Non-Muscle Invasive Bladder Cancer

Written by Keri Wiginton
Medically Reviewed by Laura J. Martin, MD on June 08, 2025
10 min read

Non-muscle invasive bladder cancer is cancer that’s only in the inner lining of your bladder. It hasn’t grown into the muscle wall. Your doctor may also call it superficial bladder cancer, urothelial carcinoma, or transitional cell carcinoma. It's the most common kind of bladder cancer. 

Here’s a quick look at the main layers of your bladder:  

Inner lining (urothelium). Where most bladder cancers begin. 

Submucosa (lamina propria). A thin layer of connective tissue just under the lining. 

Muscle layer (detrusor muscle). A thick, deeper layer that helps you empty your bladder. 

Doctors use a staging system to describe how far non-muscle invasive bladder cancer has spread:

Stage 0. Cancer cells are only in the bladder lining.

Stage I. Cancer has grown into the layer beneath the lining but not into the muscle. 

If caught early, non-muscle invasive bladder cancer is often curable. But it tends to come back. 

“When people hear ‘the big C,’ they often panic and think it’s the end of life, but this is very much a treatable condition,” says Armine Smith, MD, a urologic oncologist and director of Johns Hopkins Urologic Oncology at Sibley Memorial Hospital.

The most common sign of non-muscle invasive bladder cancer is blood in your pee, or hematuria. It may look pink, orange, or red. Blood might come and go or show up every day. Other times, it’s such a small amount that it only shows up on a lab test. 

Some symptoms may feel a lot like other bladder problems. You might:  

  • Need to pee more often than usual (frequency)
  • Feel like you have to pee right away (urgency)
  • Get up a lot at night to use the bathroom
  • Have trouble emptying your bladder all the way

Less often, you might notice: 

  • Burning or pain 
  • Lower belly or pelvic pain
  • Back or side pain
  • Weight loss without trying
  • Feeling tired all the time
  • Loss of appetite 

Most of the time, these symptoms turn out to be something less serious. They’re often due to things like kidney or bladder stones, urinary tract infections (UTIs), or gynecologic issues. But if your symptoms don’t go away after treatment or there’s no clear cause, be sure to check in with a urologist. 

Delayed bladder cancer diagnosis in people assigned female at birth

Bladder cancer is diagnosed more commonly in people assigned male at birth. But people assigned female at birth are more likely to be diagnosed with advanced bladder cancer because there is often a delay in diagnosis. Part of the reason is simple: symptoms can look like other common problems.

“Women are used to seeing blood in the toilet, right? Because they menstruate,” Smith says. “And when a woman presents with blood in the urine, the knee-jerk reaction is often to think it’s a UTI … without realizing they actually have bladder cancer.” 

If you get antibiotics or another treatment and your symptoms don’t clear up, ask for more tests. Even if you’re young or don’t have typical risk factors for bladder cancer, it’s important to rule it out.  

Non-muscle invasive bladder cancer starts when cells in the bladder lining mutate and grow in ways they shouldn’t. Over time, these abnormal cells can form tumors. 

Doctors aren’t exactly sure why this happens in some people and not in others. But research shows that certain chemicals – like cigarette smoke or industrial toxins – can irritate the bladder lining and make cancer more likely. 

Certain things raise your chance of getting non-muscle invasive bladder cancer. Some you can control, others you can’t. Here are the top risk factors for non-muscle invasive bladder cancer:

Smoking. It’s the No. 1 risk factor for bladder cancer, responsible for about half of all cases. Studies show both regular and e-cigarettes boost your odds. Harmful chemicals get into your blood when you smoke. Your kidneys can clean them out, but they just end up in your pee. These cancer-causing substances can sit in your bladder for hours if you hold your pee for long periods of time. This hurts cells and sets the stage for tumors to form.  

On-the-job exposure. Certain industrial chemicals are known to raise the risk of bladder cancer. Your exposure to them may be higher if you work with dyes, rubber, leather, textiles, paints, or printing material. Firefighters, hairdressers, and truck drivers may also be more likely to get bladder cancer.   

Family history of bladder cancer. You’re more likely to form bladder cancer if you have a close relative with the condition. This may happen because you grow up in a similar environment or have shared genes. But most people with bladder cancer don’t have a strong family history. 

