Bladder Cancer

NOTICE: This health information was not created by the University of Michigan Health System (UMHS) and may not necessarily reflect specific UMHS practices. For medical advice relating to your personal condition, please consult your doctor. Complete disclaimer

Bladder Cancer

Topic Overview

What is bladder cancer?

Cancer is the growth of abnormal cells in the body. These extra cells grow together and form masses, called tumors. In bladder cancer, these growths happen in the bladder.

The bladder is the part of your urinary tract that stores your urine until you are ready to let it out. See a picture of the female urinary system or male urinary system.

Bladder cancer can usually be successfully treated if it is found and treated early. And most bladder cancer is found early.

What causes bladder cancer?

We don't know what causes bladder cancer. But smoking cigarettes or being exposed to certain chemicals raises your risk. And like other cancers, changes in the DNA of your cells seem to play a role.

What are the symptoms?

Blood in the urine is the main symptom. Other symptoms may include having to urinate often or feeling pain when you urinate.

These symptoms can be caused by other problems, including a urinary tract infection. Always call your doctor if you see blood in your urine.

How is bladder cancer diagnosed?

To diagnose bladder cancer, your doctor will:

  • Ask about your medical history and do a physical exam, including a vaginal or rectal exam.
  • Test your urine to look for blood or abnormal cells.
  • Do a cystoscopy, a test that lets your doctor look into your bladder with a thin, lighted viewing tool. Small tissue samples (biopsies) are taken and looked at under a microscope to find out if there are cancer cells.

How is it treated?

Treatment choices for bladder cancer include:

  • Surgery to remove any cancer. Sometimes lasers or other methods can be used to get rid of tumors.
  • Chemotherapy, which uses medicine to destroy cancer cells.
  • Immunotherapy, which causes your body's natural defense system to attack bladder cancer cells.
  • Radiation therapy, which uses high-dose X-rays to kill cancer cells.

The treatment depends a lot on how much the cancer has grown. Most bladder cancers are treated without having to remove the bladder.

Sometimes doctors do have to remove the bladder. For some people, this means having urine flow into a bag outside of the body. But in many cases, doctors can make a new bladder—using other body tissue—that works very much like the old one.

Bladder cancer often comes back. The new tumors can often be treated successfully if they are caught early. So it’s very important to have regular checkups after your treatment is done.

It’s common to feel scared, sad, or angry after finding out that you have bladder cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area.

What increases your chances of getting bladder cancer?

Anything that increases your chances of getting a disease is called a risk factor. The main risk factors for bladder cancer include:

  • Smoking. Cigarette smokers are much more likely than other people to get bladder cancer.
  • Being older than 40, being male, or being white (Caucasian).
  • Being exposed to cancer-causing chemicals, such as those used in the wood, rubber, and textile industries.
  • What you eat. A diet high in fried meats and fats increases your risk for bladder cancer.
  • Parasites. There is a parasite that causes schistosomiasis, which can increase your risk. This condition is sometimes found in developing countries and rarely occurs in North America.

Frequently Asked Questions

Learning about bladder cancer:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with bladder cancer:

End-of-life issues:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Healthy Eating: Cutting Unhealthy Fats From Your Diet

Cause

The cause of bladder cancer is not known. Changes in the genetic material (DNA) of bladder cells may play a role. Chemicals in the environment and cigarette smoking also may play a role. And when the lining of the bladder is irritated for a long time, cell changes that lead to cancer may occur. Some things that cause this are radiation treatment, having catheters in place for a long time, or having the parasite that causes schistosomiasis.

Bladder cancer is twice as likely to develop in smokers than in nonsmokers. Experts believe that smoking causes about half of bladder cancer in men and more than one-fourth of bladder cancer in women.1

Exposure to chemicals and other substances at work—including dyes, paints, leather dust, and others—may also cause bladder cancer.

Symptoms

The most common symptoms of bladder cancer include:

  • Blood or blood clots in the urine (hematuria). Hematuria occurs in 8 or 9 out of 10 people who have bladder cancer and is the most common symptom. Usually it is not painful.
  • Pain during urination (dysuria).
  • Urinating small amounts frequently.
  • Frequent urinary tract infections (UTIs).

Symptoms that may indicate more advanced bladder cancer include:

  • Pain in the lower back around the kidneys (flank pain).
  • Swelling in the lower legs.
  • A growth in the pelvis near the bladder (pelvic mass).

Other symptoms that may develop when bladder cancer has spread include:

  • Weight loss.
  • Bone pain or pain in the rectal, anal, or pelvic area.
  • Anemia.

