Bladder Cancer Guide: Learn about bladder cancer treatment and prevention
Bladder cancer is a common type of cancer that begins in the cells of the bladder. The bladder is a hollow muscular organ in your lower abdomen that stores urine.Bladder cancer most often begins in the cells (urothelial cells) that line the inside of your bladder. Urothelial cells are also found in your kidneys and the tubes (ureters) that connect the kidneys to the bladder. Urothelial cancer can happen in the kidneys and ureters, too, but it's much more common in the bladder.Most bladder cancers are diagnosed at an early stage, when the cancer is highly treatable. But even early-stage bladder cancers can come back after successful treatment. For this reason, people with bladder cancer typically need follow-up tests for years after treatment to look for bladder cancer that recurs.
Bladder cancer is the sixth most common cancer in the United States, with approximately 81,000 new cases diagnosed annually. This condition occurs when cells in the bladder begin to grow abnormally and form tumors. The disease predominantly affects older adults, with the average age at diagnosis being 73. While smoking remains the leading risk factor, exposure to certain industrial chemicals and chronic bladder inflammation also increase susceptibility. This guide provides essential information about bladder cancer treatment options, prevention strategies, and considerations for different patient populations.
Understanding Bladder Cancer Types and Staging
Bladder cancer is categorized based on how deeply it has invaded the bladder wall. Non-muscle invasive bladder cancer (NMIBC) accounts for about 75% of cases and includes stages Ta, T1, and carcinoma in situ (CIS). Muscle-invasive bladder cancer (MIBC) has penetrated deeper into the bladder muscle and includes stages T2, T3, and T4. Accurate staging is crucial as it determines the appropriate treatment approach. Diagnostic procedures typically include cystoscopy, urine cytology, imaging tests, and biopsies to confirm the diagnosis and assess the extent of the disease.
Primary Bladder Cancer Treatment Options
Treatment strategies for bladder cancer vary widely depending on the cancer stage, grade, and individual patient factors. For early-stage non-muscle invasive bladder cancer, transurethral resection of bladder tumor (TURBT) is often the first-line treatment, removing visible tumors through a cystoscope. This may be followed by intravesical therapy, where medication is delivered directly into the bladder to destroy remaining cancer cells. For muscle-invasive bladder cancer, more aggressive approaches are necessary, including radical cystectomy (complete removal of the bladder), often combined with chemotherapy before or after surgery. Bladder-preserving approaches using a combination of TURBT, chemotherapy, and radiation therapy (trimodal therapy) may be options for selected patients who wish to avoid bladder removal.
Immunotherapy for Bladder Cancer
Immunotherapy has revolutionized bladder cancer treatment by harnessing the body’s immune system to fight cancer cells. Bacillus Calmette-Guérin (BCG) therapy, a form of immunotherapy, has been used for decades to treat early-stage bladder cancer by stimulating an immune response in the bladder. More recently, immune checkpoint inhibitors such as pembrolizumab, nivolumab, and atezolizumab have shown promising results in advanced or metastatic bladder cancer. These medications work by removing the “brakes” on the immune system, allowing it to recognize and attack cancer cells more effectively. Clinical trials continue to explore new immunotherapy agents and combinations to improve outcomes for patients with various stages of bladder cancer.
Treatment for Bladder Cancer in Elderly Patients
Treating bladder cancer in elderly patients presents unique challenges due to potential comorbidities, decreased physiological reserves, and concerns about treatment tolerance. Age alone should not disqualify patients from receiving effective treatment, but careful assessment of overall health status, functional capacity, and life expectancy is essential. For elderly patients with non-muscle invasive bladder cancer, TURBT with or without intravesical therapy remains standard. However, for muscle-invasive disease, treatment decisions become more complex. Some elderly patients may benefit from radical cystectomy with urinary diversion, while others might be better candidates for bladder-preserving approaches. Geriatric assessments help identify vulnerable patients who might benefit from modified treatment regimens. Supportive care measures, including management of treatment side effects and maintenance of quality of life, are particularly important in this population.
Advanced and Emerging Bladder Cancer Treatments
For advanced or metastatic bladder cancer, systemic therapies play a crucial role. Chemotherapy combinations, particularly those containing cisplatin, have been the standard first-line treatment for decades. However, many patients cannot tolerate cisplatin due to kidney problems or poor performance status. Newer targeted therapies are showing promise for specific genetic mutations. Fibroblast growth factor receptor (FGFR) inhibitors like erdafitinib can benefit patients with certain FGFR gene alterations. Antibody-drug conjugates such as enfortumab vedotin combine the targeting ability of antibodies with potent chemotherapy agents. Clinical trials are investigating novel combinations of immunotherapy with chemotherapy or targeted agents, as well as personalized approaches based on molecular profiling of tumors.
Bladder Cancer Prevention and Risk Reduction
While not all bladder cancers are preventable, several strategies may reduce risk. Smoking cessation is the most important preventable risk factor, as smokers have a three to four times higher risk of developing bladder cancer compared to non-smokers. Workplace safety measures are crucial for those exposed to industrial chemicals, particularly in the dye, rubber, leather, and aluminum industries. Adequate hydration helps dilute potential carcinogens in urine and encourages frequent urination, reducing contact time between harmful substances and bladder lining. A diet rich in fruits and vegetables may provide protective effects through antioxidants. Regular screening is not recommended for the general population but may be considered for high-risk individuals with significant exposure history or hereditary syndromes associated with bladder cancer.
Living with Bladder Cancer: Follow-up and Quality of Life
Surveillance after bladder cancer treatment is essential due to high recurrence rates. Follow-up typically includes regular cystoscopies, urine cytology, and imaging studies, with frequency depending on risk classification. For patients who undergo radical cystectomy, adjusting to life with a urinary diversion requires education and support. Various types of diversions include ileal conduit, neobladder, and continent urinary reservoir, each with different management considerations. Support groups and psychological counseling can help patients cope with body image concerns, sexual dysfunction, and anxiety about recurrence. Rehabilitation programs focusing on pelvic floor exercises, sexual health, and general physical conditioning can significantly improve quality of life during and after treatment.
This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.
