Bladder cancer: Risks, detection, treatment

Bladder cancer_dictionary

May is Bladder Cancer Awareness Month. Bladder cancer is the sixth most common type of cancer in the U.S. According to the National Cancer Institute’s Surveillance, Epidemiology and End Results Program (SEER) database – there were 82,290 new cases and 16,710 bladder cancer deaths in 2023. Approximately 2.3% of men and women will be diagnosed with bladder cancer at some point in their lifetime. 

Smoking is the most important risk factor, with a threefold increased chance of developing bladder cancer. Bladder cancer emerges when the cells that line the urinary bladder begin to grow uncontrollably. Although there is a genetic (inherited) component, the cancer is generally caused by prolonged exposure to toxins from smoking products and certain workplace chemicals. Other risk factors include chronic bladder irritation, aging, arsenic in drinking water and certain parasites (Schistosomiasis) which are generally found in the Middle East and Africa.

Early detection of bladder cancer is paramount in controlling this disease as many early-stage bladder cancers can be cured with minor procedures and treatments. There are no current recommendations to screen the general public for bladder cancer. However, a simple urinalysis (urine dip) is often routinely performed at maintenance health visits.

Everyone should be educated about the dangers of seeing blood in their urine (hematuria). While the majority of blood in the urine is due to non-cancer causes, it is often the first sign of bladder cancer and must be taken very seriously.

At a urologist’s office, additional tests may be performed to rule out the presence of bladder cancer — including CT scans, direct visualization of the bladder lining (cystoscopy), urine cytology or new urine tests for tumor markers.

If you are diagnosed with bladder cancer, it is important to understand your cancer is grouped into superficial, invasive or metastatic.

  • Superficial bladder cancer means the cancer is only in the lining of the bladder, but not in the deeper bladder muscle layer. Your treatment often entails minor surgery to remove the tumor with or without administration of immunotherapy or chemotherapy directly into the bladder.
  • Invasive bladder cancer means the cancer has grown into the deeper muscle layer of the bladder. This is a more aggressive form and treatment is usually a combination of chemotherapy, bladder removal surgery and immunotherapy. Occasionally radiation is used in combination with chemotherapy to treat invasive bladder cancer.
  • Metastatic bladder cancer means the cancer has spread outside of the bladder. The mainstay of treatment in this situation is intravenous immunotherapy and/or chemotherapy.

Bladder cancer presents unique challenges and opportunities for personalized treatment plans. A multidisciplinary approach to bladder cancer treatment is ideal. The team should involve urologic oncologists, medical oncologists, radiologists, radiation oncologists, pathologists, nurse navigators and geneticists. Northside has a dedicated genitourinary cancer tumor discussion board that meets weekly to discuss patient cases and tailor the best cancer treatment plans.

As health care professionals, staying abreast of the latest advances in bladder cancer research and treatment options is fundamental to improving outcomes. For example, we can now enhance tumor visualization with technologies such as blue light cystoscopy and narrow-band imaging. There are also many clinical trials exploring second- and third-line immunotherapy and chemotherapy agents that are administered directly into the bladder.

For invasive bladder cancer, there is ongoing research involving immunotherapy before and after bladder removal surgery. Your oncologist may choose to give you immunotherapy instead of, or in addition to, traditional chemotherapy. The most transformative development in advanced bladder cancer treatment has been the use of checkpoint inhibitors, which bolster the immune system’s ability to recognize and eliminate cancer cells, with several PD-L1 inhibitors now approved.

Surgery for invasive bladder cancer has also advanced tremendously over the last decade. We are now able to routinely perform bladder removal surgery with urinary tract reconstruction in a minimally invasive, robotic fashion.

  • The robotic approach allows for less pain, less blood loss, faster recovery and shorter hospital stays. With advances in technique, in select patients, we can even robotically create new bladders (neobladders) out of the small bowel, so that the patient can continue to urinate in a normal fashion.

Bladder Cancer Awareness Month serves as a crucial reminder for both physicians and patients to engage in open dialogue. By educating the public about the symptoms, risk factors and treatment options for bladder cancer, we can improve early detection rates and support better outcomes for those affected by this disease. Let’s use this month to enhance awareness, promote early detection and foster an environment of support and multi-disciplinary collaboration in the fight against bladder cancer.

Learn about the Northside Hospital Cancer Institute.



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Dr. Andrew Pridjian

Specialties: Urology

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Dr. Andrew Pridjian is a fellowship-trained urologist specializing in the minimally invasive treatment of urologic cancers and benign conditions. He is especially skilled in robotic surgery for invasive bladder cancer, kidney cancer, testicular cancer, and prostate cancer.

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