The symptoms of bladder cancer may be similar to symptoms of other bladder conditions.

What Happens

Bladder cancer is the rapid, uncontrolled growth of abnormal cells in the bladder. Cancer usually begins in the lining of the bladder. The cancerous cells may spread through the lining into the muscular wall of the bladder.

Invasive bladder cancer may spread to lymph nodes, other organs in the pelvis (causing problems with kidney and bowel function), or other organs in the body, such as the liver and lungs.

Your treatment will depend on how far the cancer has spread.

Most bladder cancer is found early, before it has spread into the bladder wall. Surgery can usually remove these tumors. But bladder cancer often comes back, so you may also get other treatments, such as chemotherapy or immunotherapy, to lower the chances of that happening.

What Increases Your Risk

The main risk factors for bladder cancer include:

  • Smoking. Smokers are twice as likely to get bladder cancer as nonsmokers.1
  • Chemical exposure. Bladder cancer has been linked to chemicals called aromatic amines. These chemicals are found in many products, including dyes, paints, solvents, inks, and the dust from leather. This risk may also depend on how much and how often a person was exposed to these chemicals.
  • Being older. Your risk goes up as you get older. Most people who get bladder cancer are close to their 70s.
  • Being a white male. Men are 4 times more likely to get bladder cancer than women. And white men are twice as likely to get it as African-American men.1
  • A diet that is high in nitrates or rich in meat and fatty foods.
  • Schistosomiasis, which is an infection caused by a parasite. It's sometimes found in developing countries and rarely occurs in North America.

When To Call a Doctor

If you have been diagnosed with bladder cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.

Call your doctor if you:

  • Have blood in your urine.
  • Feel pain when you urinate.
  • Are urinating small amounts frequently.
  • Have back or flank pain.

Watchful waiting

If you are concerned about your symptoms or about your risk for bladder cancer, make an appointment with your doctor. Watchful waiting is not appropriate if you have symptoms that do not go away.

Who to see

Health professionals who can evaluate your symptoms and your risk for bladder cancer include:

Doctors who can manage your cancer treatment include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

To find out whether bladder cancer may be the cause of your urinary symptoms, your doctor will:

  • Do a physical exam. This may include a rectal exam, a prostate exam for men, or a pelvic exam for women.
  • Ask questions about your medical history, including:
    • Your smoking history.
    • Your possible exposure to cancer-causing chemicals.
    • Your family history of cancer.
  • Order a urine test and urine culture to check for the presence of blood, infection, and other abnormal cells.

Cystoscopy

You will have a cystoscopy, a test that allows your doctor to look at your bladder with a thin, lighted tube. The doctor can use the same tube to take small tissue samples (biopsies) of any abnormal areas. The samples will be looked at under a microscope to find out whether cancer cells are present and what the cells look like.

Tests to determine stage and grade

Bladder cancer is classified by stage and grade. The stage is determined by the cancer growth in the bladder wall and how far it has spread to nearby tissues and other organs, such as the lungs, the liver, or the bones. The grade of bladder cancer is determined by how the cancer cells look in comparison with normal bladder cells.

Your doctor finds out the stage and grade of your bladder cancer by gathering information from several tests, including:

  • Biopsies from the cystoscopy.
  • CT scan or MRI. These help find out if the cancer has spread to lymph nodes, the lungs, the liver, or other abdominal organs.
  • Chest X-ray. This finds out if the cancer has spread to the lungs.
  • Bone scan. This finds out if the cancer has spread to the bones.

The stage and grade of your cancer are important in choosing the right treatments.

Other tests

Other diagnostic tests that may be done include:

Early detection of returning cancer

Bladder cancer often comes back, so it's important to have regular checkups. Then, if the cancer does come back, you have a better chance of finding it early enough for successful treatment.

Treatment Overview

The choice of treatment and the long-term outcome (prognosis) for people who have bladder cancer depend on the stage and grade of cancer. When deciding about your treatment, your doctor also considers your age, overall health, and quality of life.

Bladder cancer has a better chance of being treated successfully if it is found early.

Treatment choices for bladder cancer may include:

  • Surgery to remove the cancer. Surgery, either alone or along with other treatments, is used in more than 9 out of 10 cases.1 For more information, see Surgery.
  • Chemotherapy to destroy cancer cells using medicines. Chemotherapy may be given before or after surgery. For more information, see Medications.
  • Radiation therapy to destroy cancer cells using high-dose X-rays or other high-energy rays. Radiation therapy may also be given before or after surgery and may be given at the same time as chemotherapy. For more information, see Other Treatment.
  • Immunotherapy. This treatment causes your body's natural defenses, known as your immune system, to attack bladder cancer cells. For more information, see Medications.

