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Bladder Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Bladder Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the bladder and bladder cancer

The bladder is an expandable, hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra.

The bladder, like other parts of the urinary tract, is lined with a layer of cells called the urothelium. This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin, fibrous band called the lamina propria.

Bladder cancer begins when healthy cells in the bladder lining, most commonly urothelial cells, change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Types of bladder cancer

The type of bladder cancer depends on how it looks under the microscope. The three main types of bladder cancer are:

  • Urothelial carcinoma. Urothelial carcinoma accounts for about 90% of all bladder cancers. It begins in the urothelial cells found in the lining the bladder. Urothelial carcinoma is the common term for this type of bladder cancer; however, it was previously called transitional cell carcinoma or TCC.

  • Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.

  • Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.

There are other less common types of bladder cancer, including sarcoma and small cell anaplastic cancer. Sarcoma begins in the fat or muscle layers of the bladder. Small cell anaplastic cancer is a rare type of bladder cancer that is likely to spread to other parts of the body.

Ways of describing bladder cancer

In addition to its cell type, bladder cancer may be described as noninvasive, non-muscle-invasive, or muscle-invasive.

  • Noninvasive. This type of bladder cancer usually does not extend through the lamina propria. Noninvasive cancer may also be called superficial cancer, although this term is being used less often because it may incorrectly imply that this type of cancer is not serious. Noninvasive bladder cancer is less likely to spread to other parts of the body than other types of bladder cancer.

  • Non-muscle-invasive. Non-muscle-invasive bladder cancer typically has only grown into the lamina propria. It is called invasive, but it is not the deeply invasive type that can spread to the muscle layer (see below).

  • Muscle-invasive. Muscle-invasive bladder cancer has grown into the bladder's wall muscle and sometimes into the fatty layers or surrounding tissue outside the bladder.

It is important to note that both noninvasive and non-muscle-invasive bladder cancers have the possibility of spreading into the bladder muscle or to other parts of the body. Additionally, all cell types of bladder cancer can spread beyond the bladder through a process known as metastasis.

If a bladder tumor has spread into the surrounding organs, such as the uterus and vagina in women, the prostate in men, and/or nearby muscles, it is called locally advanced disease. Bladder cancer also often spreads to the lymph nodes in the pelvis. If it has spread into the liver, bones, lungs, lymph nodes outside the pelvis, or other parts of the body, the cancer is called metastatic disease. This is described in more detail in the Stages and Grades section.

Looking for More of an Overview?

If you would like additional information, read a one-page ASCO Answers Fact Sheet, available as a PDF, that offers an easy-to-print introduction to this type of cancer. Please note this link will take you to another section on Cancer.Net.

The next section in this guide is Statistics, and it helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Bladder Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find information about how many people are diagnosed with this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

This year, an estimated 74,000 adults (56,320 men and 17,680 women) will be diagnosed with bladder cancer in the United States. It is estimated that 16,000 deaths (11,510 men and 4,490 women) from this disease will occur this year. Among men, bladder cancer is the fourth most common cancer and the eighth most common cause of cancer death.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is found. This rate depends on many factors, including the stage of bladder cancer that is diagnosed. The five-year survival rate of people with non-muscle-invasive/superficial urothelial carcinoma is 96%. About half of people are diagnosed with this stage. If the tumor is invasive but has not yet spread outside the bladder, the five-year survival rate is 69%. If the cancer extends through the bladder to the surrounding tissue or has spread to nearby lymph nodes or organs, the five-year survival rate is 34%. If the cancer has spread to distant parts of the body, the five-year survival rate is 6%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, so the actual risk for a particular individual may be different. It is not possible to tell a person how long he or she will live with bladder cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2015.

The next section in this guide is Medical Illustrations, and it offers drawings of the bladder, including its layers of tissue. Or, use the menu on the left side of your screen to choose another section to continue reading this guide.  

Bladder Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find a basic drawing of the main body parts affected by this disease. To see other pages, use the menu on the side of your screen.

