Bladder cancer is a common type of cancer that starts in the cells of the bladder. The bladder is a hollow muscular organ in the lower belly that holds urine.

Bladder cancer often starts in the cells that line the inside of the bladder. They are called urothelial cells. These cells also are found in the kidneys and the tubes, called ureters, that connect the kidneys to the bladder. Urothelial cancer can happen in the kidneys and ureters too. But it's much more common in the bladder.

Most bladder cancers are diagnosed at an early stage. But even early-stage bladder cancers can come back after successful treatment. For this reason, people with bladder cancer typically need follow-up tests after treatment to look for bladder cancer that comes back.

Types of bladder cancer

Different types of cells in the bladder can become cancer. The type of bladder cancer a person has is based on the type of cell where the cancer starts.

Types of bladder cancer include:

• Urothelial carcinoma. Urothelial carcinoma starts in the cells that line the inside of the bladder. Urothelial cells get bigger when the bladder is full and get smaller when the bladder is empty. Urothelial carcinoma is the most common type of bladder cancer in the United States. This type of cancer used to be called transitional cell carcinoma.
• Squamous cell carcinoma. Squamous cell carcinoma may be linked to ongoing irritation of the bladder. That kind of irritation might be caused by, for example, an infection or by using a urinary catheter for a long time. Squamous cell bladder cancer is rare in the United States. It's more common in parts of the world where a parasitic infection called schistosomiasis is a common cause of bladder infections.
• Adenocarcinoma. Adenocarcinoma starts in cells within the glands that make mucus in the bladder. Adenocarcinoma of the bladder is very rare.

Some bladder cancers include more than one type of cell.

Bladder cancer signs and symptoms may include:

• Blood in the urine, called hematuria. This is the most common symptom. The blood may turn urine red or brown. Sometimes the urine looks unchanged, and the blood is found only with a urine test.
• Urinating more often than usual.
• Feeling an urgent need to urinate.
• Pain or burning with urination.

Blood in the urine often is an early warning sign of bladder cancer. Other urinary symptoms, such as frequent or urgent urination and pain with urination, also can occur early.

Some bladder cancer symptoms can look like a urinary tract infection (UTI). Research found bladder cancer took longer to diagnose in women first diagnosed with a UTI than in men.

When to see a doctor

See a healthcare professional if you have unexplained blood in your urine or urinary symptoms that do not have a known cause.

It's not clear what causes bladder cancer. Genetic changes in bladder cells may play a role in how the cancer develops. Some of these changes can disrupt the way cells regulate growth and help tumor cells develop.

As bladder cancer grows, it can invade deeper layers of the bladder and nearby tissues. Some bladder cancers also spread to lymph nodes or other parts of the body. Cancer that spreads to another part of the body is called metastatic cancer.

Factors that may raise the risk of bladder cancer include:

• Smoking. Smoking can raise the risk of bladder cancer by causing harmful chemicals to build up in the urine. These harmful chemicals may damage the lining of the bladder, raising the risk of cancer.
• Age. Bladder cancer can happen at any age, but it is more common in older adults.
• Sex at birth. Men are more likely to get bladder cancer than are women.
• Some chemicals. Often being around some types of chemicals may raise the risk of bladder cancer. Those chemicals include arsenic and chemicals used to make dyes, rubber, leather, textiles and paint products.
• Certain cancer treatments. Treatment for cancer with the medicine cyclophosphamide raises the risk of bladder cancer. People who have had radiation treatments aimed at the pelvis also have a higher risk of bladder cancer.
• Bladder inflammation. Urinary inflammation, called cystitis, or urinary infection that lasts or that keeps coming back may raise the risk of squamous cell bladder cancer. That could happen with long-term use of a urinary catheter. In some areas of the world, squamous cell carcinoma is linked to long-lasting bladder inflammation caused by a parasitic infection called schistosomiasis.
• Personal or family history of cancer. If you've had bladder cancer before, you're more likely to get it again. If a blood relative, such as a parent, sibling or child, has had bladder cancer, you might have a higher risk of the disease too. Lynch syndrome is an inherited condition that can raise the risk of urothelial cancer.

There's no sure way to prevent bladder cancer. But taking the following steps may lower your risk:

• Don't smoke. If you don't smoke, don't start. If you smoke, talk with your healthcare professional about a plan to help you stop.
• Use chemicals carefully. If you work with chemicals, follow all safety instructions.
• Choose a healthy diet. Eat a variety of fruits and vegetables. Limit foods high in sodium. Research suggests that a high intake of sodium may be linked to a higher risk of bladder cancer, but more research is needed.

