Your bladder is a hollow organ in the lower abdomen. It stores urine, the liquid waste made by the kidneys. Your bladder is part of the urinary tract. Urine passes from each kidney into the bladder through a long tube called a ureter. Urine leaves the bladder through a shorter tube (the urethra). The wall of the bladder has layers of tissue:
Bladder cancer may cause these common symptoms:
These symptoms may be caused by bladder cancer or by other health problems, such as an infection. People with these symptoms should tell their doctor so that problems can be diagnosed and treated as early as possible.
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the bladder and the other organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor. Tumors in the bladder can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:
Bladder cancer cells can spread by breaking away from the original tumor. They can spread through the blood vessels to the liver, lungs, and bones. In addition, bladder cancer cells can spread through lymph vessels to nearby lymph nodes. After spreading, the cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section for information about bladder cancer that has spread.
When you get a diagnosis of bladder cancer, it’s natural to wonder what may have caused the disease. Doctors can’t always explain why one person gets bladder cancer and another doesn’t. However, we do know that people with certain risk factors may be more likely than others to develop bladder cancer. A risk factor is something that may increase the chance of getting a disease.
Studies have found the following risk factors for bladder cancer:
Smoking tobacco is the most important risk factor for bladder cancer. Smoking causes most of the cases of bladder cancer. People who smoke for many years have a higher risk than nonsmokers or those who smoke for a short time.
Quitting is important for anyone who uses tobacco. Quitting at any time is good for your health. For people who already have bladder cancer, quitting may reduce the chance of getting another type of cancer (such as lung, esophagus, or oral cancer), lung disease, or heart disease caused by tobacco. Quitting can also help cancer treatments work better.
There are many ways to get help:
We can tell you about:
How to take part in a study of methods to help smokers quit
If you have symptoms that suggest bladder cancer, your doctor will try to find out what’s causing the problems.
You may have a physical exam. Also, you may have one or more of the following tests:
If cancer cells are found in the tissue sample from the bladder, the pathologist studies the sample under a microscope to learn the grade of the tumor. The grade tells how much the tumor tissue differs from normal bladder tissue. It may suggest how fast the tumor is likely to grow.
Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. Doctors use tumor grade along with other factors to suggest treatment options.
You may want to ask the doctor these questions before having a biopsy:
If bladder cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment.
Staging is a careful attempt to find out the following:
Your doctor may order these tests:
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original (primary) tumor. For example, if bladder cancer spreads to the liver, the cancer cells in the liver are actually bladder cancer cells. The disease is metastatic bladder cancer, not liver cancer. It’s treated as bladder cancer, not as liver cancer.
Doctors sometimes call the new tumor in the liver “distant” disease.
These are the stages of bladder cancer:
Treatment options for people with bladder cancer are surgery, chemotherapy, biological therapy, and radiation therapy. You may receive more than one type of treatment.
The treatment that’s right for you depends mainly on the following:
You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a urologist, a surgeon who specializes in treating problems in the urinary tract. Other specialists who treat bladder cancer include urologic oncologists (surgeons who specialize in cancers of the urinary tract), medical oncologists, and radiation oncologists.
Your health care team may also include an oncology nurse and a registered dietitian. If your treatment involves surgery to remove the bladder, a wound, ostomy and continence nurse may also be part of your team.
Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type and extent of treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.
At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Information about such care is available on NCI’s Web site at http://www.cancer.gov/cancertopics/coping and from NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) or at LiveHelp (https://livehelp.cancer.gov).
You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of bladder cancer. See the Taking Part in Cancer Research section.
You may want to ask your doctor these questions before you begin treatment:
Surgery is an option for most people with bladder cancer. You and your surgeon can talk about the types of surgery and which may be right for you:
The doctor uses a cystoscope to treat early bladder cancer (Stage 0 or Stage I). No incision (cut) into your body is needed, but general anesthesia or spinal anesthesia is usually given.