Genetics. You can be born with conditions that raise your chances of getting bladder and urinary tract cancers. One example is Lynch syndrome. It affects how cells repair themselves. Over time, too many mistakes can turn into cancer.

Researchers have also found several specific gene changes linked to bladder cancer, including: 

  • TP53 and RB1 
  • FGFR3, PIK3CA, and HRAS 
  • GSTM1 and NAT2
  • PTEN (causes Cowden disease) 

These changes can cause bladder cells to grow and divide too much. Certain mutations may also make it harder for your body to get rid of chemicals and other harmful substances that damage the bladder lining. 

Long-term bladder problems. Ongoing irritation, infection, or inflammation can damage your bladder lining. Examples include frequent UTIs, kidney stones, or bladder stones, along with long-term catheter use. This type of damage is most often linked to a rare form of bladder cancer called squamous cell carcinoma. 

Age. Your odds of getting any kind of cancer go up as you get older. Bladder cancer is no different. Most people are over 55 when they’re diagnosed. 

Being assigned male at birth. Research shows you’re about four times more likely to get bladder cancer. 

If your doctor thinks you might have bladder cancer, they’ll start by asking about your symptoms, health history, and whether you have any close family members who’ve had bladder cancer. 

From there, they may: 

  • Check your belly and press on your bladder during a physical exam.
  • Test your pee for blood, abnormal cells, or signs of infection. 
  • Order imaging tests like ultrasound, CT scan, or MRI to look for tumors.
  • Look inside your bladder with a camera (cystoscopy).

If these tests show something suspicious, the next step is a closer look. 

“The combination of imaging and cystoscopy can usually show what we’re dealing with,” Smith says. “However, that’s not enough.”

Your doctor may tell you they want to do a:

Biopsy. This is when a small sample of tissue is cut out during the cystoscopy and sent to a lab. A pathologist looks at the cells under a microscope to check if they’re cancerous. 

Resection. They’ll use special tools to remove the tumor through the cystoscope, without making any cuts on your body. This is often done at the same time as the cystoscopy and biopsy. 

Second opinion for bladder cancer 

If you’re diagnosed with bladder cancer, especially if it’s high-grade or you need more treatments, it’s a good idea to talk to another doctor. They may confirm your diagnosis and treatment plan or offer a different approach. 

“I always, always encourage patients to seek a second opinion,” Smith says. “The original provider shouldn’t get offended by that, and I think we’ve all seen scenarios where seeking a second opinion really improves the outcomes of the disease in complicated stages.” 

The main goal of treatment is to get rid of the cancer, lower the odds it comes back, and keep it from spreading. Here’s how your doctor might do that: 

Surgery

The first step for almost everyone is a procedure called transurethral resection of bladder tumor (TURBT). This surgery is both diagnostic (confirms the stage and grade) and therapeutic (removes cancer). 

“We try to remove the whole tumor, whatever is visible,” Smith says.

After surgery, your doctor may suggest more steps to help prevent the cancer from coming back. In some cases, you may need a second resection four to six weeks later. This might happen if:  

  • You have a high-grade tumor.
  • The first resection didn’t remove all of it.
  • There’s concern that cancer might invade the muscle layer.

Less often, you may need surgery to remove your entire bladder (cystectomy). This isn’t common in non-muscle invasive cancer, but it’s sometimes the best choice if your cancer is fast-growing or keeps coming back.  

Intravesical therapy 

After surgery, your doctor may put medication directly inside your bladder. This treatment helps kill any leftover cancer cells and lowers the risk of recurrence. 

The two main types of medicines used for intravesical therapy are: 

Bacillus Calmette-Guerin (BCG). A form of immunotherapy that helps your immune system attack bladder cancer cells. You’ll likely get it once a week for six weeks. If it works well, you might continue with doses every few months for up to three years. Other intravesicle immunotherapies include nadofaragene firadenovec (Adstiladrin) and nogapendekin alfa inbakicept (Anktiva).

Intravesical chemotherapy. Your doctor may place chemo drugs like mitomycin or gemcitabine straight into your bladder through a catheter. You’re more likely to get this treatment if BCG doesn’t work or isn’t an option. 