Bladder cancer diagnosis often begins with an exam and talking with a healthcare professional about symptoms. A test called cystoscopy may be used to look for anything that's not typical inside the bladder. Urine tests and imaging tests also may be useful. To check for cancer, a sample of tissue may be taken from the bladder for testing. A procedure called transurethral resection of bladder tumor (TURBT) may be used to diagnose and treat bladder cancer at the same time.

Cystoscopy

Cystoscopy is a procedure that lets a healthcare professional see inside the bladder. During cystoscopy, a healthcare professional puts a small, narrow tube, called a cystoscope, through the tube that takes urine from the bladder out of the body, called the urethra. The cystoscope has a lens the healthcare professional uses to see inside the urethra and bladder to check for signs of disease.

Urine cytology

A urine cytology test involves looking at a sample of urine with a microscope. The test looks for cancer cells.

Imaging tests

Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, make pictures that the healthcare team uses to look at the urinary tract for signs of cancer.

• CT urogram. During a CT urogram, a contrast solution is placed into a vein in the hand. The contrast flows into the kidneys, ureters and bladder. X-ray images taken during the test show a detailed view of the urinary tract. Those images help the healthcare team see any areas that might be cancer.
• Retrograde pyelogram. A retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. During this test, a thin tube, called a catheter, is placed through the urethra and into the bladder. Contrast solution then is put into the catheter and flows into the kidneys while X-ray images are taken of that area.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. A healthcare professional may get a tissue sample from the bladder during a cystoscopy exam. The healthcare professional may pass a tool through the scope and into the bladder to do a biopsy.

Transurethral resection of bladder tumor

Transurethral resection of bladder tumor (TURBT) is a procedure to diagnose bladder cancer and to remove small cancers from the inside of the bladder. During the procedure, a healthcare professional passes an electric wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut away or burn away the cancer. Sometimes a high-energy laser may be used instead of the electric wire loop.

Bladder cancer stages

Bladder cancer stages describe how far the cancer has grown and whether it has spread. The stage helps the healthcare team choose the treatments that are most likely to help. Bladder cancer is staged from 0 to 4. A lower number generally means the cancer is limited to the bladder. A higher number means it has grown farther through the bladder wall or spread beyond the bladder.

Bladder cancer grade

Bladder cancers also are classified by grade. A cancer's grade is based on how the cancer cells look under a microscope. Bladder cancer may be low grade or high grade:

• Low-grade bladder cancer. Low-grade bladder cancer has cells that are closer in appearance and organization to typical cells. A low-grade cancer tends to grow more slowly. It is less likely to grow into the muscle wall of the bladder than is a high-grade cancer.
• High-grade bladder cancer. High-grade bladder cancer has cells that don't look at all like typical tissue. A high-grade cancer tends to grow faster than a low-grade cancer. It also may be more likely to grow into the muscle wall of the bladder and spread to other tissues and organs.

Treatment for bladder cancer depends on the type, grade and stage of the cancer, along with your overall health and what you prefer. Depending on the situation, treatment options may include surgery, chemotherapy, radiation therapy, immunotherapy and targeted therapy.

Bladder cancer can sometimes be cured. Non-muscle-invasive bladder cancer has not grown into the bladder muscle and often can be managed with treatments directed at the bladder, such as TURBT and medicines placed directly into the bladder. Muscle-invasive bladder cancer has grown into the bladder muscle and generally needs more intensive treatment, such as surgery with systemic chemotherapy or a combination of chemotherapy and radiation therapy. For metastatic bladder cancer, treatment may help slow or shrink the cancer, ease symptoms, and help people live longer.

Bladder cancer surgery

Bladder cancer surgery removes the cancer cells. Sometimes surgery involves removing part or all of the bladder.

Transurethral resection of bladder tumor (TURBT) is a procedure to diagnose bladder cancer and to remove cancers that are within the inner layers of the bladder only. During the procedure, a healthcare professional passes an electric wire loop through a cystoscope and into the bladder. The electric current in the wire is used to cut away or burn away the cancer. Sometimes a high-energy laser may be used instead of the electric wire loop. Because TURBT is done through the urethra, no surgical cuts, called incisions, are needed.

As part of this procedure, medicine may be placed in the bladder. The medicine can kill cancer cells that are left behind and may help prevent bladder cancer from coming back. The medicine is left in the bladder for a certain amount of time, and then it is drained out.

Cystectomy is surgery to remove all or part of the bladder. During a partial cystectomy, a surgeon takes out only the area of the bladder that has the cancer.

