What is bladder cancer?
Cancer is the growth of
abnormal cells in the body. These extra cells grow together and form masses,
called tumors. In bladder cancer, these growths happen in the bladder.
The bladder is the part of your
urinary tract that stores your urine until you are
ready to let it out. See a picture of the
female urinary system or
male urinary system .
Bladder cancer can often be successfully treated if it
is found and treated early. And most bladder cancer is found early.
This topic is about the most common type of bladder cancer, called transitional cell cancer. This is cancer that starts in the inner layer of the bladder. It happens most often in people who are in their 60s or older.
What causes bladder cancer?
Experts don't know what
causes bladder cancer. But smoking cigarettes or being exposed to certain chemicals raises your risk. And like other cancers, changes in the DNA of your
cells seem to play a role.
What are the symptoms?
Blood in the urine is the
main symptom. Other symptoms may include having to urinate often or feeling
pain when you urinate.
These symptoms can be caused by other
problems, including a
urinary tract infection. Always call your doctor if
you see blood in your urine.
How is bladder cancer diagnosed?
bladder cancer, your doctor will:
- Ask about your medical history and do a
physical exam, including a vaginal or rectal exam.
- Test your urine
to look for blood or abnormal cells.
- Do a
cystoscopy, a test that lets your doctor look into
your bladder with a thin, lighted viewing tool. Small tissue samples (biopsies) are taken and looked at under a microscope
to find out if there are cancer cells.
How is it treated?
Treatment choices for bladder
- Surgery to remove any cancer. Sometimes
lasers or other methods can be used to get rid of tumors.
- Chemotherapy, which uses medicine to destroy cancer
- Immunotherapy, which causes your body's natural
defense system to attack bladder cancer cells.
- Radiation therapy, which uses high-dose X-rays to kill
The treatment depends a lot on how much the cancer has
grown. Most bladder cancers are treated without having to remove the
Sometimes doctors do have to remove the bladder. For some
people, this means having urine flow into a bag outside of the body. But in
many cases, doctors can make a new bladder—using other body tissue—that works
very much like the old one.
Bladder cancer often comes back. The
new tumors can often be treated successfully if they are caught early. So it's very
important to have regular checkups after your treatment is done.
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
What increases your chances of getting bladder cancer?
Anything that increases your chances of getting a disease is called a
risk factor. The main risk factors for bladder cancer include:
- Smoking. Cigarette smokers are much more
likely than other people to get bladder cancer.
- Being older than
40, being male, or being white (Caucasian).
- Being exposed to
cancer-causing chemicals, such as those used in the wood, rubber, and textile
- What you eat. A diet high in fried meats and fats
increases your risk for bladder cancer.
- Parasites. There is a
parasite that causes schistosomiasis, which can increase your risk. This
condition is sometimes found in developing countries and rarely occurs in North
Frequently Asked Questions
Learning about bladder cancer:
- What is bladder cancer?
- What causes it?
- What are the symptoms?
- What increases my chances of getting bladder cancer?
- How is bladder cancer diagnosed?
- How is bladder cancer treated?
- Will I need surgery?
- What is a transurethral resection (TUR)?
- What is a cystectomy?
- Will I need to take medicine?
- Will I need immunotherapy?
- What are clinical trials?
- What happens if my bladder cancer comes back?
Living with bladder cancer:
- When should I call my doctor?
- What can I do at home to manage the side effects of treatment?
- What is palliative care?
- What is hospice care?
- How can I prepare for end-of-life issues?
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
- Cancer: Controlling Nausea and Vomiting From Chemotherapy
- Healthy Eating: Cutting Unhealthy Fats From Your Diet
The cause of
bladder cancer is not known. Changes in the genetic
material (DNA) of bladder cells may play a role. Chemicals in
the environment and cigarette smoking also may play a role. And when the lining
of the bladder is irritated for a long time, cell changes that lead to cancer
may occur. Some things that cause this are radiation treatment, having
catheters in place for a long time, or having the parasite that causes
Bladder cancer is twice as likely to develop in
smokers than in nonsmokers. Experts believe that smoking causes about half of
all bladder cancers in men and women.1
Exposure to chemicals and other
substances at work—including dyes, paints, leather dust, and others—may also
cause bladder cancer.
