Bladder cancer is the fourth most common cancer in men in the United States.* Yet, scientists are still working to understand more about its genetic markers and how genetic testing can lead to better treatment options.
“Certain types of bladder cancer are rare. But that means there’s the biggest opportunity looking ahead, and there is great potential,” says Joshua J. Meeks, MD, PhD, Northwestern Medicine urologic oncologist. At Polsky Urologic Cancer Institute of Robert H. Lurie Comprehensive Cancer Center at Northwestern Medicine, Dr. Meeks is researching the underlying genetics of bladder cancer to help develop new treatments for the disease.
A Deeper Look at Bladder Cancer
Urothelial carcinoma, the most common bladder cancer, occurs in the innermost layer of the bladder in the urothelial cells. And though there are other types, such as squamous cell carcinoma (located inside the bladder) and adenocarcinoma (located in the lining of the bladder), these are more rare. Treatment approaches depend on the cancer's location as well as its stage of development.
Risk factors for bladder cancer include:

• Your genetics and family history
• Age
• Sex
• Personal history of bladder cancer

Though bladder cancer can impact anyone, it occurs more frequently in male patients. Dr. Meeks says scientists are beginning to understand the importance of differences between male and female bladders. “There are also differences in when they become diagnosed,” he adds. For example, those who have periods may see blood in their urine and associate it with menstruation, delaying diagnosis.
One risk factor you can change? Smoking. “We attribute 50% to 60 % of cases to smoking,” says Dr. Meeks. Other additional risk factors include occupational exposures, particularly if you have been exposed to certain chemicals and water with carcinogens.
Diagnosis and Prognosis of Bladder Cancer
The first sign of bladder cancer is often blood in the urine, which may or may not be accompanied by any other symptoms. This bleeding may occur irregularly, but it’s unlikely to occur just once. That said, blood in the urine can occur for a number of reasons, including infection, kidney stones or other kidney diseases. Regardless, Dr. Meeks suggest seeking medical attention any time you have blood in your urine to investigate the cause.
Other symptoms can include:

• Difficulty with urination, including a slow, weak or interrupted flow
• Decreased urination
• Frequent urination
• Erectile dysfunction
• Weight loss or weakness
• Loss of bladder or bowel control

Individuals with blood in their urine are evaluated in two ways ― a cystoscopy (a procedure that allows a physician to see inside your bladder) and imaging (such as a CT scan). If an abnormality is found, your care team will see if the growth is cancerous (with a biopsy) and, if it is, remove it (with a resection).
Bladder Cancer Types
Non-muscle-invasive bladder cancer

• 80% of cases
• High risk of coming back, but progression, or coming back at a higher stage is rare
• Treatment reduces the risk of recurrence
• Often becomes a chronic (long-term) disease rather than a life-threatening condition

Invasive bladder cancer

• 20% of cases
• More aggressive and harder to identify
• Invades the muscle, or the deep part of the bladder
• May require aggressive treatment and even removal of the bladder

Better Research, Better Outcomes
The treatment for bladder cancer depends on the grade and stage of cancer. Treatment options can include:

• Chemotherapy
• Radiation therapy
• Surgery.
• Trials in immunotherapy, which uses patients’ own immune system to fight cancer, have also shown promise. “Immunotherapy may be a good choice for you if you’ve had surgery to remove cancer from your bladder or the cancer has returned,” says Dr. Meeks. “We have patients alive because of this opportunity.”

As a clinical investigator at Polsky Urologic Cancer Institute, Dr. Meeks says many avenues of research are being conducted on this complex disease. “We are conducting research to better understand the expression of certain genes and genetic changes that occur in a bladder tumor,” he explains. “This is the most fundamental cancer question. We also have a clinical trial to better understand the tumor mechanisms.”
Dr. Meeks says he hopes his work leads to the development of new therapies, including intravesical therapies, to improve survival outcomes for patients with bladder cancer. He says patients have been generous in participating in research to advance the field.
“We’re learning a lot from these new trials and therapies,” he says. “The future looks bright.”