During a radical cystectomy, a surgeon takes out all of the bladder and the lymph nodes around it. Radical cystectomy typically also includes removal of the prostate gland and seminal vesicles, or the uterus, ovaries and part of the vagina.

Radical cystectomy can be done through a surgical cut on the lower part of the belly or with a number of small cuts using robotic surgery. During robotic surgery, the surgeon sits at a computer and uses hand controls to move robotic surgical instruments.

Urinary diversion is a procedure to make a new way for urine to leave the body. It's used after radical cystectomy. Options for urinary diversion may include:

• Neobladder reconstruction. This involves using a piece of intestine to make a place for the body to store urine, called a neobladder. The neobladder sits inside the body and is attached to the urethra. With a neobladder, most people can urinate as they typically would. But a small number of people have trouble emptying the neobladder. When that happens, a catheter may be needed from time to time to drain all the urine out of the body.
• Ileal conduit. For this type of urinary diversion, the surgeon makes a tube, called an ileal conduit, using a piece of intestine. The tube runs from the ureters, which drain urine from the kidneys, to the outside of the body. Urine empties into a pouch worn on the belly. The pouch is called an urostomy bag.
• Continent urinary reservoir. For this type of urinary diversion, the surgeon uses a section of intestine to make a small pouch that holds urine inside the body. The urine then is drained several times a day through an opening in the belly.

Some effects of radical cystectomy and urinary diversion can be long-lasting. Treatment may affect urinary control, sexual function, fertility, bowel function and the body's chemical balance. People who have a urinary diversion also need ongoing care for the new way urine leaves the body.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Bladder cancer chemotherapy often uses two or more medicines together.

Chemotherapy medicines can be given:

• Through a vein. Intravenous chemotherapy is given through a vein. It's often used before bladder removal surgery to raise the chances of curing the cancer. Chemotherapy also may be used to kill cancer cells that might be left behind after surgery. Sometimes, chemotherapy may be used with radiation therapy.
• Directly into the bladder. Intravesical chemotherapy is given directly into the bladder. For the procedure, a tube is passed through the urethra into the bladder. Then chemotherapy is placed in the bladder for a set amount of time before it's drained. This type of chemotherapy may be used as the main treatment for bladder cancer when the cancer cells affect only the lining of the bladder and not the deeper muscle tissue.

Chemotherapy medicines used for bladder cancer depend on the situation. Common medicines include cisplatin and gemcitabine. Chemotherapy placed directly into the bladder may include gemcitabine or mitomycin.

Chemotherapy side effects depend on the medicines used. They may include low blood cell counts, infection, mouth sores, hair loss, fatigue and digestive symptoms. Cisplatin also can affect the kidneys, hearing and nerves. Some effects, such as hearing loss or nerve damage, may last after treatment ends.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. For bladder cancer, radiation therapy typically is delivered from a machine that moves around a person's body, directing the energy beams to specific places on the body.

Sometimes, radiation therapy is used with chemotherapy to treat bladder cancer, such as when surgery isn't an option.

Radiation therapy can cause urinary and bowel side effects. Some effects can develop or continue after treatment ends. In studies of bladder-preserving treatment, severe late urinary and gastrointestinal side effects were uncommon. But radiation can sometimes cause long-term effects.

Immunotherapy

Immunotherapy is medicine that helps the immune system fight cancer. Immunotherapy can be given:

• Directly into the bladder. Intravesical immunotherapy is given directly into the bladder. It may be used after TURBT for small bladder cancers that haven't grown into the bladder's muscle layer. One medicine used in this way is called bacillus Calmette-Guerin (BCG). BCG causes an immune system reaction that directs germ-fighting cells to the bladder.

  BCG is a standard treatment for certain intermediate- and high-risk non-muscle-invasive bladder cancers. Studies show that BCG after TURBT lowers the risk of the cancer coming back. Maintenance BCG can further reduce recurrence and, in some studies, progression or spread.

  BCG commonly causes bladder irritation and flu-like symptoms. These may include painful or frequent urination, blood in the urine, fever, chills, and fatigue. Most side effects can be managed, but BCG can cause more serious complications in some people. The healthcare team may delay or stop BCG when there are severe local or systemic symptoms.

• Through a vein. Intravenous immunotherapy is given through a vein. It helps the immune system fight the cancer cells.

  Intravenous immunotherapy can cause side effects when the activated immune system affects healthy organs. These effects can involve the skin, intestines, liver, lungs or hormone-producing glands. Some hormone-related side effects can be permanent.

Targeted therapy

Targeted therapy uses medicines that target specific features of cancer cells. For advanced bladder cancer, testing for certain gene changes can help determine whether targeted therapy may be an option.

