Our experts answer common questions about bladder cancer, from symptoms and risk factors to advances in personalized treatment.
Bladder cancer is one of the most common cancers affecting the urinary system, yet many people remain unaware of its risk factors and warning signs. Recent research is expanding our understanding of bladder cancer biology and helping shape more personalized approaches to care, from diagnosis through treatment and survivorship.
Vancouver Coastal Health Research Institute researchers Drs. Gillian Vandekerkhove and Marie-Pier St-Laurent share what you should know about bladder cancer, including new research aimed at improving diagnosis and treatment as well as evidence-based resources to support people living with the disease.
Q: I noticed blood in my urine. Does this mean I have bladder cancer? What other symptoms should I watch for?
A: Blood in the urine is often caused by non-cancerous conditions. However, it is also one of the common signs of bladder cancer and should always be discussed with a health care provider so it can be evaluated by a urologist.
Other symptoms can be less specific and may include bladder irritation, frequent or urgent urination and pain in the lower abdomen or flank area. Because these symptoms can have many possible causes, it is important to seek medical advice if they persist.
Q: Who is most at risk for developing bladder cancer? How do environmental or workplace exposures contribute to risk?
A: Smoking is the leading risk factor for bladder cancer and is linked to about half of all diagnosed cases. Quitting smoking is one of the most effective ways to reduce risk. Bladder cancer is more common in men and people over the age of 65. Individuals with certain hereditary cancer predisposition syndromes, such as Lynch syndrome, are also at higher risk.
Research has identified several chemical exposures that can increase the risk of bladder cancer. These include working with certain industrial chemicals used in dyes, rubber or leather manufacturing without appropriate protective equipment. Exposure to aristolochic acid, a compound found in some traditional herbal medicines, has also been linked to bladder cancer. In some cases, bladder cancer can develop years after prior pelvic radiation used to treat cancers such as cervical, prostate or rectal cancer.
Q: How do treatments differ for early-stage versus advanced-stage bladder cancer?
A: Treatment depends largely on whether the cancer is localized or metastatic. Localized bladder cancer is divided into two types: non–muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). NMIBC is the earliest stage where the tumour is limited to the superficial inner lining of the bladder. Treatment usually involves removing the tumour through a minimally invasive surgery performed through the urethra. After surgery, medications may be delivered directly into the bladder to reduce the chance of recurrence.
MIBC is a more locally advanced stage in which the cancer grows deeper into the bladder wall, reaching at least the muscle layer. Because these tumours carry a higher risk of spreading, treatment is typically more intensive and usually include surgery to remove the bladder, or a combination of chemotherapy and bladder radiation. For many patients, the best approach starts with systemic therapy — such as chemotherapy, immunotherapy or antibody drug conjugates — before definitive treatment of the bladder itself.
Q: How is research helping to develop more personalized treatment options across the disease course?
A: Bladder cancer treatment is rapidly evolving, and research is helping us better understand the unique molecular characteristics of each patient’s cancer. One promising area is liquid biopsy, which involves ultra-sensitive tests that detect tumour DNA or cells in the blood or urine. These tests may help identify very small amounts of residual cancer that remain after treatment.
By studying tumour tissue and using liquid biopsy, researchers and clinicians can better predict which treatments are most likely to work for a particular patient and monitor how well those treatments are working over time. This approach can also help identify patients at higher risk of recurrence so that treatment plans can be adjusted accordingly. The long-term goal is personalized medicine: matching each patient to the most effective treatment and adjusting as needed while minimizing unnecessary side effects.
Q: What is supportive care, and why is it important for people living with bladder cancer during diagnosis and treatment?
A: Bladder cancer treatment can affect many aspects of daily life, such as sexual health, bowel function and financial well-being. The emotional impact of a cancer diagnosis can also be significant, and some patients experience anxiety or depression during treatment. While not everyone experiences all these challenges, supportive care can make a meaningful difference in a patient’s journey.
Supportive care focuses on helping people maintain their quality of life while living with cancer. This may include managing symptoms such as for pain, fatigue or nausea, as well as providing psychological support, nutritional counseling, exercise rehabilitation, sexual health guidance and planning for life after treatment. Supportive care is provided alongside curative or life-prolonging treatments. It is not limited to end-of-life care.
Q: What evidence-based resources are available to support people with bladder cancer?
A: Research shows that early supportive care can improve quality of life and, in some cases, even survival. Evidence specific to bladder cancer is growing, particularly in the area of prehabilitation, which focuses on helping patients become as healthy and strong as possible before treatments such as bladder removal surgery or chemotherapy.
The Bladder Cancer Supportive Care (BCSC) Program launched at the Vancouver Prostate Centre in February 2025 and is supported through philanthropic donations. The program provides free, multidisciplinary supportive care for people with bladder cancer living in British Columbia. Patients can self-refer by contacting bcsc@vch.ca or visiting the program website.