Bladder Anatomy

Larger image

The next section in this guide is Risk Factors, and it explains what factors may increase the chance of developing this disease. Or, use the menu on the side of your screen to choose another section to continue reading this guide

Bladder Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing bladder cancer:

  • Tobacco use. The most common risk factor is cigarette smoking, although smoking cigars and pipes can also raise the risk of developing bladder cancer. Smokers are four to seven times more likely to develop bladder cancer than nonsmokers. Learn more about tobacco’s link to cancer and how to quit smoking.

  • Age. The likelihood of being diagnosed with bladder cancer increases with age. More than 70% of people with bladder cancer are older than 65 years old.

  • Gender. Men are three to four times more likely to develop bladder cancer than women, but women are more likely to die from bladder cancer than men. Before smoking rates for women increased, men were five to six times more likely to develop bladder cancer than women.

  • Race. White people are more than twice as likely to be diagnosed with bladder cancer as black people, but black people are twice as likely to die from the disease.

  • Chemicals. Chemicals used in the textile, rubber, leather, dye, paint, and print industries; some naturally occurring chemicals; and chemicals called aromatic amines can increase the risk of bladder cancer.

  • Chronic bladder problems. Bladder stones and infections may increase the risk of bladder cancer. Bladder cancer may be more common for people who are paralyzed from the waist down and have had many urinary infections.

  • Cyclophosphamide (Cytoxan, Clafen, Neosar) use. People who have taken the chemotherapy drug cyclophosphamide have a higher risk of developing bladder cancer.

  • Pioglitazone hydrochloride (Actos) use. In 2011, the U.S. Food and Drug Administration (FDA) warned that people who have taken the diabetes drug pioglitazone hydrochloride for more than one year may have a higher risk of developing bladder cancer. However, published studies have shown contradictory results.

  • Personal history. People who have already had bladder cancer once are more likely to develop bladder cancer again.

  • Schistosomiasis. People who have some forms of this parasitic disease, which is found particularly in parts of Africa and the Mediterranean region, are more likely to develop bladder cancer.

  • Arsenic exposure. Arsenic is a naturally occurring substance that can cause health problems if consumed in large amounts. When found in drinking water, it has been associated with an increased risk of bladder cancer. The chance of being exposed to arsenic depends on where you live and whether you get your water from a well or from a system that meets the standards for acceptable arsenic levels.

The next section in this guide is Symptoms and Signs, and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Bladder Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with bladder cancer may experience the following symptoms or signs. Sometimes, people with bladder cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Blood or blood clots in the urine

  • Pain or burning during urination

  • Frequent urination

  • Feeling the need to urinate many times throughout the night

  • Feeling the need to urinate, but not being able to pass urine

  • Lower back pain on one side of the body

Most often, bladder cancer is diagnosed when a person tells his or her doctor about blood in the urine, also called hematuria. Gross hematuria means that enough blood is present in the urine to be visible to the patient. It is also possible there are small amounts of blood in the urine that are unable to be seen. This is called microscopic hematuria, and it can only be detected with a urine test.

General urine tests are not used to make a specific diagnosis of bladder cancer because hematuria can be a sign of several other conditions that are not cancer, such as an infection or kidney stones. One type of urine test that can indicate the presence of cancer is cytology, a test in which the urine is studied under a microscope to look for cancer cells. See the Diagnosis section for more information.

Sometimes when the first symptoms of bladder cancer appear, the cancer has already spread to another part of the body. In this situation, the symptoms depend on where the cancer has spread. For example, cancer that has spread to the lungs may cause a cough or shortness of breath, spread to the liver may cause abdominal pain or jaundice (yellowing of the skin and whites of the eyes), and spread to the bone may cause bone pain or a fracture (bone break). Other symptoms of advanced bladder cancer may include pain, unexplained appetite loss, and weight loss.

If you are concerned about one or more of the symptoms or signs listed in this section, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis, and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Bladder Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. A bladder biopsy or biopsy from another location if the cancer has spread is the only way to make a definitive diagnosis. Imaging tests may be used to find out whether the cancer has spread.

This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition

  • Signs and symptoms

  • Previous test results

The earlier bladder cancer is found, the better the chance for successful treatment. However, there is not yet a test accurate enough to screen the general population for bladder cancer, so most people are diagnosed with bladder cancer once they have symptoms. As a result, some people have more advanced (later stage) disease when the cancer is found. Most people, though, are usually diagnosed with noninvasive bladder cancer.