When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.

If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.

For more information about specific bladder cancer treatments, see the topics:

Side effects of treatment

Most treatments for bladder cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health.

  • Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss. There is also an increased chance of getting a serious infection during chemotherapy treatment. Mitomycin may cause skin peeling or a rash.
  • Side effects of surgery depend on how extensive your surgery was to treat the stage of your cancer. Men may have erection problems after surgery if the bladder is removed (cystectomy). If you choose a surgeon who does many of these procedures, you will have fewer side effects and you will recover faster.
  • Side effects of radiation may include nausea, vomiting, diarrhea, pain or discomfort when urinating, and bladder inflammation and scarring (radiation cystitis). You may also have an increased risk of infection.
  • Side effects of immunotherapy vary depending on the medicine. Bacillus Calmette-Guerin (BCG) is a tuberculosis vaccine used in countries outside the United States. With BCG, the side effects may include fever, joint pain, inflammation of the prostate, or disseminated tuberculosis.

Home treatment measures may help you manage the side effects. For more information, see Home Treatment.

Body image and sexual problems

Sexual problems can be caused by physical or psychological factors related to the cancer or its treatment. You may experience less sexual pleasure or lose your desire to be sexually intimate.

  • Women who have the bladder removed (radical cystectomy) will also have the ovaries and uterus removed. They cannot become pregnant and may experience menopause soon after having the cystectomy.
  • Men who have their prostate glands and seminal vesicles removed may have erection problems and will no longer produce semen.

Your feelings about your body may change following treatment for cancer. Managing body image issues may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may also be able to refer you to groups that can offer support and information.

Bladder cancer that comes back

After initial treatment for bladder cancer, it is important to receive follow-up care, because bladder cancer often comes back (recurs). Your doctor will set up a regular schedule of checkups and tests.

Bladder cancer may recur in the bladder, or it may spread (metastasize) to other parts of the body. Recurrent bladder cancer may be treated with surgery or chemotherapy to slow cancer growth and relieve symptoms.

Participation in a clinical trial may be recommended if you have been diagnosed with recurrent bladder cancer.

Palliative care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.

For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.

It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care. For more information, see the topics:

Prevention

Bladder cancer cannot be prevented, but you may be able to reduce some of your risk for getting it.

  • Stop smoking. Cigarette smokers are much more likely to get bladder cancer than nonsmokers. For help on how to quit smoking, see the topic Quitting Smoking.
  • Avoid exposure to industrial chemicals, such as benzene substances and arylamines. Occupational exposure from working with dyes, rubbers, textiles, paints, leathers, and chemicals raises your risk for bladder cancer.
  • Avoid exposure to arsenic. Have your drinking water tested. Drink bottled water if you think that your water is contaminated with arsenic.
  • Eat healthy foods. Experts believe that what you eat and drink may help prevent bladder cancer.
    • Choose a Click here to view an Actionset. low-fat, low-cholesterol diet that includes plenty of fruits and vegetables. For more information, see the topic Weight Management.
    • Avoid dehydration. Increase your fluid intake, particularly water. Water dilutes cancer-causing chemicals.

Home Treatment

The side effects of bladder cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects.

  • Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. A little bit of ginger candy or ginger tea can help too.
  • Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before you use any nonprescription medicines for your diarrhea. Be sure to drink enough fluids.
  • Home treatment for constipation includes making sure that you drink enough fluids and eat fruits, vegetables, and fiber every day. Do not use a laxative without first talking to your doctor.

Other problems that can be treated at home include:

  • Sleep problems. If you have trouble sleeping, some tips for managing sleep problems may help.
  • Fatigue. If you lack energy and become weak easily, try ways to help your fatigue.
  • Hair loss may be unavoidable. But you can decrease irritation of your scalp by using mild shampoos and avoiding damaging hair products.
  • Stress. Cancer and its treatment can be stressful. But there are many steps you can take to manage stress.
  • Pain. Bladder cancer rarely causes pain, and not all forms of cancer treatment cause pain. But if you do have pain, there are many home treatments that can help.

Medications

Medicines may be used to control the growth of bladder cancer cells and to relieve symptoms. These medicines may be taken by mouth, injected into a vein (intravenous, or IV), or delivered directly into the bladder using a catheter.

  • Chemotherapy uses medicines to destroy cancer cells.
  • Immunotherapy, also called biological therapy, uses medicines that cause your body's immune system to attack cancer cells in your bladder. It is most often used for early-stage bladder cancer. It may also be used after a transurethral resection (TUR) to help keep cancer from coming back.

