EASY READING

If You Have Bladder Cancer

What is bladder cancer?

Cancer can start any place in the body. Cancer that starts in the bladder is called bladder cancer. It starts when cells in the bladder grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.

Cancer cells can spread to other parts of the body. For instance, cancer cells in the bladder can travel to the bone and grow there. When cancer cells spread, it’s called metastasis (pronounced meh-TAS-tuh-sis).

Cancer is always named for the place where it starts. So when bladder cancer spreads to the bone (or any other place), it is still called bladder cancer. It’s not called bone cancer unless it starts in the bone.

The bladder

The bladder is a hollow organ that stores urine before it leaves your body. It sits in the lowest part of your belly, called your pelvis. Urine is made in your kidneys. Tubes called ureters (yur-uh-turs) connect your kidneys to the bladder. Urine flows through the ureters and into your bladder, where it is stored. When you urinate (pee), the bladder squeezes the urine out through a tube called the urethra (yur-eeth-ruh).

Bladder cancer usually starts in the inner layer of the bladder wall. As the cancer grows through the layers of the bladder wall, it becomes more advanced and harder to treat.

Illustration showing the location of the bladder in relation to the kidneys, uterus (in women), prostate (in men), ureter and urethra. There is also a close up showing the layers of the bladder wall with papillary and flat tumors.

Ask your doctor to use this picture to show you where the cancer is.

Questions to ask the doctor:

  • Why do you think I have bladder cancer?
  • Is there a chance I don’t have cancer?
  • Would you please write down the kind of cancer you think I might have?
  • What will happen next?

How does the doctor know I have bladder cancer?

Bladder cancer might cause symptoms such as:

  • Having trouble peeing
  • Feeling pain when peeing
  • Needing to go more often than normal
  • Seeing blood in the urine

Sometimes the first sign of bladder cancer is an abnormal result on a urine test. If there is a reason to think you might have bladder cancer, the doctor will use one or more exams or tests to find out if it is cancer or something else.

Physical exam and questions

Your doctor will ask questions to learn more about your symptoms. The doctor might also ask about risk factors, including your family history.

The doctor will check you for possible signs of bladder cancer and other health problems. This might include a rectal exam, during which a gloved finger is put into your rectum. If you are a woman, the doctor might do a pelvic exam as well. During these exams, the doctor can sometimes feel a bladder tumor.

Urine tests

For these tests, you will be asked to pee in a special cup, the same way you might during a routine physical. The urine sample is sent to a lab, where tests might be done to look for cancer cells, blood, or certain proteins (called tumor markers) in the urine.

Urine tests can spot some bladder cancers, but not all of them.

Cystoscopy

For this exam, a doctor called a urologist (yur-ol-uh-jist) will look at the inside of your bladder using a special tool called a cystoscope (sis-tuh-scope). This is a thin tube with a light and a lens or small video camera on its end.

The scope is placed through the opening of the urethra and up into the bladder.

This test may be done in a doctor’s office or in an operating room.

Blue light cystoscopy: Sometimes, special drugs are put into the bladder during the exam. Cancer cells soak up these drugs and will glow when the doctor shines a blue light through the scope. This can help the doctor see areas with cancer cells that might have been missed by using the normal light.

Bladder biopsy

A bladder biopsy (by-op-see) is usually needed to tell if you have bladder cancer

For this test, a special type of cystoscope is put into the bladder through the urethra. The doctor uses it to take a tiny piece of the bladder to test for cancer.

More than one sample may be taken. That's because sometimes cancer starts in more than one area of the bladder. Salt water washings of the inside of the bladder may also be collected to look for cancer cells.

Any samples are sent to a lab and looked at under a microscope for signs of cancer.

Biopsy results

If bladder cancer is found, two features of the cancer help the doctor know how best to treat it:

Invasiveness: The biopsy can show how deeply the cancer has grown into the bladder wall.

  • If the cancer stays in the inner layer of cells without growing into the outer layers, it is called non-invasive.
  • If the cancer grows into the outer layers of the bladder, it is called invasive. Invasive cancers are more likely to spread and can be harder to treat.

Grade: The grade refers to how the cancer looks under the microscope.

  • Low-grade bladder cancers look more like the normal bladder.
  • High-grade bladder cancers look less like the normal bladder. These cancers are more likely to grow and spread and can be harder to treat.

Tests to look for bladder cancer

Your doctor may do other tests to find out more about the cancer. Some of them are:

X-ray: Dye is put into a vein for a special x-ray of the kidneys, ureters, and bladder. The dye highlights these so the doctor can better see them and any tumors. This test is sometimes called an IVP.

CT scan: This is sometimes called a “CAT scan.” It is a special kind of x-ray that takes detailed pictures to see if the cancer has spread outside the bladder. The scans can also help show your doctor where to place a needle during a biopsy.

