Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the lining of the bladder. In some cases, the tumour spreads into the surrounding muscles.
The most common symptom of bladder cancer is blood in your urine, which is usually painless.
If you notice blood in your urine, even if it comes and goes, you should visit your doctor so the cause can be investigated.
Read more about the symptoms of bladder cancer.
Once diagnosed, bladder cancer can be classified by how far it has spread.
If the cancerous cells are contained inside the lining of the bladder, doctors describe it as superficial or non-muscle invasive bladder cancer. This is the most common type of bladder cancer, accounting for 7 out of 10 cases. Most people do not die as a result this type of bladder cancer.
When the cancerous cells spread beyond the lining into the surrounding muscles of the bladder, it's referred to as muscle invasive bladder cancer. This is less common but has a higher chance of spreading to other parts of the body and can be fatal.
Read more about diagnosing bladder cancer.
Most cases of bladder cancer appear to be caused by exposure of the bladder to harmful substances which, over the course of many years, lead to abnormal changes in the bladder’s cells. Tobacco smoke is a common cause, it is estimated that half of all cases of bladder cancer are caused by smoking.
Contact with certain chemicals previously used in manufacturing is also known to cause bladder cancer. However, these substances have since been banned.
In cases of non-muscle invasive bladder cancer, it is usually possible to remove the cancerous cells while leaving the rest of the bladder intact. This is done using a surgical technique called transurethral resection of a bladder tumour (TURBT). This may be followed by a dose of chemotherapy medication directly in the bladder to reduce the risk of the cancer returning.
In cases with a higher risk of recurrence, a medication known as Bacillus Calmette-Guérin (BCG) may be injected into the bladder to reduce the risk of the cancer returning.
Treatment for muscle-invasive bladder cancer may involve surgically removing the bladder in an operation known as a radical cystectomy.
When the bladder is removed, you will need another way of collecting your urine. Possible options include making an opening in the abdomen so urine can be passed into an external bag, or constructing a new bladder out of a section of bowel. This will be done at the same time as your radical cystectomy.
If it's possible to avoid removing the bladder, or if surgery is not suitable, a course of radiotherapy and chemotherapy may be recommended. Chemotherapy may sometimes be used on its own before surgery or before being combined with radiotherapy.
After treatment for all types of bladder cancer, you will have regular follow up tests to check for signs of recurrence.
Read more about treating bladder cancer.
About 10,000 people are diagnosed with bladder cancer every year.
The condition is more common in older adults, with the average age at diagnosis being 68 years old.
Rates of bladder cancer are four times higher in men than in women, possibly because in the past men were more likely to smoke and work in manufacturing industry.
Blood in your urine is the most common symptom of bladder cancer.
The medical name for this is haematuria and it is usually painless. You may notice streaks of blood in your urine or the blood may turn your urine brown. The blood is not always noticeable and it may come and go.
Less common symptoms of bladder cancer include:
If bladder cancer reaches an advanced stage and begins to spread, symptoms can include:
If you ever have blood in your urine - even if it comes and goes - you should visit your doctor so that the cause can be investigated.
Having blood in your urine does not mean that you definitely have bladder cancer, as there are other more common causes. These include a bladder infection (such as cystitis), kidney stones or an enlarged prostate gland (in men).
Bladder cancer is caused by changes to the cells of the bladder. It is often linked with exposure to certain chemicals.
Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.
It is not always known what causes the cell changes that lead to bladder cancer, but several things have been identified that can significantly increase your risk of developing it.
Smoking is the single biggest risk factor for bladder cancer. This because tobacco contains cancer-causing (carcinogenic) chemicals.
If you smoke for many years, these chemicals pass into your blood stream and are filtered by the kidneys into your urine. The bladder is repeatedly exposed to these harmful chemicals as it acts as a store for urine. This can cause changes to the cells of the bladder lining that may lead to bladder cancer.
It is estimated around half of all cases of bladder cancer are related to smoking, and people who smoke may be up to six times more likely to develop bladder cancer than non-smokers.
Exposure to certain industrial chemicals is the second biggest risk factor. Previous studies have estimated this may account for around 25% of cases.
Chemicals known to increase the risk of bladder cancer include:
Occupations linked to an increased risk of bladder cancer are manufacturing jobs involving:
Some non-manufacturing jobs have also been linked to an increased risk of bladder cancer. These include taxi or bus drivers, due to their regular exposure to chemicals in diesel fumes.