The following tests may be used to diagnose and learn more about bladder cancer:

  • Urine tests. The doctor tests a urine sample to find out if it contains tumor cells. If a patient is undergoing a cystoscopy (see below), an additional test may be performed that involves rinsing the bladder and collecting the liquid through the cystoscope or through another small tube that is inserted into the urethra. The sample can be tested in a variety of ways. The most common way is to look at the cells under a microscope, called urinary cytology. Urine passed out of the body during normal urination can also be examined by cytology. There are other urine tests using molecular analysis that can be done to help find cancer, usually at the same time as urinary cytology.

  • Cystoscopy. This is the key diagnostic procedure for bladder cancer. It allows the doctor to see inside the body with a thin, lighted, flexible tube called a cystoscope. Flexible cystoscopy is performed in a doctor's office and does not require anesthesia, which is medication that blocks the awareness of pain. This short procedure can detect growths in the bladder and determine the need for a biopsy or surgery.

  • Transurethral resection of bladder tumor (TURBT). If abnormal tissue is found during a cystoscopy, the doctor will do a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. This surgical procedure is called a transurethral bladder tumor resection or TURBT.

    During a TURBT, the doctor removes the tumor and a sample of the bladder muscle near the tumor. The doctor also usually does biopsies of other parts of the bladder. After the TURBT is done, the urologist evaluates the bladder to see if any masses can be felt. This is called an exam under anesthesia or EUA. A pathologist then analyzes the sample(s) removed during the procedure. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    A TURBT is used to diagnose bladder cancer and find out the type of tumor, how deeply it has grown into the layers of the bladder, and identify any additional microscopic cancerous changes called carcinoma in situ (CIS). A TURBT can also be used as a treatment for a non-muscle-invasive tumor. See the Treatment Options section for more information.

The following imaging tests may be used to find out if the bladder cancer has spread and to help with staging.

  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow. The patient should tell the staff giving this test beforehand if he or she is allergic to iodine or other contrast media.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Positron emission tomography (PET) scan. Ongoing research is showing that a PET scan may help find bladder cancer that has spread better than a CT scan or MRI alone. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section in this guide is Stages and Grades. It explains the systems doctors use to describe the extent of the disease and the way cancer cells look under a microscope. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Bladder Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as the way the tumor cells look when viewed under a microscope. This is called the stage and grade. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has invaded or spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

For bladder cancer, the stage is determined based on examining the sample removed during a TURBT (see the Diagnosis section) and finding out whether the cancer has spread to other parts of the body.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for bladder cancer.

Tumor (T)

Using the TNM system, the "T" plus a letter and/or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. If there is more than one tumor, the lowercase letter "m" (multiple) is added to the "T" stage category. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0: There is no evidence of a primary tumor in the bladder.

Ta: This refers to noninvasive papillary carcinoma. This type of growth often is found on a small section of tissue that easily can be removed with TURBT. However, it tends to come back after treatment.

Tis: This stage is carcinoma (cancer) in situ or a "flat tumor." This means that the cancer is only found on or near the surface of the bladder. The doctor may also call it non-muscle-invasive/superficial bladder cancer or noninvasive flat carcinoma. This type of bladder cancer often comes back after treatment, usually as another noninvasive cancer in the bladder.

T1: The tumor has spread to the subepithelial connective tissue but does not involve the bladder wall muscle (lamina propria, the tissue below the inside lining of the bladder).

T2: The tumor has spread to the muscle of the bladder wall.

T2a: The tumor has spread to the inner half of the muscle of the bladder wall, which may be called the superficial muscle.

T2b: The tumor has spread to the deep muscle of the bladder (the outer half of the muscle).

T3: The tumor has grown into the perivesical tissue (the fatty tissue that surrounds the bladder).

T3a: The tumor has grown into the perivesical tissue, as seen through a microscope.

T3b: The tumor has grown into the perivesical tissue macroscopically, meaning that the tumor(s) is large enough to be seen during imaging tests or to be seen or felt by the doctor.

T4: The tumor has spread to any of the following: the abdominal wall, the pelvic wall, a man’s prostate or seminal vesicle (the tube(s) that carry semen), or a woman’s uterus or vagina.