MRI scan: MRIs use radio waves and strong magnets instead of x-rays to take detailed pictures. MRI scans can be very helpful in finding cancer that has spread outside the bladder.

Ultrasound: This test uses sound waves to make pictures of the organs inside your body, like the bladder and kidneys. It can help show the size of a bladder cancer and if it has spread.

Bone scan: A bone scan can help show if bladder cancer has spread to the bones. This test is not done often unless you have symptoms such as bone pain.

Questions to ask the doctor:

  • What tests will I need to have?
  • Who will do these tests?
  • Where will they be done?
  • How and when will I get the results?
  • Who can explain the results to me?
  • What do I need to do next?

How serious is my cancer?

If you have bladder cancer, the doctor will want to find out how far it has spread. This is called staging. Your doctor will want to find out the stage of your cancer to help decide what type of treatment is best for you.

The stage describes the growth or spread of the cancer in the place it started. It also tells if the cancer has spread to other organs of your body that are close by or farther away.

Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread from where it started. Ask the doctor about the cancer stage and what it means for you.

Questions to ask the doctor:

  • Do you know the stage of my cancer?
  • If not, how and when will you find out the stage of my cancer?
  • Would you explain to me what the stage means in my case?
  • Based on the stage of my cancer, how long do you think I’ll live?
  • What will happen next?

What kind of treatment will I need?

There’s more than one way to treat bladder cancer. You might want to get a second opinion about the best treatment plan for you. Doctors may have different thoughts about the best treatment plan.

There are several types of treatment for bladder cancer:

  • Surgery (an operation)
  • Radiation
  • Intravesical (in-truh-vess-uh-cull) treatment
  • Chemo
  • Immunotherapy (IM-yuh-no-THAIR-uh-pee)

Sometimes more than one type may be needed. The treatment plan that’s best for you will depend on:

  • The stage and grade of the cancer
  • The chance that a type of treatment will cure the cancer or help in some way
  • Your age
  • Other health problems you have
  • Your feelings about the treatment and the side effects that come with it

Surgery for bladder cancer

Surgery is done for most bladder cancers. The type you have will depend on the stage of the cancer.

The most common surgery for early bladder cancer removes the cancer from inside the bladder. This can be done during a cystoscopy. A doctor uses a cystoscope with a looped wire on the end to remove the tumor.

In cases when the cancer is more invasive, the cancer is removed along with part of the bladder or the entire bladder.

If only part of the bladder is removed, you will still be able to hold and release urine as normal, although in smaller amounts. If the entire bladder is removed, another way to store and remove urine will be needed. Your doctor can explain the options that are available for this.

Side effects of surgery

Any type of surgery can have some risks and side effects. For example, removing the bladder not only changes how your body passes urine, but it can also cause sexual side effects. If you have these or any other problems, let your doctors know. There are ways to help deal with some side effects.

Intravesical treatment

This is sometimes used after surgery in people who still have their bladder. It can help lower the chance that the cancer will come back in the bladder.

For this treatment, a drug is put inside the bladder. This might be a chemo drug or BCG, a drug that boosts the immune system. The drug affects the cells lining the inside of the bladder, but it has little to no effect on cells elsewhere. This can help reduce side effects.

Side effects of intravesical treatment

Some people have a burning feeling in their bladder after treatment. Other side effects depend on which drug is used. Some side effects may feel like having the flu, such as fever, chills, and feeling tired.

Chemo

Chemo (key-mo) is the use of drugs to fight the cancer. The drugs may be given into a vein or taken as pills. These drugs go into the blood and spread through the body.

For early stage bladder cancers, chemo may be used:

  • Before surgery to shrink a tumor
  • After surgery to kill any cancer cells that remain
  • With radiation to help it work better

Chemo is usually the main treatment for advanced bladder cancers, such as those that have spread to other parts of the body.

Chemo is given in cycles or rounds. Each round of treatment is followed by a break. Most of the time, 2 or more chemo drugs are given. Treatment often lasts for many months.

Side effects of chemo

Chemo can make you feel very tired, sick to your stomach, and cause your hair to fall out. But those side effects go away after treatment ends.

There are ways to treat most chemo side effects. If you have side effects, talk to your cancer care team so they can help.

Radiation treatment

Radiation treatment uses high-energy rays (like x-rays) to kill cancer cells. The type of radiation used for bladder cancer is aimed at the cancer from a machine outside the body.

Radiation treatment for bladder cancer can be used:

  • To treat early stage cancer after surgery
  • As the main treatment for early stage cancer if you can't have surgery
  • As part of the treatment for advanced bladder cancer

Radiation is often combined with chemo. Chemo drugs can help the radiation work better.

Side effects of radiation treatments

The most common side effects of radiation to the bladder are:

  • Skin changes in areas getting radiation, such as redness or blistering
  • Nausea and vomiting
  • Burning or pain when you urinate, feeling the need to go often, or blood in urine
  • Diarrhea
  • Feeling tired
  • Easy bruising or bleeding due to low blood counts
  • Increased risk of infection

Most side effects get better after treatment ends. Some might last longer. Talk to your doctor about what you can expect.