The most common symptoms of
bladder cancer include:
- Blood or blood clots in the urine (hematuria).
Hematuria occurs in 8 or 9 out of 10 people who have bladder cancer and is the
most common symptom. Usually it isn't painful.
- Pain during
- Urinating small amounts frequently.
urinary tract infections (UTIs).
Symptoms that may indicate more advanced bladder cancer
- Pain in the lower back around the kidneys
- Swelling in the lower legs.
- A growth in the pelvis
near the bladder (pelvic mass).
Other symptoms that may develop when bladder cancer has
- Weight loss.
- Bone pain or pain in
the rectal, anal, or pelvic area.
The symptoms of bladder cancer may be similar to symptoms
of other bladder conditions.
is the rapid, uncontrolled growth of abnormal cells in the bladder. Cancer
usually begins in the lining of the bladder. The cancerous cells may spread
through the lining into the muscular wall of the bladder.
cancer may spread to
lymph nodes, other organs in the pelvis (causing
problems with kidney and bowel function), or other organs in the body, such as
the liver and lungs.
Your treatment will depend on how far the cancer has spread.
Most bladder cancer is found early, before it has spread into the bladder wall. Surgery can usually remove these tumors. But bladder cancer often comes back, so you may also get other treatments, such as chemotherapy or immunotherapy, to lower the chances of that happening.
The main risk factors for
bladder cancer include:
- Smoking. Cigarette smokers are much more
likely than other people to get bladder cancer.
- Chemical exposure. Bladder cancer has been linked to chemicals
called aromatic amines. These chemicals are found in many products, including dyes, paints,
solvents, inks, and the dust from leather. This risk may also depend on how
much and how often a person was exposed to these chemicals.
- Being older. Your risk goes up as you get older. Most people
who get bladder cancer are close to their 70s.
- Being a white male. Men are 4 times more likely to get bladder cancer than women. And white men are twice as likely to get it as African-American men.1
- Some cancer treatments, such as radiation therapy to the belly or pelvis.
- Some chemotherapy medicines, such as cyclophosphamide.
- A diet that
is high in nitrates or rich in meat and fatty foods.
- Schistosomiasis, which is an infection caused by a parasite. It's sometimes
found in developing countries and rarely occurs in North America.
If you have been diagnosed with
bladder cancer, be sure to follow your doctor's
instructions about calling when you have problems, new symptoms, or symptoms
that get worse.
Call your doctor if you:
- Have blood in your urine.
- Feel pain
when you urinate.
- Are urinating small amounts
back or flank pain.
If you are concerned about your symptoms or about your risk for bladder cancer, make an appointment with your
Watchful waiting is not appropriate if you have
symptoms that do not go away.
Who to see
Health professionals who can evaluate your symptoms and your risk
for bladder cancer include:
- General practitioners.
- Family medicine doctors.
- Nurse practitioners.
- Physician assistants.
Doctors who can manage your
cancer treatment include:
- Medical oncologists.
- Radiation oncologists.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
To find out whether
bladder cancer may be the cause of your urinary
symptoms, your doctor will:
- Do a physical exam. This may include
rectal exam, a
prostate exam for men, or a
pelvic exam for women.
- Ask questions about your medical history,
- Your smoking history.
- Your possible exposure to cancer-causing chemicals.
- Your family history of cancer.
- Order a urine test and
urine culture to check for the presence of blood,
infection, and other abnormal cells. A urine test may also be done to look for tumor markers, which can be signs of cancer.
You will have a cystoscopy, a test that allows your doctor to look at your bladder with a thin, lighted tube. The doctor can use the same tube to take small tissue samples (biopsies) of any abnormal areas. The samples will be looked at under a microscope to find out whether cancer cells are present and what the cells look like.
