Bladder cancer occurs when cells in the bladder begin to grow uncontrollably.
The most common — and reversible — risk factor is cigarette smoking. Quitting at any time can reduce a person’s risk of developing bladder cancer. Other risk factors include a family history of bladder cancer or exposure to certain paints, dyes, metals or petroleum products.
The main sign of bladder cancer is hematuria, or blood in the urine. This may be visible to the naked eye or detected only under a microscope. In many cases, hematuria is painless. Whether visible or not, the presence of blood in the urine should prompt evaluation by a urologist.
A key factor in determining both treatment approach and prognosis is whether the cancer has spread into the muscle layer of the bladder wall. When it has not, it is called non-muscle-invasive bladder cancer (NMIBC). This is considered an early stage, where the tumor is confined to the inner lining of the bladder. In contrast, muscle-invasive bladder cancer is more advanced and involves deeper layers of the bladder, with potential spread beyond it.
NMIBC is further classified based on how deeply it involves the bladder lining:
- Ta: The tumor is limited to the innermost layer
- T1: Cancer has spread into the connective tissue beneath the lining
- Carcinoma in situ (CIS): A high-risk, flat, high-grade cancer
Diagnosis of NMIBC usually includes several steps. A cystoscopy allows the physician to look inside the bladder using a small camera. Urine cytology examines cells in the urine under a microscope. A biopsy confirms the diagnosis, and imaging tests such as CT scans help determine whether the cancer has spread. These diagnostic tests are typically performed after a patient presents with hematuria.
The primary goals of treatment are to remove the cancer and prevent recurrence or progression. Initial treatment options include transurethral resection of the bladder tumor (TURBT), a procedure to remove the tumor from the bladder lining, and intravesical therapy, in which medication is delivered directly into the bladder.
Intravesical therapy may include:
- Chemotherapy to destroy remaining cancer cells
- Immunotherapy to stimulate the body’s immune system to attack cancer
If these treatments are not effective and the cancer continues to return or progresses, a radical cystectomy (removal of the bladder) with urinary diversion may be recommended. This surgery can be highly effective but carries significant risks.
Because NMIBC has a risk of recurrence, ongoing surveillance is critical. Patients typically undergo regular cystoscopy and urine testing after treatment.
Until recently, treatment options for NMIBC had remained largely unchanged for decades, and many patients underwent radical cystectomy due to the lack of alternate, novel therapeutic options. Fortunately, the treatment landscape has evolved significantly over the past five years, with several new therapies approved by the Food and Drug Administration.
These newer options include:
- Adstiladrin, an intravesical therapy given once every 90 days
- Anktiva, an intravesical immunotherapy given in a six-week induction followed by a three-week maintenance regimen
- Inlexzo, an intravesical device that remains in the bladder for up to three weeks and provides sustained release of chemotherapy (gemcitabine)
These therapies have shown success in patients whose cancer has not responded to standard treatments. As a result, some are now being studied as first-line options to determine whether they can improve outcomes earlier in the course of disease.
While more research is needed, these advances represent meaningful progress. Patients with NMIBC now have more options than ever before — offering hope for effective treatment while avoiding bladder removal when possible.
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