Receiving a diagnosis of bladder cancer can be a frightening and deeply worrying experience. Fortunately, there are now more effective treatment options available than ever before, leading to improved outcomes for many people.

The most common form of bladder cancer starts in the organ's innermost tissue layer. “The lining of the bladder is constantly in contact with carcinogens that enter the bloodstream and get filtered through the kidneys,” says Daniel Petrylak, MD, a urologist at Yale Medicine and a professor of medicine and urology.

Most patients who develop bladder cancer are diagnosed when the cancer is in an early “non-muscle invasive” form (also called superficial bladder cancer). In this type of bladder cancer, the cancer has not invaded the bladder’s muscle layer. Some people, however, can develop more invasive disease that involves the muscle layer of the bladder. It can also spread to nearby organs and lymph nodes.

Medicines administered directly into the bladder, surgery, chemotherapy, and radiation therapy can all be treatment options, depending on the stage of cancer and the patient’s preferences. “In the last two decades, tremendous strides in the treatment of both non-muscle invasive and more advanced bladder cancer have been made, translating directly to more options and better outcomes,” says Fed Ghali, MD, a Yale Medicine urologist.

The bladder is a hollow organ in the lower part of the abdomen that stores urine to be passed out of the body. The most common form of bladder cancer starts in cells within the innermost tissue layer of the bladder. When cancer in the lining of the bladder spreads to nearby organs and lymph nodes, it is considered advanced.

Bladder cancer is the fourth most common cancer in men and the eighth most common cancer in women. About 85,000 people in the United States are estimated to be diagnosed annually.

The exact cause of bladder cancer is not fully understood, but several factors are known to increase the risk, including:

• Age: Bladder cancer typically affects people 55 and older.
• Smoking: Carcinogens from tobacco smoke come in contact with the lining of the bladder. Smokers are three times as likely to get bladder cancer as non-smokers.
• Male sex: Bladder cancer is diagnosed three to four times more frequently in men than in women, likely due to a combination of environmental and genetic factors.
• Family history: There is evidence that bladder cancer may have a genetic component.
• Industrial chemicals: Chemicals known as aromatic amines are often used in the dye industry. Workers who have daily exposure to them, such as painters, machinists, and hairdressers, may be at a higher risk for bladder cancer.
• Drinking contaminated water: This includes water that has been treated with chlorine or drinking water with a naturally high level of arsenic, which occurs in many rural communities in the United States.
• Taking certain herbs: Supplements such as Aristolochia fangchi, a Chinese herb sometimes used for weight loss, have been linked to higher rates of bladder cancer.

The early stages of bladder cancer can be difficult to recognize, but symptoms include:

• Blood in the urine
• Frequent urination
• Pain during urination
• Lower back pain

Bladder cancer is typically diagnosed by going through the patient’s health history and checking for physical signs of the disease. Blood and urine samples may also be taken and checked for abnormal cells. A doctor may order imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) scans. Often, the diagnosis may also involve a procedure called cystoscopy.

Cystoscopy involves inserting a thin, tube-like instrument with a light and a lens into the urethra, so a doctor can see the inside of the bladder and sometimes sample tissue or growths.

“We have never had more successful options for treating bladder cancer than we do now,” says Dr. Ghali. The main types of treatments for bladder cancer include:

• Surgery: Bladder cancer treatment almost always has a surgical component that may be combined with other noninvasive approaches, including those listed below. Surgery may involve small endoscopic procedures, or a larger abdominal procedure performed through standard incisions or using minimally invasive tools such as surgical robots.
• Intravesical therapy: In this targeted treatment, chemotherapy or immunotherapy medications are inserted directly into the bladder to treat superficial bladder cancer without exposing the rest of the body to side effects.
• Immunotherapy: New medications that work by activating or modifying the individual’s own immune system to fight the cancer are often used.
• Targeted systemic therapy: These drugs target specific molecules on bladder cancer cells and can play a role in treatment, either by targeting certain genetic mutations or by using an antibody to deliver cancer-killing medicine directly to the cancer cells.
• Traditional chemotherapy: The above approaches may be combined with traditional or systemic chemotherapy, which works to kill cancer cells throughout the entire body. It also heightens the effectiveness of radiation treatments.
• Radiation therapy: In radiation therapy, high-energy radiation is used to kill cancer cells. In the case of bladder cancer, the most common form of radiation therapy is external beam focused radiation in which a beam directed from outside the body is focused on the cancer much like a traditional X-ray.

The physicians and surgeons at Yale Medicine's Urologic Oncology Program are at the forefront of bladder cancer treatment, integrating innovative approaches with the latest research and technology to provide superior patient care. The care team is committed to offering the most advanced diagnostic technologies and treatment strategies available for people who have early- or late-stage bladder cancer.

“The landscape of bladder cancer treatment is changing at an unprecedented pace, and navigating these advancements requires a team with both deep expertise and a unified vision,” says Dr. Ghali. “At Yale Medicine, we offer a fully integrated multidisciplinary program where urologic surgeons, medical oncologists, pathologists, and other specialists work together to review your case and provide a personalized and up-to-date treatment plan.”

“As national leaders in clinical trials and laboratory research, our patients not only receive the current best standard of care; they have access to the pioneering innovations and clinical trials that are defining the next generation of treatment,” Dr. Ghali adds. “This merging of world-class scientific discovery and coordinated, patient-centered care is the Yale Medicine difference.”