Bladder cancer is a type of cancer that
begins in your bladder — a balloon-shaped organ in your pelvic area that
stores urine. Bladder cancer begins most often in the cells that line
the inside of the bladder. Bladder cancer typically affects older
adults, though it can occur at any age.
The great majority of bladder cancers are diagnosed at an early stage —
when bladder cancer is highly treatable. However, even early-stage
bladder cancer is likely to recur. For this reason, bladder cancer
survivors often undergo follow-up tests to look for bladder cancer
recurrence for years after treatment.
Bladder cancer signs and symptoms may include:
* Blood in urine (hematuria) — urine may appear dark yellow, bright
red or cola colored; or urine may appear normal, but blood may be
detected in a microscopic examination of the urine
* Frequent urination
* Painful urination
* Urinary tract infection
* Abdominal pain
* Back pain
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you, such as blood in your urine.
It's not always clear what causes bladder cancer. Bladder cancer has
been linked to smoking, a parasitic infection, radiation and chemical
Bladder cancer develops when healthy cells in the bladder go awry.
Rather than grow and divide in an orderly way, these cells develop
mutations that cause them to grow out of control and not die. These
abnormal cells form a tumor.
Types of bladder cancer
The type of bladder cell where cancer begins determines the type of
cancer. Different types of cells in your bladder can become cancerous.
Your bladder cancer type determines which treatments may work best for
you. Types of bladder cancer include:
* Transitional cell carcinoma. Transitional cell carcinoma occurs in
the cells that line the inside of your bladder. Transitional cells
expand when your bladder is full and contract when your bladder is
empty. These same cells line the inside of your ureters and your
urethra, and tumors can form in those places as well. Transitional cell
carcinoma is the most common type of bladder cancer in the United
* Squamous cell carcinoma. Squamous cells appear in your bladder in
response to infection and irritation. Over time they can become
cancerous. Squamous cell bladder cancer is rare in the United States.
It's a more common in parts of the world where a certain parasitic
infection (schistosomiasis) is a prevalent cause of bladder infections.
* Adenocarcinoma. Adenocarcinoma begins in cells that make up
mucus-secreting glands in the bladder. Adenocarcinoma of the bladder is
rare in the United States.
Some bladder cancers include more than one type of cell.
It's not clear what causes bladder cancer, but doctors have identified
factors that may increase your risk of bladder cancer. Risk factors
* Increasing age. Your risk of bladder cancer increases as you age.
Bladder cancer can occur at any age, but it's rarely found in people
younger than 40.
* Being white. Whites have a greater risk of bladder cancer than do people of other races.
* Being a man. Men are more likely to develop bladder cancer than women are.
* Smoking. Smoking cigarettes, cigars or pipes may increase your
risk of bladder cancer by causing harmful chemicals to accumulate in
your urine. When you smoke, your body processes the chemicals in the
smoke and excretes some of them in your urine. These harmful chemicals
may damage the lining of your bladder, which can increase your risk of
* Exposure to certain chemicals. Your kidneys play a key role in
filtering harmful chemicals from your bloodstream and moving them into
your bladder. Because of this, it's thought that being around certain
chemicals may increase your risk of bladder cancer. Chemicals linked to
bladder cancer risk include arsenic and chemicals used in the
manufacture of dyes, rubber, leather, textiles and paint products.
Smokers who are exposed to toxic chemicals may have an even higher risk
of bladder cancer.
* Previous cancer treatment. Treatment with the anti-cancer drug
cyclophosphamide (Cytoxan) increases your risk of bladder cancer. People
who received radiation treatments aimed at the pelvis for a previous
cancer may have an elevated risk of developing bladder cancer.
* Chronic bladder inflammation. Chronic or repeated urinary
infections or inflammations (cystitis), such as may happen with
long-term use of a urinary catheter, may increase your risk of a
squamous cell bladder cancer. In some areas of the world, squamous cell
carcinoma is linked to chronic bladder inflammation caused by the
parasitic infection known as schistosomiasis.
