The Facts About Bladder Cancer

Bladder cancer is the fourth most common cancer in men. The American Cancer Society estimates there will be around 62,000 new cases in men in 2022, compared to 20,000 in women. Although related deaths have dropped during recent years, it is estimated that more than 17,000 people will die from bladder cancer in 2022.

When someone has cancer, they have abnormal cells that split and multiply uncontrollably. Abnormal cell growth occurring in the bladder—the organ responsible for urine storage—is known as bladder cancer. Under the bladder cancer umbrella are three main varieties: adenocarcinoma, urothelial carcinoma, and squamous cell carcinoma.

The bladder is part of the urinary system, which is also composed of two kidneys, ureters, and the urethra. It helps store urine and passes waste through the body via urine expulsion. Bladders are surrounded by four tissue layers, which help determine the disease's severity.

The "stages" of bladder cancer refer to its level of invasion. There are five stages, with stage 0 signifying noninvasive before the disease becomes increasingly aggressive and widespread. 

• Stage 0 is indicative of superficial abnormal cells that have not yet progressed to full-on cancer. 
• Stage I is where the tumor permeates the surface.
• Stage II is where cancer reaches the bladder muscle tissue.
• Stage III indicates cancer cells have spread to the bladder's surrounding areas.
• Stage IV means cancer has reached or surpassed the pelvic region to other organs.

Though there is no definitive cause of bladder cancer, many risk factors increase the developmental likelihood. The most notorious is smoking tobacco, the culprit behind about half of all cases. Exposure to certain chemicals, catheters, long-term bladder complications—for example, inflammation, infections, or bladder stones—and a history of prior cancer are other risk factors. 

Sex and age have effects as well. Men are far more likely to develop bladder cancer than women, and because this type of cancer is slow-acting, most people diagnosed are 75 years of age or older. Bladder cancer seldom occurs in people younger than 40.

The most commonly reported symptoms of bladder cancer involve problems with urine or urinating. Topping the list is the presence of blood in urine. The vast majority of people with bladder cancer have varying amounts of blood in their urine. Sometimes it's obvious, but even if you can't see it, a urine test can pick up any trace amounts of blood.

Other hallmark symptoms include changes in urination frequency—going more or less than usual—or experiencing pain during urination. Sometimes people describe a burning or stinging sensation, though this is more likely to have other causes, such as an enlarged prostate gland.

Methods of treatment for bladder cancer are dependent on its characteristics and overall health. Minimally invasive cancers may not require surgery and can instead be treated through targeted chemotherapy, radiation, or immunotherapies.

When surgery is indicated, there are less invasive options available that can dramatically improve quality of life after treatment compared with more radical options from the past. The first involves the insertion of a cystoscope (a thin tube with a camera at its tip) into the bladder, where it's used to remove cells by fulguration, a procedure that destroys abnormal tissue using heat from an electric current. Later cancer stages may require a cystectomy, in which some or all of the bladder (and for men, also the prostate) is removed. Cystectomies are combined with the aforementioned therapies.

A number of tests are used to diagnose and assess bladder cancer following a general physical exam to exclude other symptom causes. During an internal exam, doctors manually feel for growths within the vagina and/or rectum. Your urine undergoes urinalysis and urine cytology to check for abnormalities, and cystoscopies examine the bladder using a cystoscope. Multiple biopsies, scans, X-rays and advanced imaging modalities, such as computed tomography (CT) scans and magnetic resonance imaging (MRI), will likely be used to complete the diagnosis. 

These tests reveal the stage, grade and size of the cancer. Diagnosable bladder cancers include adenocarcinomas, urothelial carcinomas and squamous cell carcinomas, all named for where the cancer cells originated

For men, bladder cancer and its subsequent treatments pose their own risks. The bladder and prostate are closely connected, and men often undergo a radical cystectomy with prostatectomy, which removes both organs. However, the prostate and its surrounding area are laden with nerves that assist sexual function. When these areas are disturbed, erectile dysfunction (ED) may develop.

Even the less invasive treatment options, such as chemo/radiation therapies, can cause erectile dysfunction. However, these effects are less likely to be long-lasting, and have their main impact during and immediately following treatment.