Bladder preservation

Sometimes, people with bladder cancer that has gone into the bladder's muscle layer don't want to have the bladder removed. In that situation, the healthcare team may use a combination of treatments instead. Called trimodality therapy, this approach uses TURBT, chemotherapy and radiation therapy.

First, a surgeon does a TURBT procedure to take out as much of the cancer as possible while keeping bladder function. Then, after the surgery, chemotherapy along with radiation therapy is given. If any cancer remains after trimodality therapy, a radical cystectomy may be needed.

After bladder cancer treatment

Bladder cancer may come back even after successful treatment. Because of this, people with bladder cancer often have follow-up testing after treatment. What tests you'll have and how often you need them depends in part on the type of bladder cancer you had and how it was treated.

Knowing that bladder cancer might come back could make you worried or anxious. But while there's no way to ensure that bladder cancer won't come back, you can take steps to manage the stress. Try these tips:

• Get a schedule of follow-up tests and go to each appointment. When you finish bladder cancer treatment, ask your healthcare professional to give you a schedule of the follow-up tests you need. Before each follow-up exam, you might have some anxiety. You may be concerned that cancer has come back or worry about the exam. But don't let that stop you from going to your appointment. Instead, plan ways to cope with your concerns. Write your thoughts in a journal, talk with a friend, or use relaxation techniques, such as meditation.
• Do what you can to stay healthy. Take care of yourself by eating a healthy diet, including plenty of fruits and vegetables. Physical activity can help too.
• Talk with other bladder cancer survivors. Other people who have gone through treatment for bladder cancer may feel the same way you do. Talking with them might help. For information about support groups in your area, talk with a member of your healthcare team or contact the American Cancer Society. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

Make an appointment with a healthcare professional if you have any symptoms that worry you. You're likely to start by seeing your primary healthcare professional. But you might be referred to a doctor who specializes in treating diseases and conditions of the urinary tract, called a urologist. Sometimes, you may be referred to other specialists, such as a doctor who treats cancer, called an oncologist. Here are some tips to get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do before your appointment, such as not eating or drinking for a certain amount of time. Make a list of:

• Your symptoms, including any that don't seem related to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins and other supplements you take, including the doses.
• Questions to ask your healthcare professional.

Take a family member, friend or another trusted person with you, if possible, to help you remember the information you're given.

For bladder cancer, basic questions to ask your healthcare professional include:

• Do I have bladder cancer, or could my symptoms be caused by another condition?
• What tests do I need?
• What is the stage of my cancer?
• What are my treatment options?
• What treatments might cure bladder cancer?
• What are the possible risks of each treatment?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Do I need follow-up appointments?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

Be sure to ask any other questions you may have.

What to expect from your care team

Your healthcare professional is likely to ask you questions, such as:

• When did your symptoms start?
• Are your symptoms always present, or do they come and go?
• How bad are your symptoms?
• What, if anything, makes your symptoms better?
• What, if anything, makes your symptoms worse?

Staging helps the healthcare team estimate how serious the cancer is and choose treatments that are most likely to help. Bladder cancer is staged from 0 to 4. Bladder cancer stages describe how far the cancer has grown and whether it has spread. A lower number generally means the cancer is limited to the bladder. A higher number means it has grown farther through the bladder wall or spread beyond the bladder.

Staging terms

Bladder cancer staging looks at three things: the tumor, nearby lymph nodes and whether the cancer has spread to other parts of the body. These are described with the letters T, N and M. T describes how deeply the tumor has grown into or through the bladder wall. N describes whether cancer has spread to nearby lymph nodes. M describes whether cancer has spread to other parts of the body. These findings are combined to give an overall stage from 0 to 4.

Another important distinction is whether the cancer is non-muscle-invasive or muscle-invasive. Non-muscle-invasive bladder cancer has not grown into the bladder muscle. Muscle-invasive bladder cancer has grown into the muscle layer and has a greater risk of spreading.

Staging tests

The healthcare team determines the stage using information from TURBT and biopsy results along with imaging tests. CT or MRI scans of the abdomen and pelvis can help show whether cancer has grown outside the bladder or spread to lymph nodes. Chest imaging can show cancer that has spread to the lungs. Bone imaging may be used when symptoms or other findings suggest that cancer could have spread to bone.

Stage 0

Stage 0 bladder cancer is limited to the innermost lining of the bladder. It has not grown into the tissue beneath the lining or the bladder muscle. Stage 0 includes noninvasive papillary cancer and carcinoma in situ (CIS). In bladder cancer, CIS is a flat, high-grade cancer in the bladder lining.