* Personal or family history of cancer. If you've had bladder
cancer, you're more likely to get it again. If one or more of your
immediate relatives have a history of bladder cancer, you may have an
increased risk of the disease, although it's rare for bladder cancer to
run in families. A family history of hereditary nonpolyposis colorectal
cancer (HNPCC), also called Lynch syndrome, can increase your risk of
cancer in your urinary system, as well as in your colon, uterus, ovaries
and other organs.
Bladder cancer often recurs. Because of this, bladder cancer survivors
often undergo follow-up testing for years after successful treatment.
What tests you'll undergo and how often will depend on your type of
bladder cancer and your treatment, among other factors.
Ask your doctor to create a follow-up plan for you. In general, doctors
recommend a screening exam of the inside of your urethra and bladder
(cystoscopy) every three to six months for the first four years after
bladder cancer treatment. Then you may undergo cystoscopy every year.
Your doctor may recommend other tests at various intervals as well.
People with aggressive cancers may undergo more frequent screening.
Those with less aggressive cancers may undergo screening tests less
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you have
any signs or symptoms that worry you. Your doctor may suggest tests and
procedures to investigate your signs and symptoms. If your doctor
suspects you may have bladder cancer, you may be referred to a doctor
who specializes in treating diseases and conditions of the urinary tract
(urologist). In some cases, you may be referred to other specialists,
such as doctors who treat cancer (oncologists).
Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared. Here's some
information to help you get ready for your appointment, and what to
expect from your doctor.
What you can do
* Be aware of any pre-appointment restrictions. At the time you make
the appointment, be sure to ask if there's anything you need to do in
advance, such as restrict your diet.
* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along. Sometimes it can be
difficult to absorb all the information provided during an appointment.
Someone who accompanies you may remember something that you missed or
* Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For
bladder cancer, some basic questions to ask your doctor include:
* Do I have bladder cancer?
* What is the stage of my cancer?
* Will I need any additional tests?
* What are my treatment options?
* Can any treatments cure my bladder cancer?
* What are the potential risks of each treatment?
* Is there one treatment you feel is best for me?
* Should I see a specialist? What will that cost, and will my insurance cover it?
* Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions at any time that you don't understand
Tests and diagnosis
Diagnosing bladder cancer
Tests and procedures used to diagnose bladder cancer may include:
* Cystoscopy. During cystoscopy, your doctor inserts a narrow tube
(cystoscope) through your urethra. The cystoscope has a lens and
fiber-optic lighting system, allowing your doctor to see the inside of
your urethra and bladder. You usually receive a local anesthetic during
cystoscopy to make you more comfortable.
* Biopsy. During cystoscopy, your doctor may pass a special tool
through your urethra and into your bladder in order to collect a small
cell sample (biopsy) for testing. This procedure is sometimes called
transurethral resection of bladder tumor (TURBT). TURBT can also be used
to treat bladder cancer. TURBT is usually performed under general
* Urine cytology. A sample of your urine is analyzed under a
microscope to check for cancer cells in a procedure called urine
* Imaging tests. Imaging tests allow your doctor to examine the
structures of your urinary tract. You may receive a dye, which can be
injected into a vein. An intravenous pyelogram is a type of X-ray
imaging test that uses a dye to highlight your kidneys, ureters and
bladder. A computerized tomography (CT) scan is a type of X-ray test
that allows your doctor to better see your urinary tract and the
Staging bladder cancer
Once it's confirmed that you have bladder cancer, your doctor may order
additional tests to determine the extent, or stage, of the cancer.
Staging tests may include:
* CT scan
* Magnetic resonance imaging (MRI)
* Bone scan
* Chest X-ray
Bladder cancer stages
The stages of bladder cancer are:
* Stage I. Cancer at this stage occurs in the bladder's inner lining, but hasn't invaded the muscular bladder wall.
* Stage II. At this stage, cancer has invaded the bladder wall, but is still confined to the bladder.
* Stage III. The cancer cells have spread through the bladder wall
to surrounding tissue. They may also have spread to the prostate in men
or the uterus or vagina in women.
