth sores. Have hard candy lying around to use to stimulate salivation.
Frequently asked questions about bladder cancer
Which medication is indicated for bladder cancer?
Bladder cancer patients are treated with medications appropriate to the cancer stage.
What foods fight bladder cancer?
It is always a good idea to eat a nutritious, balanced diet and avoid alcohol and junk food. Bladder cancer treatments—surgery, radiation, and chemotherapy—are hard on the body and cause side effects such as nausea, vomiting, diarrhea, and loss of appetite. It is important to eat highly nutritious, bland foods to maintain good health during bladder cancer treatments.
What is the latest treatment for bladder cancer?
Targeted therapies are the most recent addition to bladder cancer treatment as a last line of attack in stage IV bladder cancer. These drugs specifically target bladder cancer tumor cells with antibodies which attach to the cell and then deliver a “payload” of anti-cancer drug.
What happens when your bladder is removed due to cancer?
When the bladder is surgically removed (radical cystectomy), urine in the body has no place to collect. In some cases, surgeons can construct a neobladder (“new bladder”) out of small intestine tissue, which will work pretty much the same way as the old bladder but will require contracting the abdominal muscles to urinate. If a neobladder is not possible, the surgeon will create a urinary diversion. Urine will be directed to a pouch or directly through a hole in the abdomen. In both cases, urine will leave the body through a hole in the abdomen into a urostomy bag on the abdomen or leg.
What herbs are good for bladder cancer?
There are no herbs or natural remedies that have been scientifically demonstrated to help bladder cancer treatment.
Is cancer of the bladder curable?
Low-grade bladder cancer has high cure rates, though there is a small chance the cancer will return. Higher grade and advanced bladder cancers have lower cure rates.
How long will you live if you have bladder cancer?
Bladder cancer survival depends on the stage of cancer before treatment begins. The prognosis for earliest-stage bladder cancer is excellent, with a five-year survival rate of roughly 96%. However, as the cancer spreads locally and then to other organs, the survival rate decreases significantly. The five-year survival rate for stage IV bladder cancer is only 5%.
Does bladder cancer spread quickly?
How quickly bladder cancer can spread depends on its grade, which is based on how much the cancer has already spread as well as the appearance of the cancer cells. Low-grade bladder cancer spreads slowly and may never develop into high-grade bladder cancer. High-grade bladder cancer, however, spreads quickly in the bladder and throughout the body.
Can bladder cancer be cured by chemo?
Chemotherapy can cure bladder cancer, but the success rate depends on the cancer grade and the stage it has progressed to before treatment.