Bladder Cancer

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This blog is for informational purposes only and should not be taken as medical advice. Content is sourced from third parties, and we do not guarantee accuracy or accept any liability for its use. Always consult a qualified healthcare professional for medical guidance.

What is Bladder Cancer?

Bladder cancer arises from malignant cells in the bladder, the organ storing urine before excretion. The predominant type is urothelial carcinoma (90%), originating in the urothelial cells lining the bladder, ureter, and urethra. Less common types include squamous cell carcinoma (linked to chronic irritation) and adenocarcinoma (glandular origin). It is classified as non-muscle invasive (NMIBC, 70-80%, superficial) or muscle-invasive (MIBC, 20-30%, aggressive), with metastatic potential in advanced stages. In 2025, bladder cancer is the 10th most common cancer globally, with approximately 82,000 new US cases annually, primarily affecting men (4:1 ratio) and older adults (median age 73).

Symptoms

Symptoms are often urinary-focused, including painless hematuria (blood in urine, visible or microscopic, in 80-90% of cases), increased urinary frequency, urgency, burning or pain during urination, and pelvic or lower back pain. Advanced or metastatic disease may cause weight loss, fatigue, bone pain (from skeletal metastases), leg swelling (lymph node involvement), or anemia. Symptoms can resemble urinary tract infections or benign prostatic hyperplasia, contributing to diagnostic delays, especially in women.

Causes

The primary cause is smoking (50-65% of cases, due to carcinogenic compounds in tobacco), followed by occupational exposure to aromatic amines and polycyclic hydrocarbons (e.g., in dye, rubber, or paint industries). Other risk factors include chronic bladder irritation (e.g., recurrent infections, bladder stones, indwelling catheters), prior pelvic radiation or chemotherapy (e.g., cyclophosphamide), arsenic in drinking water, and Schistosoma haematobium infection (linked to squamous cell carcinoma in endemic areas). Genetic mutations (e.g., FGFR3 in NMIBC, TP53/RB1 in MIBC) drive progression. Family history, male gender, age over 55, and white ethnicity increase risk. In 2025, environmental toxins and HPV (in rare squamous cases) remain significant contributors.

Diagnosis

Diagnosis begins with urinalysis to detect hematuria, followed by cystoscopy (flexible or rigid) to visualize and biopsy suspicious lesions. Urine cytology identifies malignant cells, while tumor markers (e.g., NMP22, BTA) aid detection. Imaging includes CT urography or MRI for staging, with PET scans for metastasis evaluation. Molecular testing for FGFR3, TP53, or ERBB2 mutations informs prognosis and therapy. In 2025, AI-enhanced cystoscopy improves lesion detection by 20%, and liquid biopsies (urine ctDNA) enable non-invasive monitoring of recurrence and treatment response.

Treatment

For NMIBC, transurethral resection of bladder tumor (TURBT) removes visible tumors, followed by intravesical therapy: BCG immunotherapy (standard for high-risk NMIBC, reducing recurrence by 30-50%) or chemotherapy (mitomycin-C, gemcitabine). MIBC treatment involves radical cystectomy (bladder removal) with urinary diversion (ileal conduit or neobladder), often preceded by neoadjuvant cisplatin-based chemotherapy (e.g., MVAC, improving survival by 5-10%). Bladder-preserving trimodality therapy (TURBT + chemoradiation) is an alternative for select patients. Metastatic disease uses systemic chemotherapy, immunotherapy (pembrolizumab, atezolizumab for PD-L1+ tumors), targeted therapy (erdafitinib for FGFR alterations), or antibody-drug conjugates (enfortumab vedotin for nectin-4). In 2025, novel ADCs like pivekimab sunirine and intravesical gene therapies show 40-50% response rates in advanced cases, with CAR-T trials emerging for refractory disease.

Future Outlook

In 2025, bladder cancer’s 5-year survival is 77% overall, 96% for localized NMIBC, 69% for regional MIBC, and 6% for metastatic disease. Advances in ADCs, FGFR inhibitors, and immune checkpoint inhibitors have improved progression-free survival by 20-30% in advanced cases. Research focuses on mRNA-based vaccines, AI-driven recurrence prediction, and combination therapies (e.g., immunotherapy + ADCs). By 2030, these could increase metastatic survival to 20% and reduce NMIBC recurrence by 50%, with emphasis on personalized medicine and early detection via urine-based biomarkers.

Sources

The information for bladder cancer is sourced from the National Cancer Institute’s “Bladder Cancer Treatment (PDQ®)” for comprehensive details on understanding, symptoms, causes, diagnosis, and treatment; DAVA Oncology’s “Breakthroughs in Bladder Cancer: Key Highlights from ASCO GU 2025” for advancements in immunotherapy and ADCs; UroToday’s “SNMMI 2025: Revolutionizing Bladder Cancer Treatment” for radiomolecular therapy updates; Mayo Clinic’s “Transformative advances in bladder cancer treatment” for surgical and therapeutic progress; and Weill Cornell Medicine’s “New Insights into Bladder Cancer Treatment Could Help Improve Immunotherapies” for immunotherapy developments and future directions.