Bladder Cancer: What You Need to Know

Bladder cancer is the fourth most common cancer in men and the most common cancer of the urinary tract. The hallmark symptom — blood in the urine — is often painless and intermittent, leading many to dismiss it. Dr. Christopher Vendryes, MD emphasizes that any visible blood in the urine warrants a prompt urologic evaluation.

Warning Signs

The most common symptom is gross hematuria — visible blood in the urine — typically painless. Other symptoms can include urinary urgency, frequency, burning, and pelvic pain. Because these mimic infection, bladder cancer is sometimes initially misdiagnosed.

Major Risk Factors

Smoking is the single biggest risk factor and accounts for nearly half of all cases. Other risks include occupational exposure to industrial dyes and chemicals (painters, hairdressers, truck drivers, machinists), chronic bladder inflammation, prior radiation, and a family history.

Diagnosis

Cystoscopy — passing a thin flexible camera into the bladder under local anesthesia in the office — is the gold standard for diagnosis. Urine cytology and CT urogram complete the staging workup.

Treatment of Non-Invasive Bladder Cancer

Most bladder cancers are non-muscle invasive at diagnosis. Treatment involves transurethral resection (TURBT) followed by intravesical therapy — instilling BCG immunotherapy or chemotherapy directly into the bladder to prevent recurrence.

Treatment of Muscle-Invasive Disease

When cancer invades the bladder muscle, treatment typically involves chemotherapy followed by radical cystectomy (bladder removal) with urinary diversion. Bladder-preserving approaches with chemoradiation are appropriate for selected patients.

Surveillance

Bladder cancer has the highest recurrence rate of any cancer — up to 70%. Lifelong surveillance with periodic cystoscopy and urine testing is critical.