Diagnosis and Treatment for Bladder Cancer

How is Bladder Cancer Diagnosed?

One or a combination of several of the following tests may be used to diagnose bladder cancer:

• Cystoscopy – Your doctor inserts a small tube known as a cystoscope through your urethra to examine your urethra and bladder for signs of cancer.
• Biopsy (TURBT) – Collecting a cell sample to analyze for cancer. This is sometimes done during a cystoscopy by passing a unique tool called a resectoscope through the cystoscope. 
• Urine Cytology – A urine sample is analyzed under a microscope to check for cancer cells.
• Urine Tumor Marker Test – Urine samples are taken to analyze for certain substances (markers) commonly linked to bladder cancer cells.
• Computerized Tomography (CT) Urogram – A contrast die is injected into a vein in your body that eventually flows through the kidneys, ureters, and bladder. X-ray images are taken during the test to provide a detailed view of your urinary tract and assess potential cancer areas.
• Retrograde Pyelogram – similar to a CT urogram, but done in reverse to get a better look at your upper urinary tract. A doctor will thread a catheter through your urethra to inject contrast dye into your ureters. While the dye flows to the kidney, x-ray images are taken.

Cystoscopy, in combination with a biopsy, is typically used as the definitive test for bladder cancer. However, different tests may be used depending on your symptoms and personal situation.

[during the cystoscopy] they’re basically slipping a tiny tube with a camera through your urethra to head on into the bladder and have a look-see around. That’s being shown on a screen.

– Margo W. | Read More

Diagnosing the Extent of Bladder Cancer

If it appears that the bladder cancer has spread, your doctor may recommend additional tests to see if it has spread to other parts of your body. This helps when determining the grade of bladder cancer. Some of the tests to diagnose the extent of bladder cancer include:

• Additional CT scans
• MRI
• PET scans
• Bone scans
• Chest x-ray

We had the abnormal CT, the extra scope that was abnormal, and then the surgical procedure to biopsy this growth that he saw to see more of what was going on.

Ebony G | Read More

Grading Bladder Cancer

When bladder cancer is diagnosed, it is also given a grade. Grading is done on a scale of 0 – IV, with IV being the most severe. Grading for bladder cancer is based on the TNM scale, which essentially assesses how far the tumor has grown through the bladder wall if it has spread to the lymph nodes, and if it is metastatic.

Your doctor may perform additional diagnostic tests to grade the bladder cancer. While all bladder cancer is important to treat and monitor, the higher the grade, the more urgency there is for action. 

Visit our bladder cancer overview page to learn more about staging.

Treatment for Bladder Cancer

There is no one set treatment plan for bladder cancer. Treatment options and recommendations will vary based on several different factors, including:

• The stage of the cancer
• Your age
• Expected impact of the treatment 
• Other health conditions you may have

When working through the treatment options with your care team, it’s essential to ask questions and understand each treatment’s benefits and potential side effects.

Bladder Cancer Surgery

Transurethral Resection of Bladder Tumor (TURBT)

As you may have noticed, transurethral resection is one of the procedures used to diagnose bladder cancer. However, it can also be used to treat early-stage bladder cancer.

A TURBT uses a resectoscope to go into your bladder through your urethra to remove abnormal tissue or tumors. 

Occasionally, a surgeon will need to perform fulguration after removing a tumor. This involves using a high-energy laser to burn any potentially remaining cancer cells.

A TURBT is considered a surgery, but the side effects are generally mild, and most people can go home from the hospital the same day as the surgery.

Cystectomy

When bladder cancer is invasive (it’s spread into or through the bladder muscle wall), you may need to have a cystectomy to remove either part or all of the bladder. 

• Partial cystectomy – if the cancer has only spread to one part of the cancer, then your doctor may be able to only remove part of the bladder. Lymph nodes near the tumor may also need to be removed. This helps a patient avoid reconstructive surgery.
• Radical cystectomy – If the cancer has spread to several parts of the bladder, your doctor may have to remove the entire bladder. In men, the prostate and seminal testicles are also removed. While in women, the ovaries, fallopian tubes, uterus, cervix, and part of the vagina are also removed.