Tests to determine stage and grade
Bladder cancer is classified by
stage and grade. The stage is determined by the
cancer growth in the bladder wall and how far it has spread to nearby tissues
and other organs, such as the lungs, the liver, or the bones. The grade of
bladder cancer is determined by how the cancer cells look in comparison with
normal bladder cells.
Your doctor finds out the stage and grade of
your bladder cancer by gathering information from several tests, including:
- Biopsies from the cystoscopy.
intravenous pyelogram or
CT urogram to look for a mass
near the kidneys,
ureters, or bladder.
- Ultrasound or
magnetic resonance imaging (MRI). These help find out if the cancer has
spread to lymph nodes, the lungs, the liver, or other abdominal organs.
- Chest X-ray. This finds out if the
cancer has spread to the lungs.
- Bone scan. This finds out if the cancer
has spread to the bones.
Knowing the stage and grade of your cancer is important in choosing the right treatments.
Other diagnostic tests that may be done include:
complete blood count (CBC) to find out if you have
chemistry screen to evaluate kidney, liver, and bone
Early detection of returning cancer
Bladder cancer often comes back, so it's important to have regular checkups. Then, if the cancer does come back, you have a better chance of finding it early enough for successful treatment.
The choice of treatment and the
long-term outcome (prognosis) for people who have
bladder cancer depend on the
stage and grade of cancer. When deciding about your treatment, your doctor also considers your age, overall
health, and quality of life.
Bladder cancer has a better chance of being treated successfully if it is found early.
Treatment choices for bladder cancer may include:
- Surgery to remove the cancer. Surgery,
either alone or along with other treatments, is used in most cases.
- Chemotherapy to
destroy cancer cells using medicines. Chemotherapy may be given before or after
- Radiation therapy to destroy cancer cells using
high-dose X-rays or other high-energy rays. Radiation therapy may also be given
before or after surgery and may be given at the same time as
chemotherapy. For more information, see Other Treatment.
- Immunotherapy. This treatment causes your body's natural
defenses, known as your
immune system, to attack bladder cancer cells. For more information, see Medications.
Stages and grades of bladder cancer
There are five stages of bladder cancer, stages 0 to IV:2
- Stage 0: Cancer cells are only on the surface of the inner layer of the bladder. This may be called carcinoma in situ.
- Stage I: Cancer has grown deeper into the inner layer but not into the muscle layer.
- Stage II: Cancer has grown into the muscle layer of the bladder.
- Stage III: Cancer has grown through the muscle layer and into nearby organs, such as the prostate, uterus, or vagina.
- Stage IV: Cancer has grown into the wall of the pelvis or the belly but not into any lymph nodes. Or the cancer has spread into at least one lymph node or to another part of the body, such as the liver, lungs, or bones.
The grade of bladder cancer is usually either low-grade (LG) or high-grade (HG). High-grade tumors tend to grow faster. They are also more likely to spread than low-grade tumors. When your doctor knows the grade of your cancer, this information will help him or her choose the best treatment plan for you.
More information about bladder cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/bladder.
Bladder cancer that comes back
After initial treatment for
bladder cancer, it is important to receive follow-up
care, because bladder cancer often comes back (recurs). Your doctor will set up a regular schedule of checkups and tests.
Bladder cancer may recur in the bladder, or it may spread (metastasize) to other parts of
the body. Recurrent bladder cancer may be treated with surgery or
chemotherapy to slow cancer growth and relieve
Participation in a
clinical trial may be recommended if you have been
diagnosed with recurrent bladder cancer.
Body image and sexual problems
Sexual problems can be caused by physical or psychological factors related to the cancer or its treatment. You may experience less sexual pleasure or lose your desire to be sexually intimate.
- Women who have their bladder removed (radical
cystectomy) will also have their
uterus removed. They cannot become pregnant and may
menopause soon after having this surgery.
