Bladder Cancer Symptoms, Tests, Prognosis, and Stages (PDQ®)–Patient Version

General Information About Bladder Cancer

Key Points

  • Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.
  • Smoking can affect the risk of bladder cancer.
  • Signs and symptoms of bladder cancer include blood in the urine and pain during urination.
  • Tests that examine the urine and bladder are used to help detect (find) and diagnose bladder cancer.
  • Certain factors affect prognosis (chance of recovery) and treatment options.

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 to store urine made by the kidneys. There are two kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.

Enlarge Anatomy of the male urinary system (left panel) and female urinary system (right panel); two-panel drawing showing 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.  Also shown are the prostate and penis (left panel) and the uterus (right panel).
Anatomy of the male urinary system (left panel) and female urinary system (right panel) showing the kidneys, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.

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):

  • Transitional cell carcinoma: Cancer that begins in cells in the innermost tissue layer of the bladder. These cells are able to stretch when the bladder is full and shrink when it is emptied. Most bladder cancers begin in the transitional cells. Transitional cell carcinoma can be low-grade or high-grade:
    • Low-grade transitional cell carcinoma often recurs (comes back) after treatment, but rarely spreads into the muscle layer of the bladder or to other parts of the body.
    • High-grade transitional cell carcinoma often recurs (comes back) after treatment and often spreads into the muscle layer of the bladder, to other parts of the body, and to lymph nodes. Almost all deaths from bladder cancer are due to high-grade disease.
  • Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation.
  • Adenocarcinoma: Cancer that begins in glandular cells that are found in the lining of the bladder. This is a very rare type of bladder cancer.

Cancer that is in the lining of the bladder is called superficial bladder cancer. Cancer that has spread through the lining of the bladder and invades the muscle wall of the bladder or has spread to nearby organs and lymph nodes 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 the following:

  • Using tobacco, especially smoking cigarettes.
  • Having a family history of bladder cancer.
  • Having certain changes in the genes that are linked to bladder cancer.
  • 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 Aristolochia fangchi, a Chinese herb.
  • Drinking water from a well that has high levels of arsenic.
  • Drinking water that has been treated with chlorine.
  • Having a history of bladder infections, including bladder infections caused by Schistosoma haematobium.
  • Using urinary catheters for a long time.

Older age is a risk factor for most cancers. The chance of getting cancer increases as you get older.

Signs and symptoms of bladder cancer include blood in the urine and pain during urination.

These and other signs and symptoms may be caused by bladder cancer or by other conditions. Check with your doctor if you have any of the following:

  • Blood in the urine (slightly rusty to bright red in color).
  • Frequent urination.
  • Pain during urination.
  • Lower back pain.

Tests that examine the urine and bladder 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 lubricated, 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 : A laboratory test in which a sample of urine is checked under a microscope 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.
    EnlargeCystoscopy; drawing shows a side view of the lower pelvis containing the bladder, uterus, and rectum. Also shown are the vagina and anus. The flexible tube of a cystoscope (a thin, tube-like instrument with a light and a lens for viewing) is shown passing through the urethra and into the bladder. Fluid is used to fill the bladder. An inset shows a woman lying on an examination table with her knees bent and legs apart. She is covered by a drape. The doctor looks at an image of the inner wall of the bladder on a computer monitor.
    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.
  • Intravenous pyelogram (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.
  • 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.
  • The type of bladder cancer cells and how they look under a microscope.
  • Whether there is carcinoma in situ in other parts of the bladder.
  • The patient’s age and general health.

If the cancer is superficial, prognosis also depends on the following:

  • How many tumors there are.
  • The size of the tumors.
  • Whether the tumor has recurred (come back) after treatment.

Treatment options depend on the stage of bladder cancer.

Stages of Bladder Cancer

Key Points

  • 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 body.
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • The following stages are used for bladder cancer:
    • Stage 0 (Noninvasive Papillary Carcinoma and Carcinoma in Situ)
    • Stage I
    • Stage II
    • Stage III
    • Stage IV

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 body.