If you have to have your entire bladder removed, you will require reconstructive surgery to allow your body to store and pass urine. The different types of reconstructive surgery include:

• Incontinent diversion – a portion of the intestine is used to create a passage from your ureter (tubes that carry urine from the kidney) to the skin on your abdomen via a small opening known as a stoma. Urine then flows continuously into a bag stuck on your stomach that is periodically emptied.
• Continent diversion – works similarly to an incontinent diversion, only there is a valve that prevents the continuous flow of urine. However, the urine must be removed via a catheter several times daily.
• Neobladder – the surgeon creates a “new” bladder by using a piece of intestine to connect your ureter back to the urethra. This allows you to urinate normally; however, you have to urinate on a schedule as you won’t get the feeling that you need to “go.”

What type of diversion am I going to have? Did I want to have a bag? No, I’m 52 years old. Why would I want a bag if I don’t have to?

LaSonya D. | Read More

Unfortunately, there are several side effects associated with all types of cystectomies, including:

• Infections
• Blockages
• Urine leak
• Incontinence
• Absorption issues

Depending on whether it was a partial or radical cystectomy, both men and women can be impacted sexually by the surgery. Men may lose the ability to produce sperm or get an erection, while women may lose the ability to orgasm, and sex may become uncomfortable.

Chemotherapy

Chemotherapy is a form of drug therapy used to kill cancer cells or prevent them from dividing. As a treatment for bladder cancer, chemo is typically given in one of two ways:

• Systemic chemotherapy – the chemo drug is injected into a vein to enter the bloodstream and reach cancer cells throughout the body. 
• Intravesical chemotherapy – A tube is inserted through the urethra to flush the bladder with chemo drugs. 

Chemotherapy can be given before surgery to shrink a tumor pre-operation, after surgery to prevent the chances of cancer returning, in combination with radiation therapy, or as the main form of treatment for bladder cancer. 

The one that I wanted was the dd-MVAC (dense-dose methotrexate, vinblastine, adriamycin, and cisplatin). You go in one day and they give you two of the drugs. Then you go in the second day and they give you the rest of them. That’s for two months, two times a week, every other week for two months.

Vickie D | Read More

Immunotherapy

Immunotherapy is a treatment used to help a patient’s immune system fight cancer. Before starting immunotherapy, your doctor may recommend running biomarker tests to identify the most effective drug.

• Systemic immunotherapy – immunotherapy drugs commonly used to treat bladder cancer via injections into the vein include avelumab, novolumab, and perbrolizumab. 
• Intravesical immunotherapy – the main immunotherapy drug used to treat bladder cancer via a catheter insertion is BCG (bacillus Calmette-Guérin). 

For this type of cancer (urothelial bladder cancer), BCG is immunotherapy. It’s actually the tuberculosis vaccine and it’s the most effective treatment.

Karen R | Read More

Targeted Therapy

Targeted therapy blocks cancer-causing actions by proteins, enzymes, and other molecules. Some commonly used targeted therapy drugs for the treatment of bladder cancer include enfortumab vedotin, erafitnib, ramucirumab, and cacituzumab govitecan-hziy. 

Clinical Trials

The possibilities for bladder cancer treatment are ever-growing. If there isn’t a viable treatment option for you, there may be a clinical trial that you can enroll in. To find active bladder cancer clinical trials visit the NIH’s Nation Cancer Institute’s supported clinical trial search.

Treating Bladder Cancer by Stage

While there are several options for treating bladder cancer, different approaches may be taken at different stages of the cancer. 