The link between bladder cancer and these types of occupations was discovered in the 1950s and 1960s. Since then, regulations relating to exposure to cancer-causing chemicals have been made much more rigorous and many of the above chemicals have been banned.
However, these chemicals are still linked with cases of bladder cancer now, as it can take up to 30 years after initial exposure to the chemicals before the condition starts to develop.
Other things known to increase your risk of bladder cancer include having:
Bladder cancer usually begins in the cells of the bladder lining. In some cases, it may then spread into surrounding bladder muscle. If the cancer penetrates this muscle, it can spread to other parts of the body, usually through the lymphatic system.
If bladder cancer spreads to other parts of the body, such as other organs, it is known as metastatic bladder cancer.
If you have symptoms of bladder cancer, such as blood in your urine, you should see your doctor.
Your doctor may ask about your symptoms, family history and whether you have been exposed to any possible causes of bladder cancer - such as smoking.
In some cases your doctor may request a urine sample so it can be tested in a laboratory for traces of blood, bacteria or abnormal cells (see below).
Your doctor may also carry out a physical examination of your rectum and vagina because bladder cancer sometimes causes a noticeable lump that presses against them.
If your doctor suspects bladder cancer, they will refer you to a hospital for further tests. Some hospitals have specialist clinics for people with blood in their urine (haematuria), whereas others have specialist urology departments for people with urinary tract problems.
If you are referred to a hospital specialist, there are several tests you may have to check for bladder cancer. These are outlined below.
You may be asked to provide a urine sample, so it can be checked for any infection or abnormal cells.
The test for abnormal cells is called urinary cytology.
Urinary cytology is not 100% accurate. It can sometimes detect abnormal cells even though there is no cancer present (a false-positive result) or it can fail to detect abnormal cells when cancer is present (a false-negative result). Therefore, urinary cytology is used to help diagnose bladder cancer rather than providing a definitive diagnosis.
A cystoscopy uses a thin tube with a camera and light at the end, known as a flexible cystoscope, to examine the inside of your bladder. The procedure usually takes about 5 minutes.
During a cystoscopy, a local anaesthetic gel is applied to your urethra (the tube through which you urinate) so you don't feel any pain. The gel also helps the cystoscope to pass into the urethra more easily.
If abnormalities are found in your bladder during a cystoscopy, it is likely you will be asked to return so a sample of bladder tissue can be removed for further testing. This is known as a biopsy.
A biopsy is often carried out using a procedure known as transurethral resection of a bladder tumour (TURBT). The procedure is carried out under general anaesthetic.
See treating bladder cancer for more information about the TURBT procedure.
If the results of your biopsy show cancerous cells in the lining of your bladder, you may need further tests. These will help determine whether the cancer has spread beyond the lining of your bladder and, if so, how far it has spread.
Further tests can include a:
Once these tests have been completed, it should be possible to tell you the grade of the cancer and what stage it is.
Grading is a measurement of how likely a cancer is to spread. The grade of a cancer is usually described using a number system, ranging from G1-G3. High grade cancers are more likely to spread then low grade cancers.
Staging is a measurement of how far the cancer has spread. Lower stages cancers are smaller and have a better chance of successful treatment. The most widely used staging system for bladder cancer is known as the TNM system, where:
The T staging system is as follows:
Bladder cancer up to the T1 stage is usually called early bladder cancer or non-muscle invasive bladder cancer. If the tumour grows larger than this, it is usually called muscle-invasive bladder cancer and is categorised as:
If the tumour grows larger than the T3 stage, it is considered to be advanced bladder cancer and is categorised as:
The N staging system is as follows:
There are only two options in the M system:
The TNM system can be difficult to understand, so don't be afraid to ask your care team questions about your test results and what they mean for your treatment and outlook.
The treatment options for bladder cancer largely depend on how advanced the cancer is.
Treatments usually differ between early stage, non-muscle invasive bladder cancer and more advanced muscle invasive bladder cancer.
All hospitals use multidisciplinary teams (MDTs) to treat bladder cancer. These are teams of specialists that work together to make decisions about the best way to proceed with your treatment.
Members of your MDT may include a:
Deciding what treatment is best for you can be difficult. Your MDT will make recommendations, but remember that the final decision is yours.
Before discussing your treatment options, you may find it useful to write a list of questions to ask your MDT.
If you have been diagnosed with non-muscle invasive bladder cancer (stages CIS, Ta and T1), your recommended treatment plan will depend on the risk of the cancer returning or spreading beyond the lining of your bladder.
This risk is calculated using a series of factors, including:
See diagnosing bladder cancer for more information about the staging and grading of the condition.