- Men who have their prostate glands and seminal vesicles removed
may have erection problems and will no longer produce semen.
Your feelings about your body may change after
treatment for cancer. Managing your feelings about your body may involve talking openly
about your concerns with your partner and discussing your feelings with your
doctor. Your doctor may also be able to refer you to groups that can offer
support and information.
Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.
Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you're interested in palliative care, talk to your doctor.
For more information, see
For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.
For more information, see
- Hospice Care.
- Care at the End of Life.
Bladder cancer cannot be prevented, but you may be
able to reduce some of your risk for getting it.
- Stop smoking. Cigarette smokers are much more likely to get bladder cancer
than nonsmokers. For help on how to quit smoking, see the topic
- Avoid exposure to
industrial chemicals, such as benzene substances and arylamines. Occupational
exposure from working with dyes, rubbers, textiles, paints, leathers, and
chemicals raises your risk for bladder cancer.
exposure to arsenic. Have your drinking water tested. Drink bottled
water if you think that your water is contaminated with
- Eat healthy foods. Experts believe that what you eat and
drink may help prevent bladder cancer.
- Choose a
low-fat, low-cholesterol diet that includes plenty of
fruits and vegetables. For more information, see the topic
dehydration. Increase your fluid intake, particularly
water. Water dilutes cancer-causing chemicals.
The side effects of bladder cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects.
You can try home treatments:
nausea or vomiting, such as ginger or peppermint tea, gum, or candy.
- Cancer: Controlling Nausea and Vomiting From Chemotherapy
diarrhea, such as small, frequent sips of water and bites of salty crackers.
- For constipation, such as plenty of water and fiber in your diet. Do not use a laxative without first talking to
Other issues that can be treated at home include:
- Sleep problems. If you have trouble sleeping, try having
a regular bedtime and getting exercise daily.
- Feeling very tired. If you lack energy or become weak easily, try to manage your energy and get extra rest.
- Hair loss. Hair loss may be unavoidable. But using
mild shampoos and avoiding damaging hair products will reduce irritation of
- Pain. Home treatment can help you manage pain. Be sure to talk with your doctor about any home treatment you use.
Handling the stress of having cancer
Having cancer can be very stressful, and it may feel overwhelming to face the challenges in front of you. Finding new ways of coping with the symptoms of stress may improve your overall quality of life.
These ideas may help:
- Get the support you need. Spend time with people who care about you, and let them help you.
- Take good care of yourself. Get plenty of rest, and eat nourishing foods.
- Talk about your feelings. Find a support group where you can share your experience.
- Try new ways to relax. And do things each day that help you stay calm and relaxed. Stress reduction techniques may help.
Having cancer can change your life in many ways. For support in managing these changes, see the topic
Getting Support When You Have Cancer.
Medicines may be used to control the growth
bladder cancer cells and to relieve symptoms.
These medicines may be taken by mouth, injected
into a vein (intravenous, or IV), or delivered directly into the bladder using a catheter.
- Chemotherapy uses medicines to destroy cancer cells.
- Immunotherapy, also called biological therapy, uses medicines
that cause your body's
immune system to attack cancer cells in your bladder.
It is most often used for early-stage bladder cancer. It may also be used after a transurethral resection (TUR) to help keep cancer from coming back.
- Gemcitabine and
- MVAC, a combination of
methotrexate, vinblastine, doxorubicin, and
- Mitomycin, which may be used to help keep cancer from coming back
Side effects of chemotherapy may
- Loss of appetite, nausea, or vomiting.
- Hair loss.
- Mouth sores.
- An increased risk of infection.
- Skin peeling or a rash from mitomycin.
Some people may need
medicines to control nausea and vomiting.
- Bacillus Calmette-Guerin (BCG)
Side effects of immunotherapy vary
depending on the medicine.
Bacillus Calmette-Guerin (BCG) is a type of bacteria related to the bacteria that cause tuberculosis (TB). BCG is used in TB vaccines. Also, BCG is placed into the bladder to treat bladder cancer. With BCG, the side effects
- Joint pain.
