Bladder Cancer

What Is It?

This type of cancer occurs in the bladder — the organ that stores urine. The bladder has an inner lining surrounded by a layer of muscle. Bladder cancer begins in the inner lining of the bladder. It is usually discovered before it has spread past this lining.

Risk factors for bladder cancer include:

  • Cancer-causing substances such as tobacco smoke and chemicals in the environment
  • Exposure to certain industrial chemicals
  • Long-standing bladder stones

Bladder cancer tends to return in people who have had the disease.


Many people with bladder cancer have no symptoms. Instead, the diagnosis is made when red blood cells are detected in a urine sample. However, people with bladder cancer often don’t see blood in their urine. There is not enough blood to change the urine color. This is called microscopic hematuria.

When symptoms of bladder cancer do occur, they include:

  • Red or rust colored urine caused by the presence of many red blood cells (called macroscopic hematuria)
  • Painful urination or burning when urinating
  • More frequent urination than normal


Your doctor will review your medical history. He or she will ask about any history of kidney stones or urinary tract infections. These conditions can also cause blood in the urine. Your doctor will ask about your occupation and your diet.

Your doctor will ask about your history of cigarette smoking. If you don’t smoke now, but did in the past, tell your doctor. Your risk of bladder cancer remains high for more than 10 years after your last cigarette.

After reviewing your symptoms and risk factors, your doctor will examine you. The exam will include a rectal examination. Women will also have a pelvic examination.

Your doctor will order laboratory tests. These will include urine and blood tests. The urine sample will be checked for the presence of red blood cells and to rule out an infection. The blood test is used primarily to make sure your kidneys are functioning normally. Your doctor may also send the urine sample to a special lab to look for cancer cells.

If your primary care doctor is concerned about the possibility of bladder cancer, he or she will likely refer you to a urologist for a cystoscopy. The urologist inserts a medical instrument (called a cystoscope) through your urethra into your bladder. Your urethra is the opening through which you urinate. The doctor will look inside your bladder to see if there are abnormal spots or tumors.

If there are areas of the bladder lining that appear abnormal, the doctor will take one or more biopsies through the cystoscope. This involves cutting out a small piece of tissue. It can then be examined under a microscope to look for cancer cells. If possible, the urologist will remove the entire tumor during cystoscopy.

Additional tests may be needed to determine if the cancer has spread.

Expected Duration

Bladder cancer will continue to grow and possibly spread until it is treated.


To reduce your risk of bladder cancer, don’t smoke. If you already smoke, ask your doctor about ways to help you quit.

People who drink plenty of water every day may have a lower risk of bladder cancer.

Some jobs increase exposure to chemicals that can cause bladder cancer. If you work with chemicals, find out what you can do to reduce your exposure.


Treatment of bladder cancer depends on:

How aggressive the cancer is

If it has spread beyond the lining of the bladder

How much it has spread

Tumor grade. The tumor grade is an estimate of how likely the cancer is to grow and spread rapidly.

  • High grade bladder cancer is likely to grow and spread quickly and become life threatening. High-grade cancers often need to be treated with chemotherapy, radiation or surgery.
  • Low-grade cancers appear non-aggressive and have a low chance of becoming high grade. They are rarely life threatening. Low-grade tumors tend to come back and need to be removed repeatedly. Still, aggressive treatments, such as radiation or bladder removal, are not usually needed.

Tumor stage

The stage is determined by whether:

  • The tumor involves only the bladder lining
  • The tumor has invaded the bladder muscle, tissues around the bladder or nearby organs
  • The cancer has spread to nearby lymph nodes
  • The cancer has spread to distant sites in other areas of the body

Treatment options vary depending on the stage.

Superficial tumors

Superficial tumors are cancers that involve only the bladder lining. These tumors are usually low-grade.

Superficial tumors are usually treated with a procedure called a transurethral resection. In this procedure, the doctor either removes the tumor or burns it away.

After transurethral resection, the doctor may place medications inside the bladder. This reduces the chance that the cancer will return. It may also prevent the cancer from progressing to a more advanced and dangerous stage.

High-grade superficial tumors that return more than once or twice after treatment are more serious. Many experts recommend that people with these types of tumors have surgery to remove the bladder. This is a major operation.

Carcinoma in situ

Carcinoma in situ is bladder cancer within only the most superficial lining of the bladder. Carcinoma in situ can be difficult to remove completely. Transurethral resection and medical therapy sometimes eliminate carcinoma in situ. If this fails, doctors usually recommend removing the bladder.

Tumors invading the bladder muscle

In this case, bladder cancer has grown into the muscle of the bladder wall. But it has not spread to the lymph nodes or distant organs.

The standard treatment is a surgery called radical cystectomy. Radical cystectomy removes the bladder, nearby lymph nodes and other nearby organs.

After removing the bladder, the surgeon must create a different way for the body to hold and pass urine. There are several options. Each procedure has advantages and disadvantages.