If the risk of your cancer returning or spreading is low, treatment will involve surgery to remove the tumours followed by a single dose of chemotherapy into your bladder.
If the risk of your cancer returning or spreading is moderate, you may be given a longer course of chemotherapy into your bladder after you've had surgery.
If the risk of your cancer returning or spreading is high, you may be given a course of Bacillus Calmette-Guérin (BCG) treatment into your bladder after you've had surgery.
These treatments are discussed in more detail below.
The standard surgical treatment for non-muscle invasive bladder cancer is known as transurethral resection of a bladder tumour (TURBT) procedure. In most cases, this can be performed at the same time as a biopsy.
TURBT is carried out under general anaesthetic. The surgeon uses an instrument called a cystoscope to locate the visible tumours and cuts them away from the lining of the bladder. The wounds are then sealed (cauterised) using a mild electric current.
If you experience significant bleeding afterwards, a flexible tube called a catheter may be inserted into your urethra and passed up into your bladder. The catheter will be used to drain away any blood and debris from your bladder and may be kept in place for several days.
Most people are able to leave hospital less than 48 hours after having TURBT and are able to resume normal physical activity within two weeks.
After surgery, you may be given a dose of chemotherapy directly into your bladder. This will be after you have recovered from the effects of the general anaesthetic.
A different type of chemotherapy (intravesical chemotherapy) is used directly into your bladder using a catheter (rather than affecting the whole body). The solution is kept in your bladder for about an hour before being drained away.
Some residue of the chemotherapy medication may be left in your urine which could severely irritate your skin. It helps to urinate while sitting down and be careful not to splash yourself or the toilet seat. After passing urine, wash the skin around your genitals with soap and water.
Side effects of intravesical chemotherapy can include a skin rash or irritation and inflammation of the bladder lining. This can cause a frequent need to urinate and pain when urinating. However, this should pass within a few days. You may also feel very tired or develop a rash.
If your cancer is at a low risk of spreading, you should not need additional chemotherapy treatment. However, if there is a moderate or high risk of the cancer spreading, you may be given additional courses of chemotherapy, usually once a week over six weeks.
If you are sexually active, it is important that you use a barrier method of contraception, such as a condom, while you are having intravesical chemotherapy. This is because the medication may be present in your semen or vaginal fluids, which can cause irritation.
You also shouldn't try to get pregnant or father a child while having intravesical chemotherapy, as the medication can increase the risk of having a child with birth defects.
After surgery, you may also be treated with a variant of the BCG vaccine. This is used to help prevent recurrence of bladder cancer when there is a high risk it returning.
The BCG vaccine was originally used to treat tuberculosis (TB), but it has also proved to be an effective treatment against bladder cancer. Exactly how the BCG vaccine works is still unclear.
The BCG vaccine is given in the same way as intravesical chemotherapy. The vaccine is passed into your bladder through a catheter and left in your bladder for two hours before being drained away.
As with intravesical chemotherapy, you should take precautions - such as sitting down while urinating - to ensure that urine does not get onto your skin or the toilet seat.
Most people require weekly treatments over a six-week period. Depending on your circumstances, maintenance therapy may also be recommended. This involves receiving further doses of the BCG once a week for three weeks, with six month intervals.
Maintenance therapy usually lasts for three years.
Chemotherapy is usually preferred to BCG treatment because the side effects are less severe. Common side effects of BCG can include:
The recommended treatment plan for muscle-invasive bladder cancer will depend on how far the cancer has spread (see diagnosing bladder cancer for more information about staging).
With T2 and T3 bladder cancer, treatment aims to cure the condition if possible, or at least control it for a long time.
There is only a small chance of a cure for T4 bladder cancer, but treatment may be able to control the symptoms and slow the spread of the cancer.
The different treatment options are outlined below.
The most widely used type of surgery for muscle-invasive bladder cancer is a radical cystectomy.
This removes the entire bladder as well as nearby lymph nodes, part of the urethra, the prostate (in men), and the cervix and womb (in women).
During a radical cystectomy, your surgeon will also create an alternative way for urine to leave your body. This is known as a urinary diversion.
After surgery, many men will be unable to get or maintain an erection (erectile dysfunction). This is because the operation can damage the nerves responsible for getting an erection. However, treatments for erectile dysfunction are usually available.
See the complications of bladder cancer surgery for more information about urinary diversion and sexual problems after surgery.
Radiotherapy uses pulses of radiation to destroy cancerous cells and is an alternative treatment option for muscle-invasive bladder cancer.
