Types of bladder cancer

Urothelial carcinoma (also called transitional cell carcinoma) is cancer that begins in the urothelial cells, which line the urethra, bladder, ureters, renal pelvis, and some other organs. Almost all bladder cancers are urothelial carcinomas.

Urothelial cells are also called transitional cells because they change shape. These cells are able to stretch when the bladder is full of urine and shrink when it is emptied.

Other types of bladder cancer are rare:

• Squamous cell carcinoma is cancer that begins in squamous cells (thin, flat cells lining the inside of the bladder). This type of cancer may form after long-term irritation or infection with a tropical parasite called schistosomiasis, which is common in Africa and the Middle East but rare in the United States. When chronic irritation occurs, transitional cells that line the bladder can gradually change to squamous cells.
• Adenocarcinoma is cancer that begins in glandular cells that are found in the lining of the bladder. Glandular cells in the bladder make mucus and other substances.
• Small cell carcinoma of the bladder is cancer that begins in neuroendocrine cells (nerve-like cells that release hormones into the blood in response to a signal from the nervous system).

There are other ways to describe bladder cancer:

• Non-muscle-invasive bladder cancer is cancer that has not reached the muscle wall of the bladder. Most bladder cancers are non-muscle-invasive.
• Muscle-invasive bladder cancer is cancer that has spread through the lining of the bladder and into the muscle wall of the bladder or beyond it.

Learn more about bladder cancer

Many bladder cancer symptoms are also seen with other less serious conditions. These are the warning signs you shouldn’t ignore.

Using tobacco, especially smoking cigarettes, is a major risk factor for bladder cancer. Learn about tobacco use and other risk factors for bladder cancer and what you can do to lower your risk.

Learn about bladder cancer screening tests for people at high risk.

Learn about the tests that are used to diagnose and stage bladder cancer.

Learn about bladder cancer survival rates and why this statistic doesn't predict exactly what will happen to you.

Stage refers to the extent of your cancer, such as how large the tumor is and if it has spread. Learn about bladder cancer stages, an important factor in deciding your treatment plan.

Learn about the different ways bladder cancer can be treated.

Coping with bladder cancer and the side effects of treatment can feel overwhelming. Learn about resources to help you cope and gain a sense of control.

Childhood bladder cancer is a very rare type of cancer that forms in the tissues of the bladder. Learn about the symptoms of bladder cancer in children, and how it is diagnosed and treated.

Risk factors for bladder cancer

In the United States, bladder cancer occurs more often in men than in women, and more often in White individuals than in Black individuals. Bladder cancer can be diagnosed at any age, but the risk increases as a person gets older.

Using tobacco, especially smoking cigarettes, is a major risk factor for bladder cancer. Tobacco contains harmful chemicals called carcinogens. When you use tobacco, these chemicals get absorbed into the bloodstream, are filtered by the kidneys, and then collect in the urine. This exposes your bladder to high levels of these chemicals, which can damage the DNA in the cells lining your bladder. Learn about different tools to help you quit smoking and how to use them.

Other risk factors for bladder cancer include

• having a family history of bladder cancer
• having certain changes in the genes that are linked to bladder cancer, such as HRAS, RB1, PTEN/MMAC1, NAT2, and GSTM1
• being exposed to paints, dyes, metals, or petroleum products in the workplace
• past treatment with radiation therapy to the pelvis or with certain anticancer drugs, such as cyclophosphamide or ifosfamide
• taking the Chinese herb Aristolochia fangchi
• drinking water from a well that has high levels of arsenic
• drinking water that has been treated with chlorine
• having a bladder infection caused by a parasite called Schistosoma haematobium, which is common in Africa and the Middle East but rare in the United States
• using urinary catheters for a long time

Having one or more of these risk factors does not necessarily mean you will get bladder cancer. Many people with risk factors never develop bladder cancer, while others with no known risk factors do. Talk with your doctor if you think you might be at risk of bladder cancer. Bladder cancer screening options may be available to you.

Tests to diagnose bladder cancer

The following tests and procedures are used to diagnose bladder cancer. The results will also help you and your doctor plan treatment.

Cystoscopy

Cystoscopy is a procedure in which the doctor looks inside the bladder and urethra (the tube that carries urine out of your body) to check for abnormal areas. A cystoscope is slowly inserted through the urethra into the bladder to allow the doctor to see inside. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove very small bladder tumors or tissue samples for biopsy. Cystoscopy helps to diagnose, and sometimes treat, bladder cancer and other conditions.