• Stage 0 – TURBT with fulguration followed by intravesical chemotherapy
• Stage I – TURBT with fulguration is used to determine the extent of the cancer. If it’s low grade (slow growing), a second TURBT is typically given by intravesical BCG or intravesical chemo. A radical cystectomy may be recommended if it’s high-grade (fast-growing).
• Stage II – surgical removal of the infected area of the bladder and potentially the lymph nodes is recommended at this point. This may be followed with radiation treatment or rug therapy if there’s a risk of cancer returning. 
• Stage III – Chemotherapy to shrink the tumor, followed by a radical cystectomy, is typically recommended. Following surgery, the patient is closely monitored and potentially given drug therapy to ensure the cancer doesn’t return.
• Stage IV – Chemotherapy is the main treatment for stage IV bladder cancer. Surgery at this point won’t likely remove all of the cancer, so treatment is aimed at slowing the growth of the cancer. Your doctor may recommend you for a clinical trial.

While these are the standard treatments for each stage of bladder cancer, your treatment plan may vary based on your situation and how the cancer progresses. 

Bladder Cancer Causes & Symptoms – Described by Real Patients

While the specific cause of bladder cancer may be unknown, there are risk factors and symptoms that may indicate you should take extra precautions to limit your chances of getting bladder cancer or may already have it.

In this article, we look at the gene mutations that cause bladder cancer, some of the risk factors associated with bladder cancer, and the symptoms of bladder cancer. 

What Causes Bladder Cancer?

Bladder cancer occurs when cells in the bladder develop mutations in their DNA and begin to multiply rapidly. DNA is a chemical in our cells that make up our genes, which help control the function of cells. 

There are two types of genes that impact cancer by determining when cells grow, divide, and die:

• Oncogenes – help cells grow and divide
• Tumor suppressor genes – help repair mistakes in the DNA, control cell division, and cause cells to die

Sometimes gene mutations cause cancer by allowing the oncogenes to stay on constantly or the tumor suppressor genes to remain off. This change can create an abundance of abnormal cells. Eventually, the abnormal cells replace healthy cells and form a tumor.

Can Bladder Cancer be Inherited?

When we think of genes, we often think about the traits that we inherit from our parents. However, when it comes to gene mutations, they can be acquired or inherited.

Most people do not inherit gene mutations that cause bladder cancer. However, it is possible to inherit genes that increase your risk of getting bladder cancer due to a reduced ability to break down cancer-causing chemicals.

Most of the gene mutations related to bladder cancer are from gene mutations that are acquired during your lifetime. While chemicals associated with cancer may cause the mutations, they can also occur from random events occurring within a cell.

What are the Risk Factors of Bladder Cancer?

While researchers don’t know what causes genes to mutate and become cancer cells, there are certain risk factors that have been identified as increasing your risk of getting bladder cancer. According to the Cleveland Clinic, some of these risk factors include:

• Smoking or exposure to second-hand smoke – inhaled smoke gets processed through your body. As a result, some of the harmful chemicals eventually end up being excreted into your urine, where it sits in your bladder.
• Radiation exposure – radiation therapy to treat other forms of cancer may increase your risk of getting bladder cancer.
• Exposure to certain chemicals – since your kidneys filter harmful chemicals from your bloodstream to your bladder, it is believed that some of these chemicals may contribute to an increased risk of bladder cancer. Some chemicals linked to bladder cancer include arsenic and chemicals used in producing dyes, rubber, textiles, leather, and paint products.
• Frequent bladder infections – those with a history of reoccurring bladder infections due to inflammation may be at increased risk of squamous cell bladder cancer.
• Being over 55 – the risk of bladder cancer increases as you age. The majority of people diagnosed with bladder cancer are over the age of 55.
• Being male – men are at a higher risk of bladder cancer than women.

“Unbeknownst to me at the time and to a lot of people now, there are plastic softeners in catheters that have DEHP (di(2-ethylhexyl) phthalate) in them and that is, of course, a known carcinogen. It’s a combination of a foreign object repeatedly going in and out of your bladder and then the infections. I’m working now and advocating to get DEHP and other carcinogens out of catheters because we need to be able to eliminate that.”

Karen R. | Read More

Can Bladder Cancer Be Prevented?

