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Bladder Cancer (Comprehensive)

Urothelial malignancy ranging from non-muscle-invasive to advanced metastatic disease.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Bladder Cancer (Comprehensive)?

Bladder cancer is the most common malignancy of the urinary tract, with about 90% being urothelial (transitional cell) carcinoma. Squamous cell, adenocarcinoma, small cell, and sarcomatoid variants are less common. Approximately 75% present as non-muscle-invasive bladder cancer (NMIBC: Ta, T1, CIS), 20-25% as muscle-invasive (MIBC: T2-T4), and 5% with metastasis at diagnosis.

Smoking is the strongest risk factor (50% of cases) followed by occupational exposure to aromatic amines (rubber, dye, leather industries), schistosomiasis (squamous variant), prior radiation, chronic infection, and analgesic abuse. Hematuria is the cardinal symptom. Diagnosis combines urine cytology, cystoscopy, biopsy with TURBT for staging, and cross-sectional imaging (CT urography or MRI).

Treatment depends on risk stratification (NMIBC low/intermediate/high risk per EAU/AUA criteria) and stage. NMIBC: TURBT plus single intravesical chemotherapy and intravesical BCG for high-risk; MIBC: neoadjuvant cisplatin-based chemotherapy then radical cystectomy with pelvic lymphadenectomy and urinary diversion, or trimodal therapy (TURBT plus chemoradiation) in selected candidates; metastatic: cisplatin- or carboplatin-based regimens, immune checkpoint inhibitors (pembrolizumab, atezolizumab, nivolumab), enfortumab vedotin, and FGFR inhibitors (erdafitinib) for FGFR3-altered tumors.

Symptoms

Painless gross or microscopic hematuria
Increased urinary frequency, urgency
Dysuria, suprapubic pain
Pelvic or back pain (advanced)
Lower extremity edema (lymphatic obstruction)
Bone pain (metastatic)
Weight loss, fatigue
Recurrent urinary tract infections
Urinary obstruction or retention (locally advanced)
Hydronephrosis on imaging
Anemia
Bladder mass on imaging or examination

Risk Factors

Smoking (current or former)
Occupational aromatic amine exposure (rubber, dyes, paint, leather, hairdressing)
Older age (peak 70s)
Male sex (3-4x more common)
Caucasian ethnicity
Chronic urinary tract infections
Schistosomiasis (squamous histology)
Pelvic radiation history
Cyclophosphamide therapy
Family history (Lynch syndrome)
Indwelling urinary catheter
Phenacetin or aristolochic acid

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Any visible blood in urine
  • Microscopic hematuria on routine urine analysis
  • Persistent urinary urgency or frequency
  • Recurrent urinary infections
  • Pelvic pain or low back pain unexplained
  • Unexplained weight loss
  • Lower extremity swelling
  • Bone pain

Treatment Methods

01
Diagnosis: cystoscopy, urine cytology, urinary biomarker tests, CT urography or MRI urography
02
Staging: bimanual exam, TURBT, CT abdomen/pelvis, chest imaging, bone scan if symptomatic, FDG PET in selected cases
03
Risk stratify NMIBC by AUA or EAU criteria
04
TURBT for diagnostic and therapeutic resection of all visible tumor
05
Single perioperative intravesical chemotherapy (mitomycin or gemcitabine) within 24 hours of TURBT for low/intermediate risk
06
Intravesical BCG induction (6 weekly) plus 1-3 year maintenance for high-risk NMIBC and CIS
07
Repeat TURBT at 6 weeks for high-risk T1 to confirm complete resection
08
Pembrolizumab for BCG-unresponsive high-risk NMIBC (CIS) avoiding cystectomy
09
Nadofaragene firadenovec or N-803 plus BCG as alternative second-line
10
Radical cystectomy with bilateral pelvic lymphadenectomy for MIBC and BCG-refractory high-risk NMIBC
11
Neoadjuvant cisplatin-based chemotherapy (gemcitabine-cisplatin or MVAC) before cystectomy in fit patients
12
Urinary diversion: ileal conduit, neobladder, continent cutaneous reservoir based on patient/tumor factors
13
Trimodal therapy (TURBT plus chemoradiation) as bladder preservation alternative
14
Adjuvant cisplatin-based chemotherapy for high-risk pathology
15
Adjuvant nivolumab if pT2-pT4 with positive nodes or pT3-pT4 in cisplatin-ineligible after cystectomy
16
Metastatic first-line: cisplatin-based chemotherapy if eligible, then maintenance avelumab
17
Cisplatin-ineligible: enfortumab vedotin plus pembrolizumab
18
Subsequent lines: enfortumab vedotin, sacituzumab govitecan, pembrolizumab, erdafitinib for FGFR3 alterations
19
Symptomatic palliation: TURBT for bleeding, palliative radiation, ureteral stenting for obstruction
20
Supportive care: stoma nursing, sexual function rehabilitation, lymphedema management, psychological support
21
Surveillance: cystoscopy every 3-6 months for NMIBC; cross-sectional imaging post-cystectomy or chemoradiation per protocol

Which Department to Visit?

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.