Most chemotherapy causes some side effects. Home treatment may be all that is needed to manage your symptoms. But some people may need medicines to control nausea and vomiting.

Medication choices

Chemotherapy medicines

Immunotherapy medicines

Surgery

Surgery is used to treat most stages of bladder cancer.

  • Transurethral resection (TUR) is surgery done through the urethra. A thin, lighted tube called a cystoscope is used to remove or destroy tumors in the bladder.
  • Cystectomy is surgery to remove the bladder.
    • Partial cystectomy removes only part of the bladder. It is used to treat cancer that has invaded the bladder wall in just one area.
    • Simple cystectomy removes all of the bladder.
    • Radical cystectomy removes all of the bladder as well as nearby lymph nodes, part of the urethra, and nearby organs that may contain cancer.
  • Urinary diversion is surgery that makes a new way for your body to store urine. This can be done with a pouch created inside your body from part of your intestines, called a continent reservoir. Or the surgeon may make an artificial opening, called an ileal conduit, and you will wear a flat bag to store urine outside your body.

What to think about

Side effects from your surgery can include bowel problems such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.

Adhesions may develop after surgery. And a bowel obstruction may occur as a complication if surgery was extensive.

Other Treatment

Radiation treatment

Radiation treatment for bladder cancer uses high-energy X-rays to kill cancer cells and shrink tumors. It may be given after surgery. It may be used along with chemotherapy. Sometimes it is used instead of surgery or chemotherapy.

  • External beam radiation comes from a machine outside the body. The machine aims radiation at the area where the cancer cells are found.
  • Internal radiation uses needles, seeds, wires, or catheters that contain radioactive materials placed close to or directly into the bladder.

Which treatment you receive will depend on the type and stage of your cancer.

Clinical trials

Your doctor may talk to you about joining a research study called a clinical trial if one is available in your area. Clinical trials are research studies to look for ways to improve treatments for bladder cancer. Experts are doing studies on:

  • Chemoprevention for early-stage bladder cancer. This is the use of medicines or vitamins to reduce the risk of getting cancer or having cancer come back.
  • Photodynamic therapy. This uses medicine and a special light to treat the cancer.

For some people with bladder cancer, clinical trials may offer the best treatment available.

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:

These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.

Other Places To Get Help

Organizations

American Cancer Society (ACS)
Phone: 1-800-ACS-2345 (1-800-227-2345)
TDD: 1-866-228-4327 toll-free
Web Address: www.cancer.org
 

The American Cancer Society (ACS) conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.


National Cancer Institute (NCI)
6116 Executive Boulevard
Suite 300
Bethesda, MD  20892-8322
Phone: 1-800-4-CANCER (1-800-422-6237)
Web Address: www.cancer.gov (or https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help online)
 

The National Cancer Institute (NCI) is a U.S. government agency that provides up-to-date information about the prevention, detection, and treatment of cancer. NCI also offers supportive care to people who have cancer and to their families. NCI information is also available to doctors, nurses, and other health professionals. NCI provides the latest information about clinical trials. The Cancer Information Service, a service of NCI, has trained staff members available to answer questions and send free publications. Spanish-speaking staff members are also available.


References

Citations

  1. American Cancer Society (2010). Cancer Facts and Figures 2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026238.pdf.

Other Works Consulted

  • National Cancer Institute (2010). Bladder Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/healthprofessional/allpages.
  • National Comprehensive Cancer Network (2010). Bladder Cancer. NCCN Clinical Practice Guidelines in Oncology, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/bladder.pdf.
  • American Cancer Society (2010). Bladder Cancer. Available online: http://documents.cancer.org/acs/groups/cid/documents/webcontent/003085-pdf.pdf.
  • American Cancer Society (2010). Lasers in cancer treatment. Available online: http://www.cancer.org/Treatment/TreatmentsandSideEffects/TreatmentTypes/lasers-in-cancer-treatment.
  • American Joint Committee on Cancer (2010). Urinary bladder. In AJCC Cancer Staging Manual, 7th ed., pp. 497–505. New York: Springer-Verlag.
  • Cancer of the bladder (2007). In Cancer Stat Fact Sheets based on SF Altekruse et al., eds., SEER Cancer Statistics Review, 1975–2007. Bethesda, MD: National Cancer Institute. Available online: http://seer.cancer.gov/statfacts/html/urinb.html.
  • National Cancer Institute (2010). Bladder Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/bladder/patient/allpages.
  • U.S. Preventive Services Task Force (2010). Screening adults for bladder cancer: A review of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 153(7): 461–468.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology
Last Revised May 2, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

© 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.