Cystoscopy. A cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the urethra into the bladder. Fluid is used to fill the bladder. The doctor looks at an image of the inner wall of the bladder on a computer monitor to check for abnormal areas.

Tests to stage bladder cancer

If you’re diagnosed with bladder cancer, you will be referred to a urologic oncologist. This is a doctor who specializes in diagnosing and treating cancers of the male and female urinary tract and the male reproductive organs. They will recommend tests to determine the extent of cancer. Sometimes the cancer is only in the bladder. Or, it may have spread from the bladder to other parts of the body. The process of learning the extent of cancer in the body is called staging. It is important to know the stage of the bladder cancer to plan treatment.

For information about a specific stage of bladder cancer, see Bladder Cancer Stages.

The following imaging tests may be used to determine the bladder cancer stage.

Getting a second opinion

Some people may want to get a second opinion to confirm their bladder cancer diagnosis and treatment plan. If you choose to seek a second opinion, you will need to get important medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans before giving a recommendation. The doctor who gives the second opinion may agree with your first doctor, suggest changes or another approach, or provide more information about your cancer.

To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. You can contact NCI’s Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor, hospital, or getting a second opinion. For questions you might want to ask at your appointments, see Questions to Ask Your Doctor.

Survival rates for bladder cancer

Doctors estimate bladder cancer prognosis by using statistics collected over many years from people with bladder cancer. One statistic that is commonly used in making a prognosis is the 5-year relative survival rate. The 5-year relative survival rate tells you what percent of people with the same type and stage of bladder cancer are alive 5 years after their cancer was diagnosed, compared with people in the overall population. For example, the 5-year relative survival rate for localized bladder cancer is 71%. This means that people diagnosed with localized bladder cancer are 71% as likely as someone who does not have bladder cancer to be alive 5 years after diagnosis.

The 5-year relative survival rates for bladder cancer are as follows:

• 97% for carcinoma in situ of the bladder alone (abnormal cells found in the tissue lining the inside of the bladder)
• 71% for localized bladder cancer (cancer is in the bladder only)
• 39% for regional bladder cancer (cancer has spread beyond the bladder to nearby lymph nodes or organs)
• 8% for metastatic bladder cancer (cancer has spread beyond the bladder to a distant part of the body)

Learn more about statistics for bladder cancer from our Cancer Stat Facts Collection.

Understanding survival rate statistics

Because survival statistics are based on large groups of people, they cannot be used to predict exactly what will happen to you. The doctor who knows the most about your situation is in the best position to discuss these statistics and talk with you about your prognosis. It is important to note the following when reviewing survival statistics:

• No two people are entirely alike, and responses to treatment can vary greatly.
• Survival statistics use information collected from large groups of people who may have received different types of treatment.
• It takes several years to see the effect of newer and better treatments, so these effects may not be reflected in current survival statistics.

To learn more about survival statistics and to see videos of patients and their doctors exploring their feelings about prognosis, see Understanding Cancer Prognosis.

Stage 0 (noninvasive papillary carcinoma and carcinoma in situ)

Stage 0 bladder cancer (noninvasive bladder cancer). Cancer cells are found in tissue lining the inside of the bladder but have not invaded into the bladder wall. Stage 0a (also called noninvasive papillary carcinoma) may look like long, thin growths extending into the bladder lumen (the space where urine collects). Stage 0is (also called carcinoma in situ) is a flat tumor on the tissue lining the inside of the bladder.

Stage 0 refers to noninvasive bladder cancer. This means that cancer cells are found in tissue lining the inside of the bladder but have not invaded the bladder wall. Stage 0 is divided into stages 0a and 0is, depending on the type of tumor:

• Stage 0a is also called noninvasive papillary carcinoma, which may look like long, thin growths extending into the bladder lumen (the space where urine collects). Stage 0a can be low grade or high grade, depending on how abnormal the cells look under the microscope (see the section on Bladder cancer grade).
• Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder. Stage 0is is always high grade (see the section on Bladder cancer grade).

Learn about treatment for stage 0 bladder cancer.

Stage I bladder cancer

Stage I is a form of non-muscle-invasive bladder cancer that has spread into the connective tissue but has not reached the muscle layers of the bladder.

Stage I bladder cancer (non-muscle-invasive bladder cancer). Cancer has spread into the connective tissue but has not reached the muscle layers of the bladder.

Learn about treatment for stage I bladder cancer.

