Bladder Cancer Treatment (PDQ®)
General Information About Bladder Cancer
Bladder cancer is a disease in which malignant (cancer) cells
form in the tissues of the bladder.
The bladder is a hollow organ in the lower part of the abdomen. It is shaped like a small balloon and has a muscular wall that
allows it to get larger or smaller. The bladder stores urine until it is passed out of the body. Urine is the liquid waste that is made by
the kidneys when they clean the blood. The urine passes from the two kidneys
into the bladder through two tubes called ureters. When the bladder is emptied
during urination, the urine goes from the bladder to the outside of the body
through another tube called the urethra.
Anatomy of the male urinary system; shows the right and left kidneys, the ureters, the bladder filled with urine, and the urethra passing through the penis. The inside of the left kidney shows the renal pelvis. An inset shows the renal tubules and urine. Also shown is the prostate.
Anatomy of the female urinary system; shows the right and left kidneys, the ureters, the bladder filled with urine, and the urethra. The inside of the left kidney shows the renal pelvis. An inset shows the renal tubules and urine. The uterus is also shown.
There are three types of bladder cancer that begin in cells in the lining of the
bladder. These cancers are named for the
type of cells that become malignant (cancerous):
Cancer that is confined to the lining of the bladder is called
superficial bladder cancer. Cancer that begins in the transitional cells may spread
through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes;
this is called invasive bladder cancer.
See the following PDQ summaries for more information:
Smoking can affect the risk of bladder cancer.
Anything that increases your chance of getting a disease
is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for bladder cancer. Risk factors for bladder cancer include:
- Using tobacco, especially smoking cigarettes.
- Being exposed to certain substances, such as soot from coal, or chemicals used to make rubber, certain dyes, or textiles.
- Working as a dry cleaner or in places where paper, rope, twine, or clothing is made.
- Taking Aristolochia fangchi, a Chinese herb.
- Drinking water that has high levels of arsenic.
- Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
- Using urinarycatheters for a long time.
- Having a history of kidney or bladder stones.
- Past treatment with certain anticancer drugs or radiation therapy to the pelvis.
- Having a kidney transplant.
- Having hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).
Possible signs of bladder cancer include blood in the urine or
pain during urination.
These and other symptoms may be caused by bladder cancer. Other conditions may cause the same symptoms. Check with your doctor if you have any of the following problems:
- Blood in the urine (slightly rusty to bright red in
- Frequent urination, or feeling the need to urinate without
being able to do so.
- Pain during urination.
- Lower back pain.
Tests that examine the urine, vagina, or rectum are used to
help detect (find) and diagnose bladder cancer.
The following tests and procedures may be used:
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers
into the vagina and/or rectum to feel for lumps.
Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
Urine cytology: Examination of urine under a microscope to check for abnormal cells.
Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
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.
(IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:
- The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
type of bladder cancer cells and how they look under a microscope.
- The patient’s age and general health.
Treatment options depend on the stage of bladder cancer.
Stages of Bladder Cancer
After bladder cancer has been diagnosed, tests are done
to find out if cancer cells have spread within the bladder or to other parts of
The process used to find out if cancer has spread within the
bladder lining and muscle or to other parts of the body is called staging. The information gathered from the
staging process determines the stage of the disease. It is important to know
the stage in order to plan treatment. The following tests and
procedures may be used in the staging process:
CT scan (CAT scan):
A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for bladder cancer:
Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
In stage 0, abnormalcells are found in tissue lining the
inside of the bladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is divided into stage 0a and stage 0is, depending on the type of the tumor:
In stage I, cancer
has formed and spread to the layer of tissue under the inner lining of the bladder.
In stage II, cancer
has spread to the muscle wall of the bladder.
In stage III, cancer
has spread from the bladder to the fatty layer of tissue surrounding it and may
have spread to the reproductive organs (prostate, seminal vesicles, uterus, or vagina).
In stage IV, one or more of the following is true:
Recurrent Bladder Cancer
bladder cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bladder or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with bladder
Different types of treatment are available for patients with bladder cancer. Some treatments are standard (the currently used treatment), and some
are being tested in clinical trials.
A treatment clinical trial is a research study meant to help
improve current treatments or obtain information on new treatments for patients
with cancer. When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
One of the following types of surgery may be done:
Transurethral resection (TUR) with fulguration: Surgery in which a cystoscope (a thin lighted tube) is inserted into the bladder through the urethra.
A tool with a small wire loop on the end is then used to remove the
cancer or to burn the tumor away with high-energy electricity. This is known as fulguration.
Radical cystectomy: Surgery to remove the bladder and any
lymph nodes and nearby organs that contain cancer. This surgery may be
done when the bladder cancer invades the muscle wall, or when superficial
cancer involves a large part of the bladder. In men, the nearby organs that are
removed are the prostate and the seminal vesicles. In women, the uterus, the
ovaries, and part of the vagina are removed. Sometimes, when the cancer has
spread outside the bladder and cannot be completely removed, surgery to remove
only the bladder may be done to reduce urinarysymptoms caused by the cancer.
When the bladder must be removed, the surgeon creates another way for urine to
leave the body.
Segmental cystectomy: Surgery to remove part of the
bladder. This surgery may be done for patients who have a low-grade tumor that
has invaded the wall of the bladder but is limited to one area of the bladder.
Because only a part of the bladder is removed, patients are able to urinate normally after
recovering from this surgery.
Urinary diversion: Surgery to make a new way for
the body to store and pass urine.
Even if the doctor removes all the cancer that can be seen at the
time of the surgery, some patients may be given chemotherapy after surgery to
kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Bladder cancer may be treated with intravesical (into the bladder through a tube inserted into the urethra) chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated.
See Drugs Approved for Bladder Cancer for more information.
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in
clinical trials. It may not mention every new treatment being studied.
Information about clinical trials is available from the
NCI Web site.
Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk that cancer will recur (come back).
Photodynamic therapy (PDT) is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. Fiberoptic tubes are then used to carry the laser light to the cancer cells, where the drug becomes active and kills the cells. Photodynamic therapy causes little damage to healthy tissue.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order 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. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stage 0 (Papillary Carcinoma and Carcinoma in Situ)
Treatment of stage 0 may include the
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage I Bladder Cancer
Treatment of stage I bladder cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage I bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage II Bladder Cancer
Treatment of stage II bladder cancer may include the
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage II bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage III Bladder Cancer
Treatment of stage III bladder cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Stage IV Bladder Cancer
Treatment of stage IV bladder cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IV bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Treatment Options for Recurrent Bladder Cancer
Treatment of recurrentbladder cancer depends on previous treatment
and where the cancer has recurred. Treatment for recurrent bladder cancer may
include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent bladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About Bladder Cancer
For more information from the National Cancer Institute about bladder cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Changes to This Summary (03/04/2013)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Editorial changes were made to this summary.
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Date Last Modified: 2013-03-04
* Source: The National Cancer Institute's Physician Data Query (PDQ(r))
Cancer Information Summaries ( http://www.cancer.gov/cancertopics/pdq )