* Stage IV. By this stage, cancer cells may have spread to the lymph
nodes and other organs, such as your lungs, bones or liver.
Treatments and drugs
Your treatment options for bladder cancer depend on a number of factors,
including the type and stage of the cancer, your overall health and
your treatment preferences. Discuss your options with your doctor to
determine what treatments are best for you.
The types of surgical procedures available to you may be based on
factors such as the stage of your bladder cancer, your overall health
and your preferences.
Surgery for early-stage bladder cancer
If your cancer is very small and hasn't invaded the wall of your bladder, your doctor may recommend:
* Surgery to remove the tumor. Transurethral resection of bladder
tumor (TURBT) is often used to remove bladder cancers that are confined
to the inner layers of the bladder. During TURBT, your doctor passes a
small wire loop through your urethra and into your bladder. The loop is
used to burn away cancer cells with an electric current (fulguration).
In some cases, a high-energy laser may be used instead of electric
current. TURBT may cause painful or bloody urination for a few days
following the procedure.
Surgery to remove the tumor and a small portion of the bladder.
During segmental cystectomy, sometimes called partial cystectomy, the
surgeon removes only the portion of the bladder that contains cancer
cells. Segmental cystectomy may be an option if your cancer is limited
to one area of the bladder that can easily be removed without harming
Surgery carries a risk of bleeding and infection. You may
experience more frequent urination after segmental cystectomy, since the
operation reduces the size of your bladder. Over time this may improve,
though in some people it's permanent.
Surgery for invasive bladder cancer
If your cancer has invaded the deeper layers of the bladder wall, you may consider:
Surgery to remove the entire bladder. A radical cystectomy is an
operation to remove the entire bladder, as well as surrounding lymph
nodes. In men, radical cystectomy typically includes removal of the
prostate and seminal vesicles. In women, radical cystectomy involves
removal of the uterus, ovaries and part of the vagina.
Cystectomy carries a risk of infection and bleeding. In men,
removal of the prostate and seminal vesicles will cause infertility. But
in most cases your surgeon can attempt to spare the nerves necessary
for an erection. In women, removal of the ovaries causes infertility and
premature menopause in women who haven't experienced menopause prior to
Surgery to create a new way for urine to leave your body.
Immediately after your radical cystectomy, your surgeon works to create a
new way for you to expel urine. Several options exist. Which option is
best for you depends on your cancer, your health and your preferences.
Your surgeon may create a tube (urinary conduit) using a piece of your
intestine. The tube runs from your kidneys to the outside of your body,
where your urine drains into a pouch (urostomy bag) you wear on your
In another procedure, your surgeon may use a section of intestine
to create a small reservoir for urine inside your body (cutaneous
continent urinary diversion). You can drain urine from the reservoir
through a hole in your abdomen using a catheter a few times each day.
In select cases, your surgeon may create a bladder-like reservoir
out of a piece of your intestine (neobladder). This reservoir sits
inside your body and is attached to your urethra, which allows you to
urinate normally. You may need to use a catheter to drain all the urine
from your new bladder.
Biological therapy (immunotherapy)
Biological therapy, sometimes called immunotherapy, works by signaling
your body's immune system to help fight cancer cells. Biological therapy
for bladder cancer is typically administered through your urethra and
directly into the bladder (intravesical therapy).
Biological therapy drugs used to treat bladder cancer include:
* An immune-stimulating bacterium. Bacille Calmette-Guerin (BCG) is a
bacterium used in tuberculosis vaccines. BCG can cause bladder
irritation and blood in your urine. Some people feel as if they have the
flu after treatment with BCG.
A synthetic version of an immune system protein. Interferon is a
protein that your immune system makes to help your body fight
infections. A synthetic version of interferon, called interferon alfa,
may be used to treat bladder cancer. Interferon alfa is sometimes used
in combination with BCG. Interferon alfa can cause flu-like symptoms.