Stage II bladder cancer

Stage II may also be described as muscle-invasive bladder cancer. In stage II, cancer has spread through the connective tissue into the muscle layers of the bladder.

Stage II bladder cancer (muscle-invasive bladder cancer). Cancer has spread through the connective tissue into the muscle layers of the bladder.

Learn about treatment for stage II bladder cancer.

Stage III bladder cancer

Stage III may also be described as locally advanced bladder cancer. Stage III is divided into stages IIIA and IIIB.

• In stage IIIA

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  cancer has grown all the way through the bladder muscles and bladder wall into the layer of fat surrounding the bladder and may have spread to the reproductive organs (prostate, seminal vesicles, uterus, or vagina) but has not spread to lymph nodes; or

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  cancer has spread to one lymph node in the pelvis that is not near the major arteries in the pelvis, called the common iliac arteries.

  

  Stage IIIA bladder cancer. Cancer (a) has grown all the way through the bladder muscles and bladder wall into the layer of fat around the bladder and may have spread to the prostate and/or seminal vesicles in men or the uterus and/or vagina in women but has not spread to lymph nodes; or (b) has spread to one lymph node in the pelvis that is not near the common iliac arteries.

• In stage IIIB, cancer has spread to more than one lymph node in the pelvis that is not near the common iliac arteries or to at least one lymph node that is near the common iliac arteries.

  

  Stage IIIB bladder cancer. Cancer has spread to (a) more than one lymph node in the pelvis that is not near the common iliac arteries; or (b) at least one lymph node that is near the common iliac arteries.

Learn about treatment for stage III bladder cancer.

Stage IV bladder cancer

Stage IV is divided into stages IVA and IVB.

• In stage IVA

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  cancer has spread to the abdominal wall or pelvic wall; or

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  cancer has spread to lymph nodes that are above the major arteries in the pelvis, called the common iliac arteries.

• In stage IVB, cancer has spread to other parts of the body, such as the lung, bone, or liver.

  

  Stage IVA and IVB bladder cancer. In stage IVA, cancer has spread to (a) the abdominal or pelvic wall; or (b) lymph nodes above the common iliac arteries. In stage IVB, cancer has spread to (c) other parts of the body, such as the lung, liver, or bone.

Stage IV bladder cancer is also called metastatic bladder cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the lung, the cancer cells in the lung are actually bladder cancer cells. The disease is called metastatic bladder cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Learn about treatment for stage IV bladder cancer.

Bladder cancer grade

Cancer grade describes how abnormal the bladder cancer cells look under a microscope and how quickly the cancer cells are likely to grow and spread. Your doctor uses grade and other factors about your cancer, such as its stage, to form a treatment plan and in some cases, to estimate your prognosis.

• Low-grade bladder cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells.
• High-grade bladder cancer tends to grow and spread more quickly than low-grade bladder cancer. High-grade cancers usually have a worse prognosis than low-grade cancers and may need treatment right away or treatment that is more aggressive

To learn more, see Tumor Grade.

Recurrent bladder cancer

Recurrent bladder cancer is cancer that has recurred (come back) after it has been treated. Bladder cancer tends to recur after treatment, even when it is noninvasive at the time of diagnosis. Low-grade bladder cancer mainly recurs in the bladder lining. High-grade bladder cancer is more likely to have spread to the muscle layers or other parts of the body when it recurs. Tests will be done to help determine where the cancer has returned in your body, if it has spread, and how far. The type of treatment that you have for recurrent bladder cancer will depend on where it has come back.

Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in Coping with Bladder Cancer and the booklet When Cancer Returns.

Learn about treatment for recurrent bladder cancer.

Surgery

Surgery is the main treatment for bladder cancer. The type of surgery depends on where the cancer is located. Other treatments may be given in addition to surgery:

• Treatment given before surgery is called preoperative therapy or neoadjuvant therapy. Chemotherapy may be given before surgery to shrink the tumor and reduce the amount of tissue that needs to be removed during surgery.
• Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. After the doctor removes all the cancer that can be seen, some patients may be given chemotherapy, radiation therapy, immunotherapy, and/or targeted therapy to kill any cancer cells that are left.

Learn more about Surgery to Treat Cancer.

The types of surgery done to treat bladder cancer are:

Radiation therapy

Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Bladder cancer is sometimes treated with external beam radiation therapy. This type of radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Radiation therapy may be given alone or with other types of treatment, such as chemotherapy.

Learn more about External Beam Radiation Therapy for Cancer and Radiation Therapy Side Effects.