It's not just men who experience problems with sexual health as a result of bladder cancer and its treatments. Both women and men report lower libido and less ability to have satisfying sex due to both physical and psychological factors.

Physically, the removal of bladder cancer disrupts the nerves around reproductive organs because of their proximity, which can lead to decreased sensation, arousal and reactivity. Chemo/radiation therapies often make people sick, and psychologically, cancer and treatment are exhausting. Plus, self-esteem may suffer. These combined factors significantly lessen sexual desire.

While many bladder cancer treatments do not affect fertility because they are restricted to the problem area(s), doctors advise against pregnancies and breastfeeding while undergoing such procedures. Given the higher risks associated with radiation exposure to the fetus or growing infant compared with adults, such precautions are taken.

Like men, women often need to have other parts of their body, such as reproductive organs, removed in the process of a cystectomy. If someone with bladder cancer wants to have children, doctors recommend freezing sperm or eggs.

Interest in sex has the potential to dwindle after cancer treatment. Bladder cancer poses a greater chance of this happening because of its close ties to sexual health. Age is a factor, as most people with bladder cancer are seniors and tend to experience some degree of sexual dysfunction as part of the aging process. The likelihood of having complications with sex is also greater for people with preexisting sexual health problems.

This is not to say sex after bladder cancer is out of the question. You may just have to make special considerations to repair or manage any dysfunction.

Once bladder cancer is no longer at the forefront of your concerns, you can focus more on taking steps to ease the burden it has placed on your sex life.

For women who experience vaginal dryness, lubrication may ease discomfort. Consider talking to your doctor about recommendations when over-the-counter methods, such as lubricants, are not enough. There may be other options, including medical treatment such as hormonal supplements, to aid in improving sexual function and libido and relieving discomfort.

Men also have the ability to recover sexually from treatment. Many treatment options can improve erectile dysfunction. For anyone needing a urostomy bag after surgery, certain recommended sex positions could help ease anxiety about intercourse.

The current trend of bladder cancer research focuses on treatments with fewer side effects. For example, different varieties of combination therapies are being tested to discover which provides the greatest benefit for each type of cancer.

In addition, immunotherapy drugs—also known as immune checkpoint inhibitors—are being investigated to identify which patients are more likely to respond to them, as they tend to be geared toward more aggressive bladder cancers.

Bladder cancer is a very serious condition. With early intervention, the prognosis is significantly improved, so make sure to see a general practitioner or urologist about any concerns you may have. Upon diagnosis, don't give up hope as there are treatment options available regardless of the cancer stage. 

The best course of action is to be careful, follow your treatment plan and take it one step at a time. Try your best not to let cancer put a damper on any aspect of your life, including your sex life, and make sure you establish a support system of friends and family.

According to the Centers for Disease Control and Prevention (CDC), bladder cancer affects around 20,000 women and 62,000 men annually in the United States. Mortality rates are significant, with an estimated 5,000 women and 12,000 men dying each year. 

Following heart disease, cancer is the leading cause of death in the U.S., responsible for 1 in 4 deaths.

Though unrestricted by age, race and sex, trends suggest that white men older than 85 are the most likely group to experience bladder cancer. On a global scale, each year more than 570,000 people are diagnosed with bladder cancer.

How can I reduce my risk for bladder cancer?

The best way to reduce your risk of bladder cancer is to avoid smoking tobacco or exposing yourself to secondhand smoke. Avoiding carcinogenic chemicals in the workplace, such as those present in the textile, printing, and paint industries may also help ward off bladder cancer. Avoiding bladder inflammation and infections are other preventive measures.

What are the main symptoms of bladder cancer?

The most common symptom of bladder cancer is the presence of blood in the urine. Other symptoms include a burning or stinging sensation during urination and any changes in quantity or frequency, although these are less likely and may be attributed to other conditions, including prostate cancer.

Can bladder cancer return after bladder removal?

Yes, bladder cancer can come back even after a cystectomy. Repeat chemotherapy or radiation may be recommended, depending on the treatment plan, to help mitigate recurrence. However, low-grade bladder cancers may have a higher rate of relapse, so it's important to keep a vigilant eye on any suspicious symptoms, especially for the first five years.