Understanding Bladder Cancer Risk Factors and Treatment Options
- Pro-golfer John Daly’s long-term tobacco use – nearly three decades of smoking two packs per day – significantly increased his risk for bladder cancer.
- Daly was diagnosed with bladder cancer in 2020 and underwent treatment, including chemotherapy, which can cause substantial systemic side effects such as GI toxicity, nausea, and fatigue.
- Smoking is the leading modifiable risk factor for bladder cancer; experts note that nicotine‑related toxins remain in the bladder for extended periods, contributing to tumor development.
- “About half of all bladder cancer cases are due to smoking,” notes Dr. Jay Shah, a urologic surgeon and leader of Stanford’s Cancer Care Program for Urologic Oncology.
- Treatment options for bladder cancer continue to evolve, with advances in surgical approaches, bladder‑preserving strategies, and new therapies for BCG‑unresponsive non–muscle‑invasive disease, including the recently FDA‑approved Inlexzo (TAR‑200) intravesical drug‑delivery system.
- “What makes Inlexzo distinct is that it’s not simply delivering intravesical gemcitabine in the way we would traditionally think about it,” says Dr. David Aggen, a genitourinary medical oncologist at Memorial Sloan Kettering Cancer Center.
A recent post from “Complex” highlighted Daly’s “everyman” persona, calling him “the golfer who lived on cigarettes and whiskey every day.”
Read More
Bladder cancer is the sixth most common cancer in the U.S. overall and the fourth most common among men. It develops when cells in the bladder grow uncontrollably and form tumors. Common warning signs include blood in the urine, frequent urination, and painful urination.
WATCH: Risk Factors for Bladder Cancer
Smoking remains the number one risk factor for bladder cancer.
“About half of all bladder cancer cases are due to smoking,” notes Dr. Jay Shah, a urologic surgeon and leader of Stanford’s Cancer Care Program for Urologic Oncology.
He adds that toxins from nicotine and other chemicals linger in the bladder for long periods before being flushed out in urine.
“The first and foremost thing for a healthy bladder is, don’t smoke,” says Dr. Arjun Balar, director of the genitourinary oncology program at NYU Langone’s Perlmutter Cancer Center.
View this post on Instagram
“If we can eliminate cancer risks related to smoking, that’s probably the most important thing you can do.”
Daly underwent treatment, including chemotherapy, which kills cancer cells but can also damage healthy cells — leading to harsh side effects such as nausea, fatigue, and gastrointestinal issues.
We’ll explore Daly’s bladder cancer journey in more detail shortly, but it’s worth noting that bladder cancer treatment has advanced significantly in the six years since his diagnosis, offering new hope for patients today.
New Hope for Bladder Cancer Patients
For people diagnosed with muscle‑invasive bladder cancer (MIBC) who are healthy enough for surgery, bladder removal is still considered the standard first‑line treatment. Some patients undergo a radical cystectomy, which removes the entire bladder, while others may be candidates for a partial cystectomy, which preserves part of it.
“Radical cystectomy is quite frankly a harder surgery than having a breast removed or a kidney removed,” says Dr. Elizabeth Wulff, a medical oncologist at the University of Kansas Health System.
Exactly what’s removed depends on the patient’s gender and how far the cancer has spread, but the procedure affects multiple systems in the body. As Dr. Wulff explains, the surgery doesn’t just involve the urinary tract; it also affects the gastrointestinal system.
“Without a bladder, we have to create an internal reservoir where urine can go so that it can exit our body,” she says.
“That requires some portion of the GI tract, usually the small bowel.”
WATCH: Radical Cystectomy’s Impact On The Body
Bladder‑Preserving Options
For some patients, a bladder‑sparing approach may be possible. This typically involves combining treatments such as radiation and chemotherapy.
“We think about certain factors about the tumor itself to determine which patients are the best candidates for radiation, if that’s their preference,” says Dr. Matthew Mossanen, a urologist at Brigham and Women’s Hospital.
These decisions are made in collaboration with both a radiation oncologist and a urologic oncologist.
What Happens If the Bladder Is Removed?
If the bladder is taken out, the body still needs a way to store and release urine. This is done through a urinary diversion, and there are three main types:
- Ileal conduit: The most common and simplest option. A small piece of intestine is used to create a channel that carries urine from the kidneys to a stoma (an opening on the abdomen). Urine drains continuously into an external collection bag.
- Continent cutaneous reservoir: An internal pouch is created from the intestine. Instead of wearing a bag, patients empty the pouch several times a day using a catheter inserted through a small opening in the abdomen.
- Orthotopic neobladder: A new internal “bladder” is constructed from intestine and connected to the urethra, allowing patients to urinate in a more natural way without an external stoma.
Recovery After Radical Cystectomy
The first few weeks after surgery are often the most challenging. Patients may experience:
- Low energy
- Reduced independence
- Discomfort
- Urinary changes
- GI symptoms
Recovery involves not only healing physically but also learning how to manage the new urinary diversion and gradually regaining confidence.
A New Option for Non–Muscle‑Invasive Bladder Cancer
Not all bladder cancers invade the muscle. For patients with non‑muscle‑invasive bladder cancer (NMIBC) who no longer respond to standard therapy, a newly approved treatment may offer an alternative to bladder removal.
The FDA recently approved Inlexzo (also called the gemcitabine intravesical system or TAR‑200) for adults with BCG‑unresponsive NMIBC.
Until now, these patients have often faced extremely difficult treatment choices. Inlexzo is the first device that continuously releases medication directly into the bladder ever approved for bladder cancer.
WATCH: A Potential Alternative to Bladder Cancer Surgery
How the Treatment Works
- A small, pretzel‑shaped device — smaller than a quarter — is placed inside the bladder.
- It slowly releases chemotherapy directly into the tumor environment over three weeks.
- The device is removed and replaced at the next visit.
- The entire process can be done in a doctor’s office.
“What makes Inlexzo distinct is that it’s not simply delivering intravesical gemcitabine in the way we would traditionally think about it,” says Dr. David Aggen, a genitourinary medical oncologist at Memorial Sloan Kettering Cancer Center.
“It remains in place for about three weeks and provides a sustained local release of gemcitabine, which is very different from standard intravesical gemcitabine, where the drug is instilled as a liquid and may have a short dwell time.”
Learn more about SurvivorNet's rigorous medical review process.