Chemotherapy

Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given alone or with other types of treatment. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Immunotherapy

Immunotherapy helps a person's immune system fight cancer. Your doctor may suggest biomarker tests to help predict your response to certain immunotherapy drugs. Learn more about Biomarker Testing for Cancer Treatment.

Targeted therapy

Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells. Your doctor may suggest biomarker tests to help predict your response to certain targeted therapy drugs. Learn more about Biomarker Testing for Cancer.

Targeted therapies used to treat bladder cancer include:

• enfortumab vedotin
• erdafitinib 
• ramucirumab 
• sacituzumab govitecan-hziy

Learn more about Targeted Therapy to Treat Cancer.

Clinical trials

For some people, joining a clinical trial may be an option. There are different types of clinical trials for people with cancer. For example, a treatment trial tests new treatments or new ways of using current treatments. Supportive care and palliative care trials look at ways to improve quality of life, especially for those who have side effects from cancer and its treatment.

You can use the clinical trial search to find NCI-supported cancer clinical trials accepting participants. The search allows you to filter trials based on the type of cancer, your age, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Learn more about clinical trials, including how to find and join one, at Clinical Trials Information for Patients and Caregivers.

Follow-up care

Some of the tests that were done to diagnose or stage the cancer may be repeated. Some tests will be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. These tests are sometimes called follow-up tests or check-ups.

Treatment of stages 0 and I bladder cancer

Stage 0 and stage I bladder cancer, also known as non-muscle-invasive bladder cancer (NMIBC), haven't spread to the muscle layer of the bladder. Treatment of NMIBC depends on several factors:

• the risk level of the cancer (low, intermediate, or high) for recurrence or becoming muscle-invasive
• the stage and grade of the cancer
• the size and number of tumors

The first treatment is usually a surgical procedure called transurethral resection (TUR) with fulguration to remove the tumor. Sometimes, surgery might be repeated if the first doesn't remove enough of the tumor or does not include a sample from the muscle layer. If a repeat surgery finds that the cancer has invaded the muscle layer, it will be treated as muscle-invasive bladder cancer (stage II bladder cancer or higher).

Because stage 0 and stage I bladder cancer often come back after surgery, most people receive intravesical chemotherapy with mitomycin or gemcitabine or intravesical BCG at the time of their first surgery. To help lower the risk of bladder cancer recurrence, your doctor may recommend you continue having intravesical BCG for up to 3 years, depending on the characteristics of the cancer. This is called maintenance therapy.

To learn more about the treatments below, visit Bladder Cancer Treatment.

Treatment of stages II and III bladder cancer

The two main treatments for stage II and stage III bladder cancer are radical cystectomy or a combination of radiation therapy and chemotherapy.

Radical cystectomy is surgery to remove the bladder and surrounding tissues and organs. Surgery to make a new way for urine to leave the body (called urinary diversion) will be done. Additional treatments may be given before or after surgery:

• Chemotherapy may be given before surgery to people who are well enough to tolerate it. Giving combination chemotherapy that includes cisplatin before surgery has been shown to help people live longer than surgery alone.
• The immunotherapy drug nivolumab may be given if the cancer has a high risk of coming back after surgery or did not respond to chemotherapy.

If you are unable or choose not to have surgery, treatment may include a combination of radiation therapy and chemotherapy, such as cisplatin and fluorouracil, given at the same time. Giving chemotherapy at the same time as radiation therapy helps the radiation therapy work better.

Partial cystectomy (removal of part of the bladder) is a less common treatment for stages II and III bladder cancer.

To learn more about these treatments, visit Bladder Cancer Treatment.

Treatment of stage IV bladder cancer

Treatment for stage IV bladder cancer depends on whether the cancer is locally advanced or metastatic. Treatment for metastatic bladder cancer is aimed at relieving symptoms and improving quality of life while also slowing the growth and spread of the cancer.

