Bladder cancer is the sixth most common type of cancer in the United States. Getting this diagnosis can feel overwhelming and raise many questions about what lies ahead. Taking the time to learn about bladder cancer is an important first step. Understanding the basics can help you feel more prepared and confident as you navigate your treatment and care.

This article will give you an overview of how bladder cancer develops, how it’s diagnosed, and the treatment options available to you or your loved one with bladder cancer.

1. Bladder Cancer Starts When Bladder Cells Grow Uncontrollably

Bladder cancer develops when cells in your bladder grow out of control. Your bladder is a hollow organ in your pelvis (the area below your stomach) that stores urine (pee). Urine is liquid body waste that travels from your kidneys to your bladder through long tubes called ureters. When you urinate, urine leaves your bladder through your urethra.

Your bladder wall is made of several layers of tissue:

• Urothelium (also called transitional epithelium) that lines the inside of the bladder
• Muscles that contract to help force urine out of your bladder
• Fatty connective tissue that covers the outside of the bladder

2. There Are Several Types of Bladder Cancer

Bladder cancers are classified based on the type of cell where the cancer begins. The most common type of bladder cancer is urothelial carcinoma (previously known as transitional cell carcinoma). This type of cancer starts from the cells of the urothelium.

Less common types of bladder cancer include:

• Squamous cell carcinoma
• Adenocarcinoma
• Small cell carcinoma
• Sarcoma

Bladder cancer can also be grouped based on how the cancer spreads. Non-muscle-invasive bladder cancer (NMIBC) is bladder cancer that hasn’t grown into the layer of muscles in the bladder. NMIBCs have two subtypes based on how they grow — flat and papillary. Noninvasive flat carcinomas (also known as carcinoma in situ) grow in a patch instead of toward the inside of the bladder. Noninvasive papillary carcinomas stick out from the bladder lining like a stalk.

Muscle-invasive bladder cancer (MIBC) is bladder cancer that has grown into the muscle layer. This type of bladder cancer is more likely to spread and requires a more aggressive treatment.

3. Bladder Cancer Often Involves Genetic Changes

Cancer develops when genetic mutations (changes) occur that affect how a cell grows and divides. Most bladder cancers develop because of genetic changes triggered by exposures throughout your life. Other genetic mutations associated with bladder cancer are inherited from your parents.

Risk Factors for Bladder Cancer

The American Cancer Society has found that certain factors can increase your risk of bladder cancer, including:

• Age over 55
• Male sex
• Cigarette smoking
• Exposure to chemicals in paint, dye, metal, or diesel fumes at work
• Use of certain medications, including pioglitazone (Actos) and cyclophosphamide (Cytoxan)
• Poor hydration
• Chronic (long-term) bladder infections
• Schistosomiasis (a parasitic worm infection)
• A history of pelvic radiation therapy
• Birth defects in your bladder
• A personal history of bladder cancer
• Family history of colorectal, endometrial (uterine), or bladder cancer

4. Bladder Cancer Is Most Common in Men Over 55

The National Cancer Institute estimates there will be more than 83,000 new cases of bladder cancer in the United States in 2024. It’s more common in men compared to women.

About 90 percent of people diagnosed with bladder cancer are older than 55 years. Half of people with bladder cancer are older than 73 years.

In the United States, white people are more likely to develop bladder cancer compared to those of other races and ethnicities, according to the American Cancer Society.

People who work certain jobs where they may be exposed to chemicals also have a higher risk of bladder cancer, including:

• Factory workers
• Painters
• Printers
• Firefighters
• Hairdressers
• Truck drivers

5. Blood in the Urine Is the Most Common Symptom of Bladder Cancer

The most common symptom of bladder cancer is hematuria (blood in the urine). If you have blood in your urine, you may notice that your urine has an orange, pink, or red color. Sometimes the amount of blood in the urine is too small to change the color. In this case, a urinalysis (a urine test) is the only way to detect blood in your urine.

Less common symptoms of bladder cancer may include:

• Painful urination
• Frequent urination
• Urgent urination
• Difficulty urinating
• Repetitive urinary tract infections

In advanced bladder cancer where the tumor has grown large or spread to other parts of the body, additional symptoms may occur, including:

• Inability to urinate
• Back pain
• Weakness
• Weight loss without trying
• Loss of appetite
• Swelling in your lower legs and feet
• Bone pain

6. A Urologist Diagnoses Bladder Cancer

If you have symptoms that could be bladder cancer, your primary care provider may refer you to a urologist. A urologist is a specialist in treating conditions of the urinary tract and reproductive organs.

The first tests for bladder cancer are usually urine laboratory tests to check for blood, infection, and cancer cells.

Tests to help with a bladder cancer diagnosis may include:

• Cystoscopy — A urologist uses a long tube with a camera to see the inside of your bladder and urethra.
• Biopsy — In this test, a sample of bladder tissue is removed and examined under the microscope, usually done during a procedure called transurethral resection of bladder tumor (TURBT).
• Imaging tests — These tests provide images of the inside of your body, such as computerized tomography (CT), magnetic resonance imaging (MRI), or ultrasound scans.

7. Bladder Cancer Stages Show Its Spread

Bladder cancer is assigned a stage from 0 to 4 based on the size of the tumor, whether cancer has spread to your lymph nodes (small, bean-shaped organs in the immune system that help fight infections), and whether cancer has spread to other parts of your body. In general, the higher the stage, the more advanced the cancer.

Your cancer care team will use the results of your biopsy and imaging tests to help assign a cancer stage.

Read more about the stages of bladder cancer.

8. Surgery Is the Main Treatment for Most Bladder Cancers

Most people with bladder cancer will have some type of surgery as part of their treatment plan. In some cases, a TURBT — the same procedure used to take a biopsy for diagnosis — can be used to treat bladder cancer. TURBT is most commonly used for cancer that hasn’t invaded the muscle. A second TURBT may be necessary to make sure all of the cancer cells have been removed.

When the cancer has already invaded the muscle layer of the bladder or if there’s a high risk of muscle invasion, a cystectomy may be needed. A cystectomy is a procedure to remove the bladder. If only part of the bladder is removed, it’s called a partial cystectomy. If the entire bladder is removed, it’s called a radical cystectomy. People who have a radical cystectomy will also need reconstructive surgery to create a new way for urine to leave the body.

Depending on the stage of your cancer, you may need additional treatments after surgery for bladder cancer. In early-stage bladder cancer or NMIBC, medications may be given through a tube directly into the bladder, called intravesical therapy. Other bladder cancer treatments include:

• Radiation therapy
• Chemotherapy
• Immunotherapy
• Targeted therapy

9. Bladder Cancer Outlook Has Improved

New treatments for bladder cancer have helped decrease the number of people who die from the condition over the past few years. The percentage of people who live at least five years after diagnosis (called the five-year relative survival rate) with bladder cancer is 78.4 percent.

Early detection of bladder cancer may improve the prognosis (outlook). When bladder cancer metastasizes (spreads to other parts of the body), the five-year relative survival rate drops to 8.8 percent.

Talk With Your Doctor

A bladder cancer diagnosis can be overwhelming, but learning about it can help you feel more in control. Understanding how it develops, the symptoms to watch for, and the treatments available can help you make informed decisions. Talk to your doctor about any questions or concerns you have. With new treatments and support from your health care team, there is hope for better outcomes and a better quality of life.

Find Your Team

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Do you or a loved one have bladder cancer? What else would you like to learn about bladder cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.