Monitoring and follow-up

Even after successful treatment, there’s still a high chance non-muscle invasive bladder cancer can return. How often you’ll need check-ups depends on your specific situation, “but you’ll probably have a pretty close relationship with your urologist for a while,” says Michael Karellas, MD, a urologic oncologist with Yale Medicine and Smilow Cancer Hospital. 

Your surveillance plan will likely include: 

  • Cystoscopies every three to six months for the first two years
  • Regular pee tests to screen for blood or cancer cells

If you have high-risk bladder cancer, you may also need ongoing imaging tests to monitor your bladder, kidneys, and nearby areas. Your doctor will let you know what’s best for your situation. 

There’s no surefire way to prevent bladder cancer. But certain healthy habits can lower your risk. One of the biggest things you can do is not smoke. 

“People think smoking causes lung cancer or heart disease,” Karellas says. “They don’t always associate it with bladder cancer.” 

Other ways to support your bladder health include: 

  • Drink plenty of water to flush out irritants.
  • Eat lots of nutritious foods like fruits, vegetables, and whole grains. 
  • Avoid or limit red and processed meats.

It’s also a good idea to ask your doctor about any genetic risks. They may suggest extra screening to catch any changes early if you have an inherited risk, like Lynch syndrome. While you can’t change your genes, close monitoring can help find bladder cancer before it spreads, when it’s easier to treat. 

The five-year survival rate for non-muscle invasive bladder cancer is around 97%. That means most people with NMIBC live at least five years after diagnosis. 

Still, your personal outlook can depend on a few things: 

  • The number and size of your tumors.
  • Whether cancer cells are in the connective tissue under the bladder lining.
  • Whether the cancer has come back after treatment.

That’s why ongoing care is so important. Cancer that comes back is easier to manage if you catch it early. 

Healthy habits don’t replace medical treatment, but they can make a big difference in how you feel. Along with how well your body handles treatment and recovery.  

Tips to support your bladder and overall well-being include: 

Stick to your follow-up plan. Expect regular bladder checkups for at least five to 10 years after treatment. Your doctor will let you know how often you need to come in. Make sure to keep every appointment, even if you feel fine. 

Know what’s normal for you. Learn the signs your doctor wants you to watch for, like new urinary symptoms, pain, or blood in your pee. If something feels off, tell your doctor. 

Conserve your energy. Fatigue is common after bladder cancer treatments. Rest when you need to, and pace yourself. Gentle exercises, like walking or stretching, can help you build energy back over time. 

Support your emotional health. It’s normal to worry that your cancer might come back. If you’re feeling overwhelmed, talk to a counselor, join a support group, or reach out to friends and family. Staying connected can help you feel less alone. 

Focus on healthy choices. You don’t have to change your whole lifestyle overnight. But not smoking, staying hydrated, eating nutritious foods (like the Mediterranean diet), and moving your body a little each day can help you feel more in control and better support recovery.

Non-muscle invasive bladder cancer (NMIBC) is an early form of bladder cancer. It stays in the inner layers of the bladder and is usually easier to treat than deeper, muscle-invasive types. Most people are diagnosed at this stage. 

While NMIBC often responds well to treatment, it can come back over time. That’s why regular follow-up care is key. Catching any changes early gives you the best chance to manage the cancer successfully. 

What stage is non-muscle invasive bladder cancer?

Non-muscle invasive bladder cancer (NMIBC) can be stage 0 or stage I. Stage 0 means you have cancer cells in the inner layer of your bladder lining but not the bladder wall. Stage I is when bladder cancer spreads to the connective tissue but not to the muscle. 

What is the difference between non-muscle invasive and muscle invasive bladder cancer?

The main difference is how deep the cancer has grown into the bladder. Non-muscle invasive bladder cancer (NMIBC) stays in the inner layers. Muscle-invasive bladder cancer (MIBC) means cancer cells have grown deeper,  into the muscle layer. MIBC is more likely to spread to other parts of the body and is often harder to treat than NMIBC. 

What is the most aggressive form of bladder cancer?

There isn’t a single most aggressive form, but muscle-invasive bladder cancer is often more aggressive than non-muscle invasive. There’s also a rare but very fast-growing type called micropapillary bladder cancer. It usually grows and spreads quickly, even if it starts as non-muscle invasive.