T4a: The tumor has spread to the prostate, uterus, or vagina.

T4b: The tumor has spread to the pelvic wall or the abdominal wall.

Node (N)

The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near where the cancer started, within the true pelvis (called hypogastric, obturator, iliac, perivesical, pelvic, sacral, and presacral lymph nodes), are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0: The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to a single regional lymph node in the pelvis.

N2: The cancer has spread to more than one regional lymph node in the pelvis.

N3: The cancer has spread to the common iliac lymph nodes, which are located behind the major arteries in the pelvis, above the bladder.

Metastasis (M)

The "M" in the TNM system indicates whether the cancer has spread to other parts of the body called distant metastasis.

M0: The disease has not metastasized.

M1: There is distant metastasis.

Cancer stage grouping

Doctors assign the stage of the bladder cancer by combining the T, N, and M classifications.

Stage 0a: This is an early cancer that is only found on the surface of the inner lining of the bladder. Cancer cells are grouped together and can often be easily removed. The cancer has not invaded the muscle or connective tissue of the bladder wall. This type of bladder cancer is also called noninvasive papillary urothelial carcinoma (Ta, N0, M0).

Stage 0is: This stage of cancer, also known as flat or carcinoma in situ, is found only on the inner lining of the bladder. It has not grown in toward the hollow part of the bladder, and it has not spread to the thick layer of muscle or connective tissue of the bladder (Tis, N0, M0). This is always a high-grade cancer (see Grades, below).

Stage I: The cancer has grown through the inner lining of the bladder into the lamina propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs (T1, N0, M0).

Stage II: The cancer has spread into the thick muscle wall of the bladder. It is also called invasive cancer or muscle-invasive cancer. The tumor has not reached the fatty tissue surrounding the bladder and has not spread to the lymph nodes or other organs (T2, N0, M0).

Stage III: The cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder. It may also have spread to the prostate in a man or the uterus and vagina in a woman. It has not spread to the lymph nodes or other organs (T3 or T4a, N0, M0).

Stage IV: Any of these conditions:

  • The tumor has spread to the pelvic wall or the abdominal wall but not to the lymph nodes or other parts of the body (T4b, N0, M0).

  • The tumor has spread to one or more regional lymph nodes but not to other parts of the body (any T, N1-3, M0).

  • The tumor may or may not have spread to the lymph nodes but has spread to other parts of the body (any T, any N, M1).

Recurrent cancer: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor.

Many urologic surgeons classify a tumor’s grade based on the chance that the cancer will recur or progress (grow and spread). They often plan treatment based on the grade, using the following categories:

Papilloma. This is also called benign papillary urothelial neoplasm of low malignant potential (PUNLMP). This type of cancer may recur but has a low risk of progressing.

Low grade. This type of cancer is more likely to recur and progress compared with PUNLMP.

High grade. This type of cancer is the most likely to recur and progress.

More recently, the World Health Organization (WHO) has recommended changing bladder cancer grading to only two categories: 1) well-differentiated or low grade, and 2) poorly differentiated or high grade. This is the system that is used in the latest version of the American Joint Committee on Cancer (AJCC) Staging System.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Bladder Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best known treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, visit the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. This team is usually led by a urologist, a doctor who specializes in the genitourinary tract, which includes the kidneys, bladder, genitals, prostate, and testicles, or a urologic oncologist, a doctor who specializes in treating cancers of the urinary tract. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for bladder cancer are listed below, followed by an outline of general approaches to treatment according to the stage of the cancer. Treatment options and recommendations depend on several factors, including the type, stage, and grade of bladder cancer; possible side effects; and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. There are different types of surgery for bladder cancer, and the most beneficial option usually depends on the stage and grade of the disease. Surgical options to treat bladder cancer include:

  • Transurethral bladder tumor resection (TURBT). This procedure is used for diagnosis and staging, as well as treatment. During TURBT, a surgeon inserts a cystoscope through the urethra into the bladder. The surgeon then removes the tumor using a tool with a small wire loop, a laser, or fulguration (high-energy electricity). The patient is given medication to block the awareness of pain, known as an anesthetic, before the procedure begins.

