Bladder Cancer

Bladder cancer is marked by uncontrolled cell growth in the bladder. This leads to growths that may spread to other body parts.

The bladder is a hollow organ located in the lower part of the abdomen. It stores urine produced by the kidneys. Its muscular wall expands to accommodate more urine and contracts to release it from the body.

Bladder cancer can disrupt these standard functions, causing blood in the urine, frequent urination and pain during urination. As the cancer advances, it can penetrate deeper layers of the bladder wall. It may spread to nearby tissues or other organs.

There are multiple forms of bladder cancer.

Who Is at Risk?

Smoking is the leading risk factor for bladder cancer. Smokers are at least three times more likely to get bladder cancer than nonsmokers, according to the American Cancer Society.

“Cigarette smoking was found to be the major risk factor for bladder cancer as it accounts for nearly 50% of this disease,” Dr. Michael Lahey of St. Johnsbury, Vt., told Drugwatch.

Smoking puts harmful chemicals into the body, which the kidneys then filter into the urine. This can expose the bladder to things that cause cancer.

People who work with certain chemicals to make dyes, rubber, leather and paints are also at a higher risk.

Additionally, older adults, especially men, are more likely to get bladder cancer, as are people who have family members with the disease.

Frequent bladder infections, irritation from frequent catheter use and exposure to schistosomiasis-causing parasites may also raise the risk.

Bladder cancer treatments may include different drugs, drug combinations or surgery. These treatments include intravesical therapy, systemic chemotherapy and immunotherapy.

Systemic Chemotherapy

Systemic chemotherapy for bladder cancer involves injecting chemotherapy drugs into a vein. When administered this way, the drugs enter your bloodstream to target cancer cells throughout your body.

These drugs may be used alone or in combination with one another or other chemotherapy drugs.

While taxanes, like paclitaxel, and vinca alkaloids, like vinblastine, function similarly, they have different action methods. Both bind to tubulin, a protein that makes up microtubules, to prevent mitosis cell division. However, taxanes prevent microtubules from degrading, while vinca alkaloids prevent microtubules from assembling.

Mitosis requires both the breakdown and assembly of microtubules, so stopping either will prevent cell division. The best drug may depend on your specific bladder cancer.

Immunotherapy Drugs for Bladder Cancer

Immunotherapy is a cancer treatment that helps your body’s natural immune system fight cancer. It introduces substances that help the immune system better recognize and attack cancer cells.

This treatment helps your immune system find and fight cancer cells, which can sometimes hide from the body’s natural defenses.

After a doctor puts medication into your bladder, you usually need to wait for one to two hours before urinating. Depending on the treatment schedule, you may have to repeat this procedure several times.

Additionally, all intravesical immunotherapy treatments for bladder cancer can cause symptoms such as a burning feeling in the bladder, a burning sensation when urinating, feeling the need to urinate more often and blood in the urine.

Radiation therapy uses high-energy beams – like X-rays – to kill cancer cells. It’s often used after surgery to remove the cancer or as an alternative for patients who can’t or don’t want surgery. It can also be used for advanced bladder cancer or to help with symptoms.

The most common type of radiation therapy for bladder cancer, external beam radiation therapy, targets the cancer from outside your body. It’s often combined with chemotherapy to make it work better. A radiation treatment combined with chemotherapy medication is called chemoradiation.

Before treatment, patients will need images taken from devices such as CT or MRI scans. This is so the doctor can find the best angles to target the tumor. Before treatment, doctors will likely ask the patient to empty their bladder.

Radiation treatments usually happen five days a week over several weeks. Although the treatment itself is typically painless, side effects can include bladder pain, frequent urination and fatigue.

Sometimes, there are long-term issues like incontinence or bladder irritation. Radiation therapy in the bladder can also cause erectile dysfunction if it damages the nerves and blood vessels that contribute to erections.

Surgery is part of the treatment for most bladder cancers.

The type of surgery will depend on the cancer’s extent and your health and preferences.