The doctor inserts the cystoscope into the bladder through your urethra. The cutting tool is slipped through the cystoscope. A small wire loop at the end of the tool removes the cancer and burns away remaining cancer cells with an electric current.
TUR may need to be repeated. Also, chemotherapy or biological therapy may be given after this type of surgery.
For a few days after TUR, you may have some blood in your urine and difficulty or pain when passing urine. Otherwise, TUR generally causes few problems.
The surgeon makes an incision into your body to remove the cancer from your bladder.
Part of the bladder (called a partial cystectomy): For some people with a single, small tumor in the bladder, the surgeon does not remove the entire bladder. The surgeon removes the tumor, the part of the bladder containing the tumor, and nearby lymph nodes.
After part of the bladder is removed, you may not be able to hold as much urine in your bladder as before surgery. You may need to empty your bladder more often. This problem usually gets better with time.
All of the bladder (called a radical cystectomy): For bladder cancer that has invaded the muscle layer (Stage II or some Stage III), the most common type of surgery is radical cystectomy. The surgeon removes the entire bladder, nearby lymph nodes, and part of the urethra. In addition, the surgeon usually removes the prostate from a man and may remove the uterus from a woman. Other nearby tissues may also be removed.
When the entire bladder is removed, the surgeon makes another way for urine to be collected from the kidneys and stored. You may wear a flat bag outside the body under your clothes, or the surgeon may use part of your intestine to create a pouch inside the body. The Rehabilitation section has more information.
When the prostate or uterus is removed, a man can no longer father a child and a woman can no longer get pregnant. Also, a man may be unable to have sex after surgery. If the surgeon removes part of a woman’s vagina, sex may be difficult.
Because bladder cancer surgery may affect your sex life, it may help you and your partner to talk about your feelings and help one another find ways to share intimacy during and after treatment. See Sources of Support for more information.
It takes time to heal after surgery, and the time needed to recover is different for each person. It’s common to feel weak or tired for a while.
Also, you may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.
After TUR or partial cystectomy, the urethra needs time to heal. You’ll have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You’ll have the catheter for 5 days to 3 weeks. Your nurse or doctor will show you how to care for it.
You may want to ask your doctor these questions before having surgery:
Chemotherapy uses drugs to kill cancer cells. It may be used to treat bladder cancer before or after surgery. You may receive chemotherapy in different ways:
You may have your treatment in an outpatient part of the hospital, at the doctor’s office, or at home. Rarely, you may need to stay in the hospital.
Chemotherapy is usually given in cycles. Each cycle has a treatment period followed by a rest period.
The side effects depend mainly on how the drug is given. If the drugs are given into the bladder, the side effects are usually mild. For a few days after treatment, you may need to empty your bladder more often. You may have blood in your urine. Also, you may have pain when emptying your bladder. Some people get a rash. These problems usually go away after treatment.
If the drugs are given by vein or taken by mouth, the side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
Some drugs used for bladder cancer may also cause tingling or numbness in your hands and feet. Your health care team can suggest ways to control many of these side effects. You may wish to read the NCI booklet Chemotherapy and You.
People with early bladder cancer may receive a treatment called biological therapy. The treatment is BCG solution, which is a liquid containing weakened bacteria. The bacteria help your body’s natural defenses (the immune system) to kill cancer cells in the bladder.
Several weeks after TUR, the doctor inserts a tube through your urethra to put a liquid treatment in your bladder. You’ll be asked to hold the liquid treatment in your bladder for about two hours.
BCG solution is usually given once a week for six weeks. This treatment helps keep the cancer from coming back.
You may feel unusually tired during the treatment period. Also, BCG solution can irritate the bladder. You may feel an urgent need to empty your bladder, and you may need to empty your bladder more often. Also, you may have pain, especially when emptying your bladder. You may have blood in your urine, nausea, a fever, or chills. Tell your health care team about any problems that you have during the treatment period.
It may help to know that the side effects usually go away when treatment is over. You may want to read the NCI fact sheet Biological Therapies for Cancer.