    For people with non-muscle-invasive bladder cancer, TURBT may be able to eliminate the cancer. However, the doctor may recommend additional treatments to prevent cancer recurrence, such as intravesical chemotherapy or immunotherapy (see below).  For people with muscle-invasive bladder cancer, additional treatments involving surgery to remove the bladder or, less commonly, radiation therapy are usually recommended.

  • Cystectomy. A radical cystectomy is the removal of the whole bladder and possibly nearby tissues and organs. For men, the prostate and urethra also may be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. In addition, lymph nodes in the pelvis are removed for both men and women. This is called a pelvic lymph node dissection. A thorough pelvic lymph node dissection is the most accurate way to find cancer that has spread to the lymph nodes. Rarely, for some specific cancers, it may appropriate to remove only part of the bladder, which is called partial cystectomy.

    During a laparoscopic or robotic cystectomy, the surgeon makes several small incisions (cuts) instead of the one larger incision used for traditional surgery. The surgeon then uses telescoping equipment with or without robotic assistance to remove the bladder. The surgeon must make an incision to remove the bladder and surrounding tissue. This type of operation requires a surgeon who is very experienced in minimally invasive surgery. Several studies are still in progress to determine whether laparoscopic or robotic cystectomy is as safe as the standard surgery and whether it is able to eliminate bladder cancer as successfully as standard surgery.

  • Urinary diversion. If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.

    Increasingly, surgeons can use part of the small or large intestine to make a urinary reservoir, which is a storage pouch that sits inside the body. With these procedures, the patient does not need a urinary bag and can have a better quality of life. For some patients, the surgeon is able to connect the pouch to the urethra, creating what is called a neobladder, so the patient can pass urine out of the body normally. However, the patient may need to insert a thin tube called a catheter if urine does not empty through the neobladder. Also, patients with a neobladder will no longer have the urge to urinate and will need to learn to urinate on a consistent schedule.

    For other patients, the pouch is connected to the skin on the abdomen or umbilicus through a small stoma, which creates a type of continent urinary reservoir. This means urine will stay in the reservoir until the patient drains the pouch and no urinary pad is needed. The pouch is drained by inserting a catheter through the small stoma and then removing the catheter.

Living without a bladder can affect a patient’s quality of life. Finding ways to keep all, or part, of the bladder is an important treatment goal, as long as the patient’s prognosis isn’t affected. For some patients with muscle-invasive bladder cancer, certain treatment plans involving chemotherapy and radiation therapy (see below) may be used as an alternative to removing the bladder. 

The side effects of bladder cancer surgery depend on the procedure. Patients should talk with their doctor in detail to understand exactly what side effects may occur, including urinary and sexual side effects, and how they can be managed. In general, side effects may include:

  • Delayed healing

  • Infection

  • Mild bleeding and discomfort after surgery.

  • Infections or urine leaks after cystectomy or a urinary diversion. If a neobladder has been created, a patient may sometimes be unable to urinate or completely empty the bladder.

  • Men may be unable to have an erection, called impotence, after cystectomy. Sometimes, a nerve-sparing cystectomy can be performed. When this is done successfully, men may be able to have a normal erection.

  • Damage to the nerves in the pelvis and loss of sexual feeling and orgasm for both men and women. Often, these problems can be fixed.

Patients should talk with their doctor about any side effects they are experiencing. Learn more about the basics of cancer surgery.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. A chemotherapy regimen typically consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

There are two types of chemotherapy that may be used to treat bladder cancer. The type the doctor recommends and when it is given depends on the stage of the cancer. Patients should talk with their doctor about chemotherapy before surgery.

  • Intravesical chemotherapy. Intravesical (local) chemotherapy is usually given by a urologist. During this type of therapy, drugs are delivered into the bladder through a catheter that has been inserted through the urethra. Local treatment only destroys superficial tumor cells that come in contact with the solution. It cannot reach tumor cells in the bladder wall or tumor cells that have spread to other organs. Mitomycin (Mitozytrex, Mutamycin) and thiotepa (multiple brand names) are the drugs used most often for intravesical chemotherapy. Other drugs that are used include doxorubicin (Adriamycin), gemcitabine (Gemzar), and valrubicin (Valstar).