Immunotherapy

Immunotherapy is treatment that boosts your immune system to attack the cancer cells. Different types of immunotherapy can be used to treat bladder cancer. These drugs can be put directly into the bladder (as a liquid) or given into a vein.

Side effects of immunotherapy

Immunotherapy can cause different side effects depending on which drug is used. These tend to be mild, such as feeling tired or having an upset stomach, but in some people the side effects can be serious. Most side effects go away after treatment ends.

If you have side effects, talk to your cancer care team so they can help.

Clinical trials

Clinical trials are research studies that test new drugs or other treatments in people. They compare standard treatments with others that may be better.

If you would like to be in a clinical trial, start by asking your doctor if your clinic or hospital takes part in clinical trials. You can also call our clinical trials matching service at 1-800-303-5691 or go online at www.cancer.org/clinicaltrials to find studies near you.

Clinical trials are one way to get state-of-the-art cancer treatment. They are the best way for doctors to find better ways to treat cancer. Still, they’re not right for everyone. And it’s up to you whether to take part in a clinical trial.

What about other treatments that I hear about?

When you have cancer you might hear about other ways to treat cancer or treat your symptoms. These may not always be standard medical treatments. These treatments can be vitamins, herbs, special diets, and other things. You may wonder about these treatments.

Some of these are known to help, but many have not been tested. Some have been shown not to be helpful. A few have even been found to be harmful. Talk to your doctor about anything you are thinking about using, whether it’s a vitamin, a diet, or anything else.

Questions to ask the doctor:

  • What treatment do you think is best for me?
  • What’s the goal of this treatment? Do you think it could cure the cancer?
  • Will treatment include surgery? If so, who will do the surgery?
  • What will the surgery be like?
  • Will I have other types of treatment, too?
  • What’s the goal of these treatments?
  • What side effects could I have from these treatments?
  • Is there a clinical trial that might be right for me?
  • What about treatments like special vitamins or diets that friends tell me about? How will I know if they are safe?
  • What should I do to be ready for treatment?
  • Is there anything I can do to help the treatment work better?
  • What’s the next step?

What will happen after treatment?

You will be glad when treatment is over. But it’s hard not to worry about cancer coming back. Even when cancer never comes back, people still worry about this. For years after treatment ends, you will see your cancer doctor. Be sure to go to all of your follow-up visits. People who have had bladder cancer are at high risk of developing a second bladder cancer.

If you have no signs of cancer remaining, most experts advise following up with your doctor every 3-6 months. These visits might include urine tests, blood work, and other tests. If you still have your bladder, you likely will need regular exams of your bladder as well. The time between doctor visits may be longer after a few years if no new cancers are seen.

Having cancer and dealing with treatment can be hard, but it can also be a time to look at your life in new ways. You might be thinking about how to improve your health. Call us or talk to your doctor to find out what you can do to feel better.

You can’t change the fact that you have cancer. What you can change is how you live the rest of your life – making healthy choices and feeling as well as you can.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Bladder: a hollow organ that stores urine

Biopsy (by-op-see): taking out a piece of tissue to see if there are cancer cells in it

Cystectomy (sis-tek-tuh-mee): surgery to remove the bladder

Cystoscopy (sis-tah-scuh-pee): a procedure that looks at the inside of the bladder with a thin, lighted tube called a cystoscope

Intravesical (in-truh-vess-uh-cull): within the bladder

Invasive cancer: cancer that has spread beyond the layer of cells where it first began

IVP: a test that uses dye and x-rays to look at the kidneys, ureters, and bladder

Kidneys: a pair of bean-shaped organs, each about the size of a fist, that help the body make urine

Lymph nodes: small bean-shaped parts of the immune system

Metastasis (meh-TAS-tuh-sis): cancer cells that have spread from where they started to other places in the body

Non-invasive cancer: cancer that is still only in the layer of cells where it first began

Partial cystectomy (sis-tek-tuh-mee): surgery to remove only part of the bladder

TURBT: a procedure that removes small pieces from the inside of the bladder to see if someone has bladder cancer. It can also be used to treat some small bladder cancers.

Ureter (yur-uh-tur): a tube that carries urine from each kidney to the bladder

Urethra (yur-eeth-ruh): the tube that carries urine from the bladder to the outside of the body

Urine: liquid waste made by the kidneys and stored in the bladder. Also called pee.

Urologist (yur-ol-uh-jist): a doctor who is an expert in treating problems of the urinary tract, as well as the genital area in men

We have a lot more information for you. You can find it online at www.cancer.org. Or, you can call our toll-free number at 1-800-227-2345 to talk to one of our cancer information specialists.

Last Medical Review: March 30, 2016 Last Revised: May 23, 2016

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