Treatment commonly starts with TURBT. Depending on the tumor and its risk of coming back or progressing, treatment may include medicine placed directly into the bladder, such as chemotherapy or BCG immunotherapy.

Stage 1

Stage 1 bladder cancer has grown through the bladder lining into the connective tissue underneath, called the lamina propria. It has not reached the bladder muscle. This is still considered non-muscle-invasive bladder cancer.

Treatment usually includes TURBT, and higher-risk cancers often are treated with BCG. Radical cystectomy may be considered for some very high-risk cancers or cancer that persists or returns despite bladder-directed treatment.

Stage 2

Stage 2 bladder cancer has grown into the muscle layer of the bladder wall. The cancer has not spread to nearby lymph nodes or distant parts of the body. This is muscle-invasive bladder cancer.

For people who are able to have surgery, treatment commonly includes cisplatin-based chemotherapy before radical cystectomy. Another option for selected people is bladder-preserving therapy using TURBT, chemotherapy and radiation therapy.

Stage 3

Stage 3 bladder cancer has grown through the bladder muscle into tissue around the bladder. The cancer may have spread to nearby organs or lymph nodes.

Treatment depends on exactly where the cancer has spread and a person's overall health. Treatment may combine medicines that work throughout the body with radical cystectomy and lymph-node removal. For some people, treatment may include chemotherapy with radiation therapy.

Stage 4

Stage 4 bladder cancer is advanced cancer. It may have grown into the wall of the pelvis or abdomen. The cancer may have spread to lymph nodes beyond the pelvis or to distant organs. Common distant sites include the bones, lungs and liver.

Treatment usually uses medicines that work throughout the body. Treatment may help slow the cancer, ease symptoms and help people live longer. In some situations, radiation or surgery may be used to control symptoms or treat specific areas of cancer.

How fast does bladder cancer grow or spread?

How quickly bladder cancer grows or spreads varies. Low-grade cancers tend to grow more slowly and are less likely to invade the bladder muscle. High-grade cancers are more likely to grow into the muscle and spread.

Stage and grade describe different things. Stage describes where the cancer is in the body. Grade describes how the cancer cells look and gives clues about how quickly the cancer may grow or spread.

The five-year relative survival rate for bladder cancer is 79.1%. This means that, overall, people diagnosed with bladder cancer are about 79% as likely as people without bladder cancer to be alive five years after diagnosis. This statistic includes bladder cancers diagnosed at all stages and is based on people diagnosed from 2016 through 2022.

Survival rates are estimates based on large groups of people. They cannot predict exactly what will happen for one person. A person's outlook depends on factors such as the cancer's stage and grade, whether it has grown into the bladder muscle, the type of bladder cancer, age, overall health, and how the cancer responds to treatment.

Survival statistics

Five-year relative survival compares people with bladder cancer with people in the general population who are the same age and sex. It helps show the effect of bladder cancer on survival while accounting for deaths from other causes.

Five-year relative survival rates also vary based on how far the cancer has spread when it is diagnosed:

• In situ: 98.0%. The cancer is only in the layer of cells where it began.
• Localized: 73.0%. The cancer is confined to the bladder.
• Regional: 41.8%. The cancer has spread to nearby lymph nodes or nearby tissues or organs.
• Distant: 9.6%. The cancer has spread to distant parts of the body.

These categories describe how far the cancer has spread. They are not the same as bladder cancer stages 0 through 4.

How bladder cancer affects long-term survival varies. In one study that followed people for up to 25 years, the risk of dying of bladder cancer was low for people with low-risk non-muscle-invasive bladder cancer. People with high-risk disease continued to have a risk of dying of bladder cancer many years after diagnosis.

For high-grade non-muscle-invasive bladder cancer, about 70% to 85% of people are alive 10 years later without having died of bladder cancer. This is called cancer-specific survival. The rate is higher for low-grade disease.

Survival rates by age and sex

Five-year relative survival rates also vary by age and sex. Available data show different survival patterns for people younger than 50, ages 50 to 64, and ages 65 and older. These population trends describe groups of people, but they cannot predict an individual person's life expectancy.

What you can do

Some things that affect survival, such as your age and the cancer's stage, cannot be changed. But getting recommended treatment and follow-up care is important. If you smoke, quitting can improve your overall health and lower your risk of other smoking-related diseases. Ask your healthcare team how your stage, grade and response to treatment may affect your outlook.

Survival statistics are based on people treated in earlier years. Treatments can change over time, so the statistics may not reflect newer treatments. This is especially true for long-term studies. Your healthcare team can explain how newer treatments may affect your outlook.