Treatment of stage IVA (locally advanced) bladder cancer may include:

• the immunotherapy drug pembrolizumab in combination with the targeted therapy drug enfortumab vedotin
• the immunotherapy drug nivolumab in combination with the chemotherapy drugs cisplatin and gemcitabine
• the chemotherapy drugs cisplatin and gemcitabine followed by the immunotherapy drug avelumab
• for people well enough to tolerate it, cisplatin-based systemic chemotherapy, such as one of the following regimens:

  -

  dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)

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  cisplatin, methotrexate, and vinblastine (CMV)

• pembrolizumab alone
• a cisplatin-based chemotherapy regimen followed by surgery to remove the bladder and surrounding tissues and organs (radical cystectomy) and urinary diversion or surgery alone
• radiation therapy and chemotherapy, such as cisplatin and fluorouracil, given at the same time, to help the radiation therapy work better
• urinary diversion, as palliative therapy or to prevent a blockage of urine that could cause kidney damage
• surgery to remove part or all of the bladder (cystectomy) as palliative therapy

Treatment of stage IVB (metastatic) bladder cancer may include:

• the immunotherapy drug pembrolizumab in combination with the targeted therapy drug enfortumab vedotin
• the immunotherapy drug nivolumab in combination with the chemotherapy drugs cisplatin and gemcitabine
• the chemotherapy drugs cisplatin and gemcitabine followed by the immunotherapy drug avelumab
• systemic chemotherapy, such as one of the following regimens:

  -

  gemcitabine with either cisplatin or carboplatin

  -

  dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)

  -

  cisplatin, methotrexate, and vinblastine (CMV)

• an immunotherapy drug alone, such as avelumab, nivolumab, or pembrolizumab
• radiation therapy as palliative therapy
• urinary diversion, as palliative therapy or to prevent a blockage of urine that could damage the kidneys
• surgery to remove part or all of the bladder (cystectomy) as palliative therapy

To learn more about these treatments, visit Bladder Cancer Treatment.

Treatment of recurrent bladder cancer

Treatment of bladder cancer that has recurred (come back) depends on previous treatment and where the cancer has come back. Treatment may include:

• systemic chemotherapy, such one of the following regimens:

  • gemcitabine with either cisplatin or carboplatin
  • dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)
  • cisplatin, methotrexate, and vinblastine
• an immunotherapy drug, such as avelumab, nivolumab, or pembrolizumab
• a targeted therapy drug, such as enfortumab vedotin, erdafitinib, or ramucirumab
• surgery for non-muscle-invasive or localized tumors, which may be followed by immunotherapy and chemotherapy
• radiation therapy as palliative therapy

To learn more about these treatments, visit Bladder Cancer Treatment.

Adjusting after urostomy

For those who have a stoma and urostomy bag, getting used to them takes time. Some people need to learn how to use a catheter to empty their bladder, which is another big change. And if you have incontinence or problems controlling your bladder, it can be frustrating to deal with.

Know that you aren't alone in how you feel. Adjusting to these changes can be hard. But, over time, many people are able to do a lot of what they did before surgery. Support from family members and your health care team can help you get used to life after urostomy surgery. Ask your nurse for resources and support groups that may be helpful. Learn more about Patient’s Concerns About Surgery.

Self-image and sexual problems

Body changes may affect your self-image and sex life after treatment. Some treatments for bladder cancer, including chemotherapy, radiation therapy, surgery, or certain medicines, can cause short-term or long-term problems with sex. For example, having a cystectomy may affect the nerves and make it harder for men to have an erection. Women may have pain during sex or problems with lubrication and orgasm.

It’s important to discuss any issues and concerns you have about sex with your health care team before treatment. Knowing your thoughts ahead of time may help them plan your treatment.

Learn more about the sexual problems some cancer treatments can cause and ways to cope in Sexual Health Issues in Women with Cancer and Sexual Health Issues in Men with Cancer. For help communicating your feelings, see Self-Image and Sexuality.

The stress of follow-up care

It’s common for bladder cancer to come back, even after successful treatment. As a result, it is important for people who have been treated for bladder cancer to visit their doctor regularly to get certain follow-up exams or tests. This can be hard for a number of reasons, such as:

• Planning and scheduling these appointments can be stressful and time-consuming.
• Waiting for test results can cause anxiety and an ongoing fear of recurrence.
• The added costs of things such as copays, medicines, and parking and transportation fees only add to the stress.

For information about how to prepare for follow-up appointments, see Follow-Up Medical Care.

For tips on how to deal with the fear of cancer coming back, see the section Coping with Fear of Recurrence on our New Normal page.

Cost of cancer treatment

Cancer is one of the most costly diseases to treat in the United States. Even if you have health insurance, you may face major financial challenges and need help dealing with the costs of bladder cancer treatment. Having cancer may also make it hard for you to work and pay your bills. The problems a person has related to the cost of treatment is known as financial toxicity. For ways to cope, see  Managing Costs and Medical Information. To learn about financial toxicity and find out if you are at risk, see Financial Toxicity (Financial Distress) and Cancer Treatment.