What you need to know about bladder cancer


December 1, 2020

Learn about risk factors, signs and symptoms, cancer types, and treatments.

About 75,000 people in the United States are diagnosed with bladder cancer each year, according to the U.S. Centers for Disease Control and Prevention. If you’ve recently been diagnosed or are concerned about risk factors or symptoms, you may have a lot of questions.

We sat down with Sam S. Chang, M.D., Patricia and Rodes Hart Chair of Urologic Surgery and Chief Surgical Officer at Vanderbilt-Ingram Cancer Center Center, to provide an overview.

Risk factors

The biggest risk factor for bladder cancer is smoking, Chang said. People who smoke are at least twice as likely to develop bladder cancer when compared to people who haven’t smoked. “All the cancer-causing bad material from smoking,” he explained, “initially gets filtered in the lungs but put into the bloodstream, and then the kidneys filter it out. All the bad waste products from the blood end up in the urine. And all that then sits in the bladder.”

Another risk factor is exposure to toxic compounds. Repeated exposure to certain paint dyes or materials to make asphalt are examples, he added. Age can also be a risk factor, simply because the prevalence for bladder cancer increases for those over 50. And bladder cancer is more common in men than in women. “For every four to five men, there’s a woman who is diagnosed with bladder cancer,” Chang said. Although certain familial or linked syndromes can cause bladder cancer, the disease is generally not one that is passed down.

Symptoms to watch for

“The most common symptom that will bring a patient in to a doctor is they see blood in the urine,” Chang said. Sometimes people disregard this symptom because it’s painless, he added.

Visual blood in the urine is called gross hematuria, but patients may also have what’s called microscopic hematuria, blood that’s not visible to the naked eye. “One of the reasons why physicians will get a urinalysis and will examine the urine is they are looking for microscopic blood,” Chang said.

If microscopic hematuria is present in your urine, your physician will want to examine the cause. “It’s commonly due to a lot of other things,” Chang said. “Kidney stones or infection or trauma are much more common causes of hematuria, but you need to rule out cancer.”

Types of bladder cancer

The cells that line the inside of the bladder are called urothelial cells, Chang said. Bladder cancer occurs when these cells change or become abnormal. Three types of bladder cancers  are the most common. Most cases of bladder cancer are urothelial cell carcinoma, affecting cells in the urinary tract. Squamous cell carcinomas develop in the bladder’s lining. And the third type, adenocarcinomas, originate in glandular cells.


“The therapy for your bladder cancer depends upon the aggressiveness of the bladder cancer and how deep it has grown or planted roots into your bladder,” Chang said.

Most cases of bladder cancer, about 70 to 80 percent, are not invasive. That means cancerous cells can be removed via a transurethral resection of the bladder tumor (TURBT), usually an outpatient procedure with minimal recovery time. “The vast majority of patients who have their bladders kept in place can be treated with medicines put inside the bladder,” Chang said. In some cases after an initial TURBT, patients can simply be followed closely with imaging and cystoscopy, which evaluates the bladder.

About a quarter of patients with bladder cancer have invasive disease. “A proportion of those patients can still have their bladders kept in place,” Chang said. But they will likely need a combination of medication-based therapies and radiation to treat the cancer. An invasive bladder cancer may require bladder removal along with additional treatments such as radiation, chemotherapy, immunotherapy, or other medications.

Bladder cancer treatment at Vanderbilt

Vanderbilt has the ability to conduct a Cysview TURBT. Cysview is a contrast solution that bladder cancer cells will absorb, turning them bright pink. This procedure looks at the bladder under normal light but also a special blue light that shows the pink tissue. “By using it,” Chang said, “you decrease the chance of missing tumors and you decrease the chance of tumors coming back.” Vanderbilt was the first hospital in the state to begin using this technology, he added.

Additionally, the national cancer organizations and the American Urological Association have guidelines for evaluation of microscopic hematuria and guidelines to treat bladder cancer, both invasive and non-invasive. Vanderbilt surgeons chaired those guidelines, Chang said.

Vanderbilt Health’s Urological Cancers team is dedicated to preventing, diagnosing and treating cancers that affect the kidney, bladder, prostate and testicles. The specialized team works together to provide a precise diagnosis and effective treatment options.

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