Some cancer doctors recommend chemotherapy before radical cystectomy. This is controversial. Cancer is less likely to return in some patients who receive chemotherapy before surgery. These patients may live longer. However, cancer doctors cannot predict which patients will get these benefits.

The other approach is to examine the bladder after surgery to see if a patient could benefit from chemotherapy. However, chemotherapy given after surgery may not be as effective as chemotherapy before surgery.

In some people who have very localized, less aggressive tumors, doctors may remove only the diseased part of the bladder.

Non-surgical approaches

One alternative to surgery is radiation therapy combined with chemotherapy. Only certain patients qualify for this approach. The advantage is the potential to keep your bladder. However, doctors don’t know whether it is as effective as surgery.

This approach should be considered if a patient is not a good candidate for surgery.

More extensive tumors

Radical cystectomy is usually used to remove bladder cancer that has invaded beyond the bladder wall. If the entire tumor cannot be removed, chemotherapy or radiation therapy can shrink the tumor. It may then be removed surgically.

Metastatic bladder cancer

Bladder cancer that has spread to lymph nodes and/or other organs is considered metastatic. Platinum based chemotherapy is usually the initial treatment. Patients that either don’t respond or have recurrent disease may be treated with immunotherapy.

Important follow up

Patients who have had bladder cancer continue to have an increased risk of developing cancers in and around the bladder. Patients should be closely monitored for the rest of their lives.

When to Call a Doctor

Call your doctor immediately if:

  • You notice blood in your urine
  • Your urine turns the color of rust
  • You begin to urinate more often than normal
  • Urination is painful or uncomfortable


Your outlook depends on the stage of bladder cancer and the type of treatment used. Patients with superficial tumors have the best chance of survival. People with more invasive tumors or metastatic cancer generally have a poorer outlook.

Additional Information

National Cancer Institute (NCI)

American Cancer Society (ACS )

National Institute for Occupational Safety and Health

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

A person finds joy in giving an apt reply— and how good is a timely word! Proverbs 15:23 NIV

That is why, for Christ’s sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong. 2 Corinthians 12:10 NIV

Rejoice with those who rejoice; mourn with those who mourn. Romans 12:15 NIV

You are my hiding place; you will protect me from trouble and surround me with songs of deliverance. Psalm 32:7 NIV

So that I may come to you with joy, by God’s will, and in your company be refreshed. Romans 15:32 NIV

Your statutes are my heritage forever; they are the joy of my heart. Psalm 119:111 NIV

But godliness with contentment is great gain. 1 Timothy 6:6 NIV

And without faith it is impossible to please God, because anyone who comes to him must believe that he exists and that he rewards those who earnestly seek him. Hebrews 11:6 NIV

For the Lord takes delight in his people; he crowns the humble with victory. Psalm 149:4 NIV

Command those who are rich in this present world not to be arrogant nor to put their hope in wealth, which is so uncertain, but to put their hope in God, who richly provides us with everything for our enjoyment. 1 Timothy 6:17 NIV

The father of a righteous child has great joy; a man who fathers a wise son rejoices in him. Proverbs 23:24 NIV
I rejoice in following your statutes as one rejoices in great riches. Psalm 119:14 NIV

While he was still speaking, a bright cloud covered them, and a voice from the cloud said, “This is my Son, whom I love; with him I am well pleased. Listen to him!” Matthew 17:5 NIV

Recommended contacts for prayer request and Bible study

It Is Written

Bible verses for today’s meditation and inspiration: Matthew E. McLaren’

Rejoice always, pray continually, give thanks in all circumstances; for this is God’s will for you in Christ Jesus. 1 Thessalonians 5:16-18 NIV

Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. Philippians 4:6-7 NIV

This is the confidence we have in approaching God: that if we ask anything according to his will, he hears us. 1 John 5:14 NIV

Devote yourselves to prayer, being watchful and thankful. Colossians 4:2 NIV
Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours. Mark 11:24 NIV

Then you will call on me and come and pray to me, and I will listen to you. Jeremiah 29:12 NIV
Be joyful in hope, patient in affliction, faithful in prayer. Romans 12:12 NIV
And when you pray, do not keep on babbling like pagans, for they think they will be heard because of their many words. Matthew 6:7 NIV

The Lord is near to all who call on him, to all who call on him in truth. Psalm 145:18 NIV
‘Call to me and I will answer you and tell you great and unsearchable things you do not know.’ Jeremiah 33:3 NIV
“For where two or three gather in my name, there am I with them.” Matthew 18:20 NIV
Let us then approach God’s throne of grace with confidence, so that we may receive mercy and find grace to help us in our time of need. Hebrews 4:16 NIV

But when you pray, go into your room, close the door and pray to your Father, who is unseen. Then your Father, who sees what is done in secret, will reward you. Matthew 6:6 NIV
In my distress I called to the Lord; I cried to my God for help. From his temple he heard my voice; my cry came before him, into his ears. Psalm 18:6 NIV

Recommended contacts for prayer request and Bible study

It Is Written

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