Biological therapy can be administered after TURBT to reduce the risk that cancer will recur.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy treatment for
bladder cancer usually involves two or more chemotherapy drugs used in
combination. Drugs can be given through a vein in your arm
(intravenously), or they can be administered directly to your bladder by
passing a tube through your urethra (intravesical therapy).
Chemotherapy may be used to kill cancer cells that might remain after an
operation. It may also be used before surgery. In this case,
chemotherapy may shrink a tumor enough to allow the surgeon to perform a
less invasive surgery. Chemotherapy is sometimes combined with
Radiation therapy uses high-energy beams aimed at your cancer to destroy
the cancer cells. Radiation therapy can come from a machine outside
your body (external beam radiation) or it can come from a device placed
inside your bladder (brachytherapy).
Radiation therapy may be used before surgery to shrink a tumor so that
it can more easily be removed. Radiation therapy can also be used after
surgery to kill cancer cells that might remain. Radiation therapy is
sometimes combined with chemotherapy.
No complementary or alternative bladder cancer treatments have been
found to cure bladder cancer. But doctors are studying ways to prevent
bladder cancer, including some complementary and alternative approaches.
If you're worried about your risk of bladder cancer or that your cancer
could recur, you may be interested in trying complementary and
alternative treatments. Talk to your doctor about your options.
Fruits and vegetables are the safest way to get your vitamins. Some
research suggests larger doses of certain vitamins, such as vitamin E,
in pill form may help reduce the risk of bladder cancer. But other
studies haven't found this.
More study is needed to understand what dose is safest and most
effective. Until then, focus on eating a wide variety of fruits and
vegetables that are rich in vitamins. If you're interested in vitamin
supplements, ask your doctor about what doses may be reasonable.
Drinking green tea has been linked to many health benefits. But whether
it can reduce the risk of bladder cancer isn't clear. Animal studies
have shown promise, but studies in humans have been mixed. For example,
one study showed that people who drink the most green tea have a reduced
risk of bladder cancer, while another study found that drinking green
tea over many years increased the risk of bladder cancer. More study is
needed to understand whether green tea is helpful or harmful when it
comes to preventing bladder cancer.
Coping and support
Living with the concern that your bladder cancer may recur can leave you
feeling as if you have little control over your future. But while
there's no way to ensure you won't have a recurrence of bladder cancer,
you can take steps to manage the stress.
Over time you'll find what works for you, but until then, you might:
* Have a schedule of follow-up tests, and go to each appointment.
When you finish bladder cancer treatment, ask your doctor to create a
personalized schedule of follow-up tests. Before each follow-up
cystoscopy exam, expect to have some anxiety. You may fear that cancer
has come back or worry about the uncomfortable exam. But don't let this
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.
* Take care of yourself so that you're ready to fight cancer if it
comes back. Take care of yourself by adjusting your diet to include
plenty of fruits, vegetables and whole grains. Exercise for at least 30
minutes most days of the week. Get enough sleep so you wake feeling
* Talk with other bladder cancer survivors. Connect with bladder
cancer survivors who are experiencing the same fears you're feeling.
Contact your local chapter of the American Cancer Society to ask about
support groups in your area. Or contact CancerCare at 800-813-HOPE, or
800-813-4673, for information on telephone-based support groups. Online
message boards, such as the American Cancer Society's Cancer Survivors
Network and the Bladder Cancer WebCafe, are another option.
Although there's no guaranteed way to prevent bladder cancer, you can take steps to help reduce your risk. For instance:
* Don't smoke. Not smoking means that cancer-causing chemicals in
smoke can't collect in your bladder. If you don't smoke, don't start. If
you smoke, talk to your doctor about a plan to help you stop. Support
groups, medications and other methods may help you quit.
* Take caution with chemicals. If you work with chemicals, follow all safety instructions to avoid exposure.
* Drink water throughout the day. Drinking liquids, especially
water, dilutes toxic substances that may be concentrated in your urine
and flushes them out of your bladder more quickly.
* Choose a variety of fruits and vegetables. Choose a diet rich in a
variety of colorful fruits and vegetables. The antioxidants in fruits
and vegetables may help reduce your risk of cancer.