Bladder Cancer FAQ: Signs, Symptoms, Stages and Treatment Options

Bladder cancer is often highly treatable when caught early, but understanding the disease can be overwhelming for patients and caregivers. During Bladder Cancer Awareness Month, CURE® spoke with Dr. Benjamin Garmezy who specializes in genitourinary research for Sarah Cannon Research Institute at Tennessee Oncology. We spoke about common symptoms, risk factors, treatment options and what patients can expect after diagnosis.

What are the first signs and symptoms of bladder cancer?

One of the most common early signs of bladder cancer is blood in the urine, also called hematuria. In some cases, patients can see blood or notice a darker color in their urine. Other times, blood may only be detected through testing.

If blood in the urine does not resolve after treatment for a possible urinary tract infection, further evaluation by a urologist may be needed. This evaluation can include urine cytology, which looks for cancer cells in the urine, or cystoscopy, a procedure that uses a camera to examine the bladder.

Although less common, some patients with advanced bladder cancer may experience symptoms such as weight loss, fatigue, night sweats, pelvic pain or a general feeling of being unwell.

Who is most at risk for developing bladder cancer?

Several factors can increase a person's risk of developing bladder cancer, including:

• A history of smoking
• A family history of bladder cancer
• A strong family history of multiple cancers
• Exposure to certain workplace chemicals or dyes

According to Dr. Garmezy, chemicals and toxins filtered by the kidneys become concentrated in the urine before being stored in the bladder. Over time, repeated exposure to these substances can damage the cells lining the bladder and increase cancer risk.

What do the stages of bladder cancer mean?

Bladder cancer stages describe how deeply the cancer has grown into the bladder and whether it has spread.

Stage 1 bladder cancer

Stage 1 bladder cancer is confined to the inner lining of the bladder. Treatment often includes removal of the tumor and intravesical therapy, which delivers treatment directly into the bladder through a catheter.

Stage 2 bladder cancer

Stage 2 disease has grown into the muscle of the bladder wall. Treatment may include systemic therapy, surgery, radiation or a combination of approaches.

Stage 3 bladder cancer

Stage 3 bladder cancer may involve nearby lymph nodes or growth beyond the bladder muscle. Treatment generally includes systemic therapy combined with surgery or radiation.

Stage 4 bladder cancer

Stage 4 bladder cancer has spread to other parts of the body. Although metastatic bladder cancer was once considered incurable, newer therapies have improved outcomes significantly and may allow some patients to achieve long-term disease control.

What is BCG therapy and how does it work?

BCG therapy is a commonly used treatment for early-stage bladder cancer.

The treatment involves placing a weakened form of bacteria directly into the bladder. This stimulates an immune response that helps the body attack and destroy cancer cells.

BCG has been used for decades and remains one of the most effective treatments for certain patients with non-muscle-invasive bladder cancer. In some cases, it may be combined with immunotherapy to further enhance the immune response.

What side effects can patients expect from bladder cancer treatment?

Side effects vary depending on the type of treatment being used.

For patients receiving intravesical therapies, side effects are usually localized and may include:

• Urinary burning
• Bladder irritation
• Increased urinary frequency
• Blood in the urine

Patients receiving systemic therapies such as immunotherapy or antibody-drug conjugates may experience:

• Fatigue
• Rash
• Neuropathy
• Inflammatory side effects related to immunotherapy

Dr. Garmezy emphasized that most treatment-related side effects can be managed effectively by experienced care teams.

How can bladder cancer affect daily life?

The impact of bladder cancer on daily activities depends largely on the stage of disease and treatment approach.

Patients with early-stage bladder cancer are often able to maintain their usual routines. Some may experience urinary symptoms such as irritation, leakage or incontinence, but these issues can frequently be managed with supportive care.

For patients receiving systemic treatment, work schedules may need some flexibility to accommodate clinic visits and treatment appointments. However, many patients can continue working during treatment.

Some therapies can cause neuropathy, leading to numbness or tingling in the hands and feet. Care teams often adjust treatment doses if these symptoms develop.

Bladder cancer can also affect intimacy and relationships, particularly when urinary symptoms are present. Open communication with partners and healthcare providers can help patients navigate these challenges.

Is there reason for optimism for patients with advanced bladder cancer?

Yes. According to Dr. Garmezy, treatment options for advanced bladder cancer have improved significantly in recent years.

New immunotherapies and targeted treatments have helped patients live longer and maintain quality of life. Researchers continue to explore ways to improve outcomes and potentially increase the number of patients who achieve long-term remission or cure, even in metastatic disease.

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