- Inflammation of the prostate.
- Disseminated tuberculosis.
Surgery is used to treat most
- Transurethral resection (TUR) is surgery done through the urethra. A thin, lighted tube called a cystoscope is used to remove or destroy tumors in the bladder.
- Cystectomy is surgery to remove the bladder.
- Partial cystectomy removes only part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area.
- Radical cystectomy removes all of the bladder as well as nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer cells.
- Urinary diversion is surgery that makes a new way for your body to store urine. This can be done with a pouch created inside your body from part of your intestines, called a continent reservoir. Or the surgeon may make an artificial opening, called an ileal conduit, and you will wear a flat bag to store urine outside your body.
The side effects of surgery may include:
- Bowel problems, such as constipation or diarrhea.
- Scar tissue that forms inside your body from having surgery (adhesions).
blockage in the intestines (bowel obstruction).
- In men, erection problems if the bladder was removed.
Radiation treatment for
bladder cancer uses high-energy X-rays to kill cancer
cells and shrink tumors. It may be given after surgery. It may be used along with chemotherapy. Sometimes it is used instead of surgery or chemotherapy.
- External beam radiation comes from a machine outside
the body. The machine aims radiation at the area where the cancer cells are
- Internal radiation uses needles, seeds, wires, or catheters that contain
radioactive materials placed close to or directly into the bladder.
treatment you receive will depend on the type and stage of your cancer.
Side effects of radiation may include:
- Nausea, vomiting, or diarrhea.
- Pain or discomfort when you urinate.
- An increased risk for infection.
- In women, changes to the cells lining the vagina. These changes can make intercourse difficult or painful.
- In men, erection problems if the nerves that control erection were affected by radiation.
Your doctor may talk to you about joining a research study called
a clinical trial if one is available in your area. Clinical trials are research studies to look for ways
to improve treatments for bladder cancer. Experts are doing studies on:
- Chemoprevention for early-stage bladder cancer. This is the
use of medicines or vitamins to reduce the risk of getting cancer or having
cancer come back.
- Photodynamic therapy. This uses medicine and a
special light to treat the cancer.
For some people with bladder cancer, clinical trials may offer the best treatment available.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
- Acupuncture to relieve pain.
- Meditation or yoga to relieve stress.
- Massage and biofeedback to reduce pain and ease tension.
- Breathing exercises for relaxation.
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
Organizations American Cancer Society (ACS) 250 Williams Street NW
Atlanta, GA 30303 www.cancer.org National Cancer Institute (U.S.) www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)
- Preparing for Your Hospital Stay
- Urinary Tract Infections in Teens and Adults
American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.
National Cancer Institute (2010). What You Need To Know About Bladder Cancer (NIH Publication No. 10-1559). Available online: http://www.cancer.gov/cancertopics/wyntk/bladder.
Other Works Consulted
National Cancer Institute (2012). Bladder Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional.
American Cancer Society (2011). Lasers in cancer treatment. Available online: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/lasers-in-cancer-treatment.
American Cancer Society (2012). Bladder cancer. Available online: http://www.cancer.org/cancer/bladdercancer/detailedguide/index.
American Joint Committee on Cancer (2010). Urinary bladder. In AJCC Cancer Staging Manual, 7th ed., pp. 497–505. New York: Springer-Verlag.
National Cancer Institute (2012). Bladder Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/patient.
National Cancer Institute (2012). SEER Fact Sheets: Bladder. Bethesda, MD: National Cancer Institute. Available online: http://seer.cancer.gov/statfacts/html/urinb.html.
National Comprehensive Cancer Network (2013). Bladder Cancer. NCCN Clinical Practice Guidelines in Oncology, version 1.2013. Available online: http://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf.
U.S. Preventive Services Task Force (2011). Screening for bladder cancer: Recommendation statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf11/bladdercancer/bladcanrs.htm.