People with bladder cancer may experience the following symptoms or signs. Sometimes, people with bladder cancer do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer.

  • Blood or blood clots in the urine
  • Pain or burning sensation during urination
  • Frequent urination
  • Feeling the need to urinate many times throughout the night
  • Feeling the need to urinate, but not being able to pass urine
  • Lower back pain on 1 side of the body

Sometimes when the first symptoms of bladder cancer appear, the cancer has already spread to another part of the body. In this situation, the symptoms depend on where the cancer has spread. For example, cancer that has spread to the lungs may cause a cough or shortness of breath, spread to the liver may cause abdominal pain or jaundice (yellowing of the skin and whites of the eyes), and spread to the bone may cause bone pain or a fracture (broken bone). Other symptoms of advanced bladder cancer may include pain in the back or pelvis, unexplained appetite loss, and weight loss.

The following tests may be used to diagnose and learn more about bladder cancer:

  • Urine tests. 
  • Cystoscopy is the key diagnostic procedure for bladder cancer. It allows the doctor to see inside the body with a thin, lighted, flexible tube called a cystoscope. Flexible cystoscopy is performed in a doctor’s office and does not require anesthesia, which is medication that blocks the awareness of pain. This short procedure can detect growths in the bladder and determine the need for a biopsy or surgery.
  • Transurethral resection of bladder tumor (TURBT). During a TURBT, the doctor removes the tumor and a sample of the bladder muscle near the tumor. The doctor can also decide to do additional biopsies of other parts of the bladder based on the results of the cystoscopy. Another often procedure done before completing a TURBT is called EUA (exam under anesthesia). In this procedure, the urologist evaluates the bladder to see if any masses can be felt. Any tissue sample (s) removed during the TURBT is then analyzed by a pathologist.

A TURBT is used to diagnose bladder cancer and find out the type of tumor, how deeply it has grown into the layers of the bladder, and identify any additional microscopic cancerous changes, called carcinoma in situ (CIS) (see Stages and Grades). A TURBT can also be used as a treatment for a non-muscle-invasive tumor. See the Treatment Options section for more information.

The following imaging tests may be used to find out if the bladder cancer has spread and to help with staging.

  • Computed tomography (CT or CAT) scan. 
  • Magnetic resonance imaging (MRI).
  • Positron emission tomography (PET) or PET-CT scan.
  • Ultrasound

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging and grading.

Bladder Cancer: Treatment Options

Treatment overview

Treatment options and recommendations depend on several factors, including:

  • The type, stage, and grade of bladder cancer
  • Possible side effects
  • The patient’s preferences and overall health

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

Surgery

disease. Surgical options to treat bladder cancer include:

  • Transurethral bladder tumor resection (TURBT).TURBT may be the complete treatment for the superficial bladder tumours.
  • A radical cystectomy is the removal of the whole bladder and possibly nearby tissues and organs. For men, the prostate and urethra also may be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. In addition, lymph nodes in the pelvis are removed for both men and women. This is called a pelvic lymph node dissection. An extended pelvic lymph node dissection is the most accurate way to find cancer that has spread to the lymph nodes. Rarely, for some specific cancers, it may appropriate to remove only part of the bladder, which is called partial cystectomy.

During a laparoscopic or robotic cystectomy, the surgeon makes several small incisions (cuts) instead of the 1 larger incision used for traditional surgery. The surgeon then uses telescoping equipment with or without robotic assistance to remove the bladder. The surgeon must make an incision to remove the bladder and surrounding tissue. This type of operation requires a surgeon who is very experienced in minimally invasive surgery. Several studies are still in progress to determine whether laparoscopic or robotic cystectomy is as safe as the standard surgery and whether it is able to eliminate bladder cancer as successfully as standard surgery.

  • Urinary diversion.If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.

Increasingly, surgeons can use part of the small or large intestine to make a urinary reservoir, which is a storage pouch that sits inside the body. With these procedures, the patient does not need a urinary bag. For some patients, the surgeon is able to connect the pouch to the urethra, creating what is called a neobladder, so the patient can pass urine out of the body normally. However, the patient may need to insert a thin tube called a catheter if urine does not empty through the neobladder. Also, patients with a neobladder will no longer have the urge to urinate and will need to learn to urinate on a consistent schedule.

For other patients, an internal (inside the abdomen) pouch made of small intestine is created and connected to the skin on the abdomen or umbilicus (belly button) through a small stoma. With this approach, patients do not need to wear a bag. Patients drain the internal pouch multiple times a day by inserting a catheter through the small stoma and immediately removing the catheter.

Living without a bladder can affect a patient’s quality of life. Finding ways to keep all or part of the bladder is an important treatment goal. For some patients with muscle-invasive bladder cancer, certain treatment plans involving chemotherapy and radiation therapy (see below) may be used as an alternative to removing the bladder.

Chemotherapy

There are 2 types of chemotherapy that may be used to treat bladder cancer. The type the doctor recommends and when it is given depends on the stage of the cancer. Patients should talk with their doctor about chemotherapy before surgery.

  • Intravesical chemotherapy.Intravesical (local) chemotherapy is usually given by a urologist. During this type of therapy, drugs are delivered into the bladder through a catheter that has been inserted through the urethra. Local treatment only destroys superficial tumor cells that come in contact with the chemotherapy solution. It cannot reach tumor cells in the bladder wall or tumor cells that have spread to other organs.
  • Systemic chemotherapy. Systemic (whole body) chemotherapy is usually prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

Which chemotherapy regimen is selected depends on the treatment goals and the stage of the bladder cancer.

Immunotherapy

The standard immunotherapy drug for bladder cancer is a weakened bacterium called bacillus Calmette-Guerin (BCG), which is similar to the bacteria that causes tuberculosis. BCG is placed directly into the bladder through a catheter. This is called intravesical therapy. BCG attaches to the inside lining of the bladder and stimulates the immune system to destroy the tumor. BCG can cause flu-like symptoms, chills, mild fever, fatigue, a burning sensation in the bladder, and bleeding from the bladder.

Interferon is another type of immunotherapy that can be given as intravesical therapy. It is sometimes combined with BCG if using BCG alone does not help treat the cancer.

An active area of immunotherapy research is looking at drugs that block a protein called PD-1. PD-1 is found on the surface of T-cells, which are a type of white blood cell that directly helps the body’s immune system fight disease. Because PD-1 keeps the immune system from destroying cancer cells, stopping PD-1 from working allows the immune system to better eliminate the disease.