Transurethral Resection of Bladder Tumor (TURBT)

Transurethral resection of bladder tumor (TURBT) is a standard procedure used to diagnose and treat early-stage bladder cancer.

It involves inserting a thin, flexible instrument called a cystoscope through the urethra. This device has a camera and other tools to help locate and remove tumors from the bladder’s inner lining. This minimally invasive technique also allows doctors to collect tissue samples for testing. TURBT is often the first treatment when the cancer is confined to the bladder lining.

In some cases, doctors may perform a second TURBT a few weeks later to ensure all cancerous tissue is gone. This follow-up helps prevent recurrence and provides more accurate staging.

Cystectomy

A cystectomy is a surgery that removes all or part of your bladder when there’s cancer in the muscle layer.

In a partial cystectomy, your doctor only removes the tumor and part of the bladder wall so the bladder can still work. This is sometimes an option for small cancers, but it might make you urinate more often because of the reduced bladder size. Nearby lymph nodes are also removed and tested for cancer. Doctors rarely perform partial cystectomies for bladder cancer, however, due to a high risk of the cancer returning.

Doctors may perform a radical cystectomy for bigger or more widespread cancers. It removes your whole bladder, nearby lymph nodes and sexual organs. Depending on your anatomy, this may include the prostate and seminal vesicles, uterus, ovaries, cervix, fallopian tubes and part of the vagina.

Both surgeries can be done with a regular cut or minor cuts using a surgical robot.

Urinary Diversion

Urinary diversion is a reconstructive surgery performed after a radical cystectomy. Since the bladder is no longer available to store urine, doctors create an alternate way for your body to collect and pass urine.

There are several types of urinary diversions. These include an ileal conduit, where a piece of the intestine is used to form a tube for urine to pass into a bag outside your body, and a neobladder, which uses intestine to create a new bladder-like pouch inside your body.

Bladder Cancer Stages

The most appropriate cancer treatment depends on your condition and how far the cancer has advanced.

There are five cancer stages, including stage 0. Earlier stages are typically easier to treat because the cancer hasn’t spread much yet, if at all.

Treatments are unlikely to cure stage IV cancers and doctors may recommend joining a clinical trial.

A 2021 study published in the Journal of the American Heart Association involving over a million valsartan users found no overall increase in cancer risk. However, it did reveal a slight increase in certain cancers, such as liver cancer and melanoma.

In 2018, valsartan, a medication used to treat high blood pressure, was found to be contaminated with a chemical called N-nitrosodimethylamine (NDMA). NDMA is classified as a probable human carcinogen. There was a valsartan recall after this discovery.

Studies have looked at whether this contamination increases the risk of cancer, including bladder cancer.

A 2022 study published in the journal Deutsches Ӓrzteblatt International involving over 780,000 people also found a small increased risk of liver cancer but did not find a higher risk for bladder cancer or other types.

Valsartan Cancer Lawsuits

People who developed cancer after taking valsartan have filed over 1,200 lawsuits against valsartan manufacturers. They claim the drug caused their cancers due to NDMA contamination.

A federal panel has consolidated these valsartan lawsuits into a multidistrict litigation (MDL) in New Jersey. The plaintiffs claim that the companies knew about the contamination but did not inform the public.

Some lawsuits seek compensation for personal injury, while others focus on refunds for the cost of the medication. As of September 2024, no settlements or jury verdicts have been announced.

Other Drugs Linked to Bladder Cancer Risk

Certain medications, supplements and chemotherapy agents have been linked to an increased risk of bladder cancer.

According to the American Journal of Medicine, studies have found no link between SGLT2 inhibitors, a diabetes drug class, and bladder cancer. However, the authors still advise caution for people with a history of bladder cancer when taking SGLT2 inhibitors.

Bladder cancer survivors and those wanting to prevent bladder cancer can benefit from several lifestyle changes. While there’s no guaranteed way to prevent bladder cancer, adopting healthy habits can help lower risk and improve overall well-being.

Making these changes can help you live a healthier life and may reduce the risk of bladder cancer.

Editor Lindsay Donaldson contributed to this article.