You may want to ask your doctor these questions about chemotherapy or biological therapy:
Radiation therapy uses high-energy rays to kill cancer cells. It may be given after surgery. Usually it’s given along with chemotherapy for cancer that has invaded the muscle layer of the bladder. However, it is sometimes given instead of surgery or chemotherapy.
The radiation comes from a large machine. The machine aims beams of radiation at the bladder area in the abdomen.
You’ll go to a hospital or clinic 5 days a week for several weeks to receive radiation therapy. Each treatment session takes about 30 minutes.
Although radiation therapy is painless, it may cause other side effects. The side effects include nausea, vomiting, or diarrhea. Also, you may feel very tired during radiation therapy. Your health care team can suggest ways to treat or control these side effects.
You may find it helpful to read the NCI booklet Radiation Therapy and You.
You may want to ask your doctor these questions about radiation therapy:
Before starting treatment, you may want a second opinion about your diagnosis, the stage of cancer, and the treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor’s diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you’ve looked at all of your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it’s not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, or a nearby hospital or medical school for names of specialists.
Also, you can get information about treatment centers near you from NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) or LiveHelp (https://livehelp.cancer.gov).
Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.
Your health care team will help you return to normal activities as soon as possible. The goals of rehabilitation depend on the extent of disease and surgery.
If the surgeon removes your bladder, you’ll need a new way to store urine. After your bladder is removed, the surgeon uses a piece of your small intestine or large intestine to make a new path for urine to exit the body or be stored. With this piece of intestine, the surgeon can either make a tube that carries urine from the ureters to the outside of the body or create a new bladder that holds urine inside the body.
Your health care team can tell you more about the following options:
Bag worn outside your body under your clothing: The surgeon can attach a small piece of intestine to the ureters and to a stoma (an opening in the wall of the abdomen). Urine drains from the ureters through the piece of intestine to the stoma. A flat bag fits over the stoma to collect urine, and special glue holds the bag in place. The bag is emptied several times a day.
New bladder or pouch inside your body: The surgeon can create a new bladder or pouch made from a piece of your intestine. The surgeon connects the pouch to the ureters so that urine can flow from the ureters and can be stored in the pouch in the pelvis.
The surgeon also connects the pouch either to your urethra or to a stoma in the wall of your abdomen:
At first, you will empty your bladder every two or three hours. But later on, you should be able to hold the urine for four to six hours.
A wound, ostomy and continence nurse or another member of your health care team will visit you before surgery to describe what to expect. The nurse or doctor will teach you how to care for yourself after surgery. If you need an ostomy, the nurse or doctor will help you decide where the opening should be on your abdomen and will teach you how to care for the stoma after surgery.
Ask your health care team about your physical, emotional, or sexual concerns. Often they can provide information about resources and support groups.
It’s important for you to take very good care of yourself before, during, and after cancer treatment. Taking care of yourself includes eating well so you get the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don’t taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth blisters) can make it hard to eat well.
Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs. Also, the NCI booklet Eating Hints has many useful ideas and recipes.
You’ll need regular checkups (such as every 3 to 6 months) after treatment for bladder cancer. Checkups help ensure that any changes in your health are noted and treated if needed.
If you have any health problems between checkups, you should contact your doctor.
Bladder cancer may come back after treatment. Your doctor will check for return of cancer. Checkups may include a physical exam, blood tests, urine tests, cystoscopy, or CT scans.
NCI has publications to help answer questions about follow-up care and other concerns. You may find it helpful to read the NCI booklet Facing Forward: Life After Cancer Treatment. You may also want to read the NCI fact sheet Follow-up Care After Cancer Treatment.
Learning that you have bladder cancer can change your life and the lives of those close to you. These changes can be hard to handle. It’s normal for you, your family, and your friends to need help coping with the feelings that a diagnosis of cancer can bring.
Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.
Here’s where you can go for support:
For tips on coping, you may want to read the NCI booklet Taking Time: Support for People With Cancer.