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. To stage bladder cancer, the CT scan may take pictures of the chest, abdomen, and pelvis.
  • MRI (magnetic 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, such as the brain. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. This procedure is done to check whether there are malignant tumor cells in the lymph nodes.
  • 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 with cancer and is detected by a scanner.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if bladder cancer spreads to the bone, the cancer cells in the bone are actually bladder cancer cells. The disease is metastatic bladder cancer, not bone cancer.

Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.

The following stages are used for bladder cancer:

Stage 0 (Noninvasive Papillary Carcinoma and Carcinoma in Situ)

Enlarge Stage 0 bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. First inset shows stage 0a (also called noninvasive papillary carcinoma) on the inner lining of the bladder. Second inset shows stage 0is (also called carcinoma in situ) on the inner lining of the bladder. Also shown are the layers of connective tissue and muscle tissue of the bladder and the layer of fat around the bladder.
Stage 0 bladder cancer. Abnormal cells are found in the tissue lining the inside of the bladder. Stage 0a (also called noninvasive papillary carcinoma) may look like long, thin growths growing from the lining of the bladder. Stage 0is (also called carcinoma in situ) is a flat tumor on the tissue lining the inside of the bladder.

In stage 0, abnormal cells 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 stages 0a and 0is, depending on the type of the tumor:

  • Stage 0a is also called noninvasive papillary carcinoma, which may look like long, thin growths growing from the lining of the bladder.
  • Stage 0is is also called carcinoma in situ, which is a flat tumor on the tissue lining the inside of the bladder.

Stage I

Enlarge Stage I bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. Inset shows cancer in the inner lining of the bladder and in the layer of connective tissue next to it.  Also shown are the muscle layers of the bladder and the layer of fat around the bladder.
Stage I bladder cancer. Cancer has spread to the layer of connective tissue next to the inner lining of the bladder.

In stage I, cancer has formed and spread to the layer of connective tissue next to the inner lining of the bladder.

Stage II

Enlarge Stage II bladder cancer; drawing shows the bladder, ureter, prostate, and urethra. Inset shows cancer in the inner lining of the bladder, the layer of connective tissue, and the muscle layers. Also shown is the layer of fat around the bladder.
Stage II bladder cancer. Cancer has spread to the layers of muscle tissue of the bladder.

In stage II, cancer has spread to the layers of muscle tissue of the bladder.

Stage III

Stage III is divided into stages IIIA and IIIB.

  • In stage IIIA:
    EnlargeStage IIIA bladder cancer; drawing shows cancer in the bladder and in  (a) the layer of fat around the bladder and (b) one lymph node in the pelvis. Also shown are the  right and left common iliac arteries and the prostate.
    Stage IIIA bladder cancer. Cancer has spread from the bladder to (a) 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, and cancer has not spread to lymph nodes; or (b) one lymph node in the pelvis that is not near the common iliac arteries.
  • In stage IIIB, cancer has spread from the bladder 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.
    EnlargeStage IIIB bladder cancer; drawing shows cancer in the bladder and in  (a) more than one lymph node not near the common iliac artery and (b) one lymph node near the common iliac artery. Also shown are the right and left common iliac arteries.
    Stage IIIB bladder cancer. Cancer has spread from the bladder 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.

Stage IV

Enlarge Stage IVA and IVB bladder cancer; drawing shows cancer that has spread from the bladder to (a) the abdominal or pelvic wall and (b) lymph nodes above the  common iliac arteries. Also shown is cancer that has spread to (c) other parts of the body, including the lung, liver, and bone.
Stage IVA and IVB bladder cancer. In stage IVA, cancer has spread from the bladder to (a) the wall of the abdomen or pelvis; 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 is divided into stages IVA and IVB.

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

Recurrent Bladder Cancer

Recurrent 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.

  • Updated: May 3, 2018

Most text on the National Cancer Institute website may be reproduced or reused freely. The National Cancer Institute should be credited as the source and a link to this page included, e.g., “Bladder Cancer Symptoms, Tests, Prognosis, and Stages (PDQ®)–Patient Version was originally published by the National Cancer Institute.”

Please note that blog posts that are written by individuals from outside the government may be owned by the writer, and graphics may be owned by their creator. In such cases, it is necessary to contact the writer, artists, or publisher to obtain permission for reuse.

We welcome your comments on this post. All comments must follow our comment policy.