Radiotherapy can be used:
Radiotherapy used to shrink tumours and achieve a cure is given by a machine that beams the radiation at the bladder (external radiotherapy).
Sessions of external radiotherapy for bladder cancer are usually given on a daily basis for five days a week, over the course of four-to-seven weeks. Each session lasts for about 10 to 15 minutes.
As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include:
Most of these side effects should pass a few weeks after your treatment finishes, although there is a chance they will be permanent.
The fact that radiation has been directed at your pelvis will usually mean that you will be infertile for the rest of your life. This is not a problem for most people who undergo radiotherapy, as they are too old to have children by the time they have treatment.
Palliative radiotherapy, where the aim is to relieve symptoms, is usually only given for short periods, so it will not usually cause side effects. If there are side effects, they will only last for a short time.
However, it can take time for palliative radiotherapy to be effective, so you might feel worse before you start feeling better.
Read more about radiotherapy.
Your MDT may recommend specific treatment due to your individual circumstances.
For example, someone with a small bladder or many existing urinary symptoms is better suited to surgery. Someone who has a single bladder tumour with normal bladder function is better suited for treatments that preserve the bladder.
However, your input is also important, so you should discuss which treatment is best for you with your MDT.
Both surgery and radiotherapy have their own set of pros and cons.
The pros of having a radical cystectomy include:
The cons of having a radical cystectomy include:
The pros of having radiotherapy include:
The cons of having radiotherapy include:
In some cases, chemotherapy may be used to treat muscle-invasive bladder cancer.
However, this is different from the intravesical chemotherapy used to treat non-muscle invasive bladder cancer. Instead of medication being put directly into your bladder, it is put into a vein in your arm. This is called intravenous chemotherapy and can be used:
As yet, there is not enough evidence to say whether chemotherapy is an effective treatment when it is given after surgery to prevent the cancer returning, so it usually only used this way as part of a [clinical trial].
Chemotherapy is usually given over a few consecutive days at first. You will then have a few weeks off to allow your body to recover before the treatment begins again. This cycle will be repeated for a few months.
As the chemotherapy medication is being injected into your blood, you will experience a wider range of side effects than if you were having intravesical chemotherapy. These side effects should stop after the treatment has finished.
The most important side effect of chemotherapy is that it can weaken your immune system, making you more vulnerable to infection.
It is therefore important to report any symptoms of a potential infection, such as a high temperature, persistent cough or reddening of the skin, to your MDT. Avoid close contact with people who are known to have an infection
Other side effects of chemotherapy can include:
Read more about chemotherapy.
If your treatment did not involve removing your bladder, there is a risk that the cancer will return. In cases of superficial bladder cancer, this risk can be as high as 80%. The risk of muscle-invasive bladder cancer returning is much lower.
The risk is increased if you have:
Due to this risk, it is recommended that you attend regular follow-up appointments so you can be assessed.
Your MDT will be able to provide more advice and recommendations regarding the timing of your follow-ups.
It is not always possible to prevent bladder cancer, but you can reduce your risk of contracting it.
If you smoke, giving up is the best way to reduce your risk of developing bladder cancer and preventing it from recurring. If you are committed to giving up smoking but do not want to be referred to a stop smoking service, your doctor should be able to prescribe medical treatment to help with any withdrawal symptoms you may experience after giving up.
If your job involves exposure to certain chemicals, your risk of developing bladder cancer could be increased. Occupations linked to an increased risk of bladder cancer are manufacturing jobs that involve the following substances:
Nowadays, there are rigorous safety protocols in place designed to minimise your risk of exposure and chemicals known to increase the risk of bladder cancer have been banned. If you are uncertain about what these protocols involve, talk to your line manager or health and safety representative.
If you are concerned your employer may be disregarding recommendations about workplace safety, you should contact the Health and Safety Executive for advice.
There is some evidence to suggest a diet high in fruit and vegetables and low in fat can help prevent bladder cancer.
Even though this evidence is limited, it is a good idea to follow this type of healthy diet because it can help prevent other types of cancer, such as bowel cancer, as well as other serious health conditions, such as high blood pressure (hypertension), stroke and heart disease.
A low-fat, high-fibre diet is recommended, including plenty of fresh fruit and vegetables (five portions a day) and whole grains. Limit the amount of salt that you eat to no more than 6g (0.2oz) a day (one teaspoon) because too much salt can increase your blood pressure.
You should try to avoid foods that contain a type of fat called saturated fat, as it can increase your cholesterol levels.