  • Systemic chemotherapy. Systemic (whole body) chemotherapy is usually prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

    A combination of drugs, called MVAC, has been the standard treatment for bladder cancer for many years. MVAC combines four drugs: methotrexate (multiple brand names), vinblastine (Velban, Velsar), doxorubicin, and cisplatin (Platinol). When given before surgery, MVAC can extend life and cure patients. For people with bladder cancer that has spread, known as metastatic disease, this combination can shrink the cancer and potentially prolong life. In addition, depending on the situation, MVAC may help delay bladder cancer recurrence. However, it has severe side effects.

    The combination of gemcitabine plus cisplatin may also be recommended. It provides similar benefits as MVAC for people with metastatic disease, but this combination has somewhat fewer side effects.

    Many systemic chemotherapies continue to be tested in clinical trials to help find out which drugs or combinations or drugs work best to treat bladder cancer. Usually a combination of drugs works better than one drug alone. Researchers are also studying when it is best to use chemotherapy, either before or after surgery.

Side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

The standard immunotherapy drug for bladder cancer is a weakened bacterium called bacillus Calmette-Guerin (BCG), which is similar to the bacteria that causes tuberculosis. BCG is placed directly into the bladder through a catheter. This is called intravesical therapy. BCG attaches to the inside lining of the bladder and stimulates the immune system to destroy the tumor. BCG can cause flu-like symptoms, chills, mild fever, fatigue, a burning sensation in the bladder, and bleeding from the bladder.

Interferon (Roferon-A, Intron A, Alferon) is another type of immunotherapy that can be given as intravesical therapy. It is sometimes combined with BCG if using BCG alone does not help treat the cancer.

Learn more about the basics of immunotherapy.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Radiation therapy is usually not used by itself as a primary treatment for bladder cancer, but it may be given in combination with chemotherapy. Some people who cannot receive chemotherapy might receive radiation therapy alone. The combination of radiation therapy and chemotherapy may be used to treat cancer that is located only in the bladder for the following reasons:

  • To destroy any cancer cells that may remain after TURBT to avoid removing all or part of the bladder

  • To relieve symptoms caused by a tumor, such as pain, bleeding, or blockage

  • To treat a metastasis located in one area, such as the brain or bone

Side effects from radiation therapy may include fatigue, mild skin reactions, and loose bowel movements. For bladder cancer, side effects most commonly occur in the pelvic or abdominal area and may include bladder irritation with the need to pass urine frequently during the treatment period and bleeding from the bladder or rectum. Most side effects go away soon after treatment is finished.

Learn more about the basics of radiation therapy.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.   

Developing a treatment plan

The first treatment a person is given is called first-line therapy. If that treatment stops working, then a person receives second-line therapy. In some situations, third-line therapy may also be available.

Adjuvant therapy is treatment that is given after the first treatment, which is usually surgery. Neoadjuvant therapy is treatment that is given before the primary treatment, such as chemotherapy before surgery.

The treatment options your doctor recommends mainly depend on the stage of bladder cancer you have been diagnosed with. (See the Stages and Grades section for detailed descriptions of each stage.) However, the tumor’s size and grade may also affect the recommended treatment options. Talk with your doctor about the risks and benefits of all the available treatment options and when treatment should begin.

Non-muscle-invasive bladder cancer

People with low-grade, non-muscle-invasive bladder cancer rarely develop aggressive or metastatic bladder cancer. However, they are at risk for developing additional low-grade cancers throughout their life. This requires life-long checkups, called surveillance, using cystoscopy. For people who develop frequent recurrences, the urologist may recommend having intravesical chemotherapy to prevent more recurrent tumors from developing.

People with high-grade, non-muscle-invasive bladder cancer are at risk for developing recurrent tumors. Sometimes these tumors come back at a more advanced stage with a risk of developing metastatic bladder cancer. To prevent this from happening, the urologist may recommend removing the whole bladder (radical cystectomy), especially if the person is young and/or has large tumors or a number of tumors at the time of diagnosis.