While limiting risk factors can help decrease your chances of getting bladder cancer, it doesn’t necessarily mean that you won’t get it. However, aside from living a generally healthy lifestyle, there are a few things that you can do to lower your risk:

• Avoid smoking – smoking increases your risk for most cancers, but it is especially bad for bladder cancer. If you smoke now and want to quit, smokefree.gov provides some excellent resources to get started. 
• Limit exposure to chemicals – while some substances linked to bladder cancer can’t be avoided. Limiting exposure to chemicals used in leather, rubber, textiles, and paint is best. If you work with these items daily, practicing proper workplace safety habits is essential.
• Drink water – heard this one before? Drinking plenty of water is not only good for your health overall, but it may lower your risk of bladder cancer.
• Eat fruits and veggies – some studies suggest that eating fruits and vegetables may significantly decrease your risk of bladder cancer.

Bladder Care Symptoms

The signs and symptoms of bladder cancer can vary based on how far the cancer has progressed. However, the general symptoms of bladder cancer include the following:

• Blood in urine
• Painful urination
• Back pain
• Frequent urination or not being able to empty your bladder fully

While the above symptoms don’t necessarily indicate that you have bladder cancer, you should visit your healthcare provider if you are experiencing them.

“I think one of the things that is very common for cancer patients is that we don’t feel anything. Nothing’s up. We don’t have any pain symptoms or discomfort or anything like that. It was the same for me, except for that one day late in November, I noticed that my urine was the color of rosé, like a deep rosé.”

Margo W. | Read More

“My initial symptom was after a visit with my annual gynecologist, and they noticed that there was blood in my urine [at] a microscopic level. I couldn’t even see it, but a microscopic level of blood in my urine. They referred me to a urologist to try to look into what was going on. [It] kind of freaked me out. “

Ebony | Read More

Early Symptoms of Bladder Cancer

In its early stages, bladder cancer can present symptoms associated with abnormal changes in your urination. Some of these symptoms include:

• Having to urinate more frequently, especially at night
• Feeling the need to urinate even when your bladder isn’t full
• A burning sensation or pain when urinating
• Having a weak urine stream or struggling to urinate

These symptoms often suggest other urinary tract issues like a urinary tract infection (UTI), bladder stones, or an enlarged prostate. However, if you are experiencing these symptoms, getting tested to determine the root cause is essential.

Late-Stage Symptoms of Bladder Cancer

As bladder cancer spreads beyond the bladder into other body parts, those impacted by the disease may experience different symptoms. Some of the symptoms of late-stage bladder cancer include:

• Lower back pain, especially on one side
• Loss of appetite
• Extreme fatigue
• Unintentional weight loss
• Swelling in the feet
• Bone pain

Are There Different Bladder Cancer Symptoms for Men and Women?

The symptoms of bladder cancer are generally the same for both men and women. However, bladder cancer is more prevalent in men than in women, but women tend to get diagnosed at a later stage than men.

Additionally, it may take longer for older women, particularly women of color to be diagnosed, according to Dr. Samuel Washington, a urologist oncologist and assistant professor in residence at the University of California, San Francisco.

He says, “Particularly in women who are past menopause, postmenopausal bleeding is most certainly a concern to make sure we don’t miss a cancer diagnosis or something else that may be going on.”

More Bladder Cancer Patient Stories

Vickie D., Bladder Cancer



Symptoms: Intermittent pain in the gut and burning sesnsation

Treatments: Chemotherapy (dd-MVAC), surgery (cystectomy)

Michelle R., Recurrent Bladder Cancer, Stage 1



Symptoms: Irregular occurrences of seeing streaks of blood in urine, specific type of pain when bladder is full, unexplained weight loss, urinary urgency, malaise, fatigue
Treatments: Chemotherapy (gemcitabine), surgery (TURBT: transurethral resection of bladder tumor)

Margo W., Bladder Cancer, Stage 1



Symptom: Blood in urine



Treatments: Chemotherapy (methotrexate, vinblastine, doxorubicin & cisplatin), surgery (radical cystectomy)

LaSonya D.



Symptom: Blood in urine
Treatment: BCG immunotherapy, cystectomy (bladder removal surgery)

LaSonya D., High-Grade Bladder Cancer

Symptom: Clumps of blood in urine Treatments: Surgery (bladder removal, Indiana pouch), BCG immunotherapy