What Is Bladder Cancer?
Bladder cancer happens when cells in the bladder become abnormal and grow out of control. Over time, a tumor forms. It can spread to nearby lymph nodes and other organs. In severe cases, it can spread to distant parts of your body, including your bones, lungs, or liver.
The American Cancer Society’s estimates for bladder cancer in the U.S. for 2025 are about 84,870 new cases, with about 65,000 in men and nearly 20,000 in women. Bladder cancer is the fourth most commonly diagnosed malignancy in men in the country and the 10th leading cause of cancer deaths in the U.S.
The bladder is a hollow, flexible pouch in your pelvis. Its main job is to store urine before it leaves your body. Your kidneys make pee. Tubes called ureters carry the pee from your kidneys to your bladder. When you use the bathroom, the muscles in your bladder push the urine out through a tube called the urethra.
Types of Bladder Cancer
Transitional cell carcinoma
This is the most common type of cancer that starts in the bladder. It's also known as urothelial carcinoma because it starts in the cells that line the bladder, known as urothelial cells. These cells also line other parts of the urinary tract, such as the urethra and part of the kidney. If you have this type of cancer, your doctor should check your whole urinary tract for other tumors.
Squamous cell carcinoma
Only about 5% of cancers are this type, which look like cancers found on the skin. Squamous cell carcinomas are usually caused by bladder irritation, often due to long-term catheter use or repeated infections.
Adenocarcinoma
Adenocarcinomas are only found in about 2% of people with bladder cancer. These tumors begin in the cells that form glands.
Small cell carcinoma of the bladder
Only about 1% of cancers are small cell carcinomas. These are fast-growing cancers that start in nerve-like cells of the bladder and are usually treated with chemotherapy.
Sarcoma
These are very rare cancers that start in the bladder's muscle cells.
Bladder Cancer Causes
Doctors aren't sure exactly what causes cancer, but they do know that several things increase your risk for the disease. If you have these risk factors, you are more likely to have changes in the bladder cells that can cause cancer. These changes in the DNA of bladder cells, or gene mutations, usually develop over time due to things such as exposure to chemicals.
Bladder cancer risk factors
Factors that make you more likely to have bladder cancer include:
Genetic makeup, race, and family history. Bladder cancer is most common in White men and people assigned male at birth, over age 55. If you or someone in your immediate family (parents or siblings) has had cancer of the bladder or the urinary tract before, you're more likely to get it.
Chronic bladder inflammation. If you have bladder infections that keep coming back or another condition that causes bladder irritation for long periods, you have a bigger risk of getting bladder cancer.
Smoking. Every time you inhale tobacco fumes, you're taking in all kinds of harmful chemicals. Research shows that smoking causes about 50% of all bladder cancers.
Working around harmful chemicals. People who work in certain industries (painters, machinists, printers, hairdressers, and truck drivers, among others) may be exposed to harmful chemicals for long periods. This can raise their risk of disease.
Taking certain diabetes medications. If you've taken pioglitazone (Actos) for more than a year, you may stand a greater chance of getting bladder cancer. Taking other diabetes medications that contain pioglitazone (Actoplus Met and Duetact) can also raise your risk.
Prior chemo therapy or radiation treatment. If you've had radiation therapy to your pelvis, you're more likely to develop bladder cancer. The same is true if you've taken the chemotherapy medication cyclophosphamide (Cytoxan) for a long time.
Bladder Cancer Symptoms
Stage I bladder cancer symptoms
The most common symptom of bladder cancer is having blood in your urine, which can be a sign of stage I bladder cancer. There may be small amounts of blood in your pee, turning it orange or pink. Advanced bladder cancer may make your urine dark red. Blood in the urine may come and go. In the early stages of bladder cancer, there is usually no pain or other symptoms. But you may notice these symptoms:
- Peeing more than usual
- Pain or burning when you pee
- Feeling like you need to pee even when you don't have a full bladder
- Difficulty peeing
- Having a weak stream
- Peeing a lot during the night
Advanced-stagebladder cancer symptoms
If your cancer has grown or spread to other parts of your body (stages II, III, and IV), you may have symptoms such as:
- Low back pain, just on one side
- Being unable to pee
- Lack of appetite and weight loss
- Foot swelling
- Bone pain
- Fatigue or weakness
If you have symptoms such as blood in your urine, back pain, or pain when you pee, it doesn't mean you have bladder cancer. But you should talk to your doctor. Bladder cancer, especially in women, is often diagnosed later because they think blood in the pee could be due to their period or another gynecological issue. Early detection helps prevent the worsening and spread of bladder cancer.
Bladder Cancer Staging
Bladder cancer staging is a tool that tells you about your cancer — its size, how much of the bladder wall it has spread to, and if it has spread to other parts of the body. Bladder cancer staging is numbered from stage 0 to stage IV. Your doctor will use staging to decide what kind of treatment is needed for your bladder cancer.
Your doctor will also give your cancer a grade. By looking at the cells, they can tell whether it's low-grade cancer (slow-growing and more likely to spread) or high-grade cancer (faster-growing and less likely to spread).
Stage 0
This kind of bladder cancer is only in the tissue lining the bladder and hasn't moved further into the wall. It is divided into two grades:
- Noninvasive papillary carcinoma: Can be either low-grade or high-grade and looks like long growths
- Carcinoma in situ: Always high grade and looks like a flat tumor
Stage I
This cancer