More often, people with high-grade, non-muscle-invasive bladder cancer receive intravesical immunotherapy using BCG after TURBT to prevent recurrence and the development of muscle-invasive disease. Before BCG treatment, these patients will need to have another TURBT to make sure that the cancer has not spread to the muscle. The first round of BCG treatment is given weekly for six weeks. After that, the doctor will perform a cystoscopy and sometimes a bladder biopsy (see the Diagnosis section) to see if the BCG has eliminated all of the cancer. If there is no evidence of cancer, the person will have maintenance therapy, which may be given once a week for three weeks or every six months, for three years, followed by lifelong surveillance. If recurrent tumors develop, the doctor may recommend having a cystectomy.

Muscle-invasive bladder cancer

Bladder cancer found at this stage has grown into the muscle layer of the bladder wall. As with other stages of cancer, surgery is often used as the initial treatment. However, instead of TURBT, a radical cystectomy is the standard treatment. Lymph nodes near the bladder are usually removed as well. A TURBT may still be done, but it usually is used to help the doctor figure out the extent of the cancer rather than as a treatment option.

People with muscle-invasive bladder cancer are optimally treated with systemic chemotherapy followed by radical cystectomy and urinary diversion (see above). Research shows that having chemotherapy before a radical cystectomy reduces the risk of the cancer spreading to other parts of the body and increases survival for men with muscle-invasive bladder cancer.

An important clinical trial showed that having MVAC chemotherapy before radical cystectomy helped patients with muscle-invasive bladder cancer live longer. Based on this research, this approach is considered a standard treatment for people whose overall health allows it, meaning they have adequate kidney and heart function and functional status. This type of initial chemotherapy, called neoadjuvant chemotherapy, may shrink the tumor in the bladder and may also destroy small areas of cancer that have spread beyond the bladder.

It is important to note that chemotherapy with one drug does not seem to help patients with locally advanced bladder cancer live longer, and some people may not be healthy enough to receive chemotherapy. Therefore, it is important for anyone who has been diagnosed with muscle-invasive bladder cancer to talk with a urologist and medical oncologist about their treatment options, including the risks and benefits of chemotherapy.

In very specific people with small muscle-invasive cancers, an approach using chemotherapy with radiation therapy may provide the same benefits as removing the bladder.

Metastatic bladder cancer

If bladder cancer has spread to another part of the body, it is called metastatic bladder cancer. Patients with this diagnosis are encouraged to talk with doctors, usually medical oncologists, who are experienced in treating this stage of cancer because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials studying new treatments.

Your health care team may recommend a combination of treatments to help manage the cancer. There are no methods to permanently cure metastatic bladder cancer for most people. The goals of treatment are to slow the spread of cancer, shrink the tumor (called remission, see below), and extend life for as long as possible. Palliative care is also important to help relieve symptoms and side effects.

Since there are relatively few treatment options for metastatic bladder cancer, clinical trials are often the best option for treatment. Currently, the standard treatment options are MVAC and gemcitabine-cisplatin chemotherapy. There are other drugs and combinations that can be used for patients who for medical reasons are unable to receive gemcitabine-cisplatin or MVAC. Changes to these regimens or the use of new treatment regimens aimed at helping patients live longer and improve their quality of life are being studied in clinical trials.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence, also known as metastasis).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options.

In general, non-muscle-invasive bladder cancers that come back in the same location as the original tumor or somewhere else in the bladder are treated in the same way as the first cancer. However, if the cancer continues to return after treatment, a cystectomy may be recommended. Bladder cancers that recur outside the bladder are more difficult to eliminate with surgery and are often treated with chemotherapy and/or radiation therapy. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from bladder cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials, and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Bladder Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

What are clinical trials?

Doctors and scientists are always looking for better ways to treat patients with bladder cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the FDA was previously tested in clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. People who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are the only way to make progress is treating bladder cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with bladder cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for bladder cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research, and it explains areas of scientific research currently going on for this type of cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Bladder Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about bladder cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Laparoscopic cystectomy. Several studies are underway to find out whether laparoscopic bladder removal is as safe as standard surgery and whether the cure rates are the same. Learn more about this type of surgery in the Treatment Options section.