Foods high in saturated fat include:
However, a balanced diet should include a small amount of unsaturated fat because this will actually help to control your cholesterol levels.
Foods high in unsaturated fat include:
A diagnosis of bladder cancer, and some of treatments for it, can have a significant impact on your life.
The emotional impact of living with bladder cancer can be huge.
Many people report experiencing a kind of "rollercoaster" effect. For example, you may feel down at receiving a diagnosis, up when the cancer is removed and down again as you try to come to terms with the after-effects of your treatment (see below).
This type of emotional disruption can sometimes trigger feelings of depression. Signs that you may be depressed include:
Contact your doctor for advice if you think you may be depressed. There is a range of relatively successful treatments for depression, including antidepressant medication and therapies like cognitive behavioural therapy (CBT).
If bladder is removed, an alternative way of passing urine out of your body will be created during the operation. This is called a urinary diversion.
There are various types of urinary diversion, which are described below. In some cases, you may be able to make a choice based on your personal preferences. However, certain treatment options will not be suitable for everyone.
Your multi-disciplinary team (MDT) will provide information about option(s) suitable for you.
A urostomy is carried out during a radical cystectomy.
A small section of small bowel is removed and connected to your ureters (the two tubes that normally carry urine out of the kidneys). The surgeon then creates a small hole in the surface of your abdomen and the open end of the removed bowel is placed in this hole, creating an opening known as a stoma.
A special waterproof bag is placed over the stoma to collect urine.
A stoma nurse will teach you how to care for your stoma and how and when to change the bag.
The Urostomy Association is a UK-based charity which provides information and assistance to people who have recently had, or are about to have, a urostomy.
A continent urinary is a similar to a urostomy, but without an external bag. Instead, a section of your bowel is used to create a pouch inside your body that stores urine.
The ureters are connected to the pouch and the pouch is connected to an opening in the abdominal wall. Urine is prevented from leaking out by a valve in the opening (stoma).
The pouch is emptied using a thin, flexible tube (catheter). Most people need to empty their pouch about four or five times a day.
In some cases, it may be possible to create a new bladder, known as a neobladder. This involves removing a section of your bowel and reconstructing it into a balloon-like sac, before connecting it to your urethra (the tube that carried urine out of the body) at one end and your ureters at the other end.
Bladder reconstruction is not a suitable treatment for everyone.
You will be taught how to empty your neobladder by relaxing the muscles in your pelvis while at the same time tightening the muscles in your abdomen.
Your neobladder will not contain the same types of nerve endings as a real bladder so you will not get the distinctive sensation that tells you that you need to pass urine. Some people experience a feeling of fullness inside their abdomen while others have reported that they feel like they need to pass wind.
Due to the loss of normal nerve function, most people with a neobladder will experience some episodes of urinary incontinence (involuntary passing of urine), which usually occurs during the night while asleep.
You may find it useful to empty your neobladder at set times during day, including before you go to bed, to help to prevent incontinence (accidentally wetting yourself).
Guy’s and St Thomas’ Hospital Trust has more information and advice about bladder removal and bladder reconstruction (PDF, 81KB).
Contact your MDT if you lose the ability to obtain or maintain an erection after a radical cystectomy. It may be possible for you to be treated with a type of medicine known as phosphodiesterase type 5 inhibitors (PDE5). PDE5s work by increasing the blood supply to your penis.
Sometimes, PDE5s are combined with a device called a vacuum pump, which consists of a cylinder connected to a pump. The penis is placed inside the cylinder and the air is pumped out. This creates a vacuum that causes blood to flow into the penis. A rubber ring is then placed around the base of the penis, which allows an erection to be maintained for around 30 minutes.
Read more about treating erectile dysfunction.
Both radiotherapy and cystectomy can cause a woman’s vagina to become shortened and narrowed, which can make penetrative sex painful or difficult.
There are two main treatment options available if you have a narrowed vagina. The first is to apply hormonal cream to your vagina which should help to increase moisture inside your vagina. The second is to use vaginal dilators. These are plastic cone-shaped devices, of various sizes, designed to gently stretch your vagina and make it more supple.
It is usually recommended you use them for a five to ten minute period every day, starting with the dilator that fits in easiest first and gradually increasing the size as your vagina stretches over the following weeks.
Many women find this an embarrassing issue to discuss but it is a well recognised treatment for narrowing of the vagina. Your specialist cancer nurse should be able to provide more information and advice.
You may find the more you have penetrative sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.