  • Molecular testing. Tests to identify changes to genes or proteins that could be a sign of bladder cancer may help predict a bladder cancer recurrence or predict which patients may need more intense treatment. DNA changes may also help predict prognosis for people with bladder cancer.

  • Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Research is underway to find out how targeted therapy may be used to treat bladder cancer. For instance, a clinical trial is looking at combining targeted therapy with radiation therapy to help preserve bladder function. Learn more about the basics of targeted therapy.

  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. One active area of immunotherapy research is looking at drugs that block a protein called PD-1. PD-1 is found on the surface of T-cells, which are a type of white blood cell that directly helps the body’s immune system fight disease. Because PD-1 keeps the immune system from destroying cancer cells, stopping PD-1 from working allows the immune system to better eliminate the disease. Currently researchers are studying PD-1 immunotherapy for people with metastatic bladder cancer in clinical trials. Learn more about the basics of immunotherapy.

  • New drug combinations. As described in the Treatment Options section, researchers are studying new combinations of chemotherapies and other drugs.

  • Palliative care. Clinical trials are underway to find a better way of reducing symptoms and side effects of current bladder cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding bladder cancer, explore these related items:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

  • Visit ASCO’s CancerProgress.Net website to learn more about the historical pace of research for bladder cancer. Please note this link takes you to a separate ASCO website.

  • Visit the website of the Conquer Cancer Foundation to find out how to help support research for every cancer type. Please note this link takes you to a separate ASCO website. 

The next section in this guide is Coping with Side Effects, and it offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Bladder Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment.

Common side effects from each treatment option for bladder cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Talking with your health care team about side effects

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with bladder cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

The next section in this guide is Follow-Up Care, and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Bladder Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. For bladder cancer, follow-up care typically includes a general physical examination, cystoscopy (if the bladder has not been removed), urine cytology, x-rays, and routine blood tests to make sure the bladder is working well and to check for any signs that the cancer has come back.

For patients with a urinary diversion, follow-up care may include checking for infection with urine tests, checking and fixing problems with controlling urination, checking for recurrent cancer in the upper urinary tract, and checking for changes in kidney function with blood tests and x-rays.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence.

Tell your doctor about any new symptoms, such as pain during urination, blood in the urine, frequent urination, or an immediate need to urinate. These symptoms may be signs that the cancer has come back or signs of another medical condition.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist or urologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship, and it describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Bladder Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people. Two common definitions include:

  • Having no signs of cancer after finishing treatment.

  • The process of living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every person.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from bladder cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-Up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Bladder Cancer - Questions to Ask The Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of bladder cancer do I have?

  • Is it noninvasive or invasive? What does this mean?

  • If the cancer is invasive, does it involve the muscle?

  • Can you explain my pathology report (laboratory test results) to me?

  • What is the stage of my cancer? What does this mean?

  • What is the grade? What does this mean?

Questions to ask about choosing a treatment and managing side effects

  • Do I need to start treatment right away?

  • What are my treatment options?

  • What clinical trials are open to me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be coordinating my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long? How can we manage any sexual side effects that may occur?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will I have?

  • Will my entire bladder be removed?

  • Do you have experience making urinary reservoirs? Can I have this type of surgery?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term side effects of having this surgery?

  • How will the surgery affect my ability to urinate?

  • Will I need to use a catheter?

  • Will I need to have a urostomy? If so, how do I care for my urostomy?

  • If I have a neobladder, how will I know when I need to empty it?

Questions to ask about having chemotherapy

  • What type of chemotherapy do you recommend?

  • What is the goal of this treatment?

  • How will it be delivered? Through an IV, a catheter, or a pill?

  • How long will it take to give this treatment?

  • How can I prepare for this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of this type of chemotherapy?

  • What can be done to prevent or manage these side effects?

Questions to ask about having immunotherapy

  • What type of immunotherapy do you recommend?

  • What is the goal of this treatment?

  • How can I prepare for this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to prevent or manage these side effects?

Questions to ask about having radiation therapy

  • What type of radiation therapy do you recommended?

  • What is the goal of radiation therapy?

  • How long will it take to give radiation therapy?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to prevent or manage these side effects?

Questions to ask about planning follow-up care

  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be coordinating my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide.    

Bladder Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 06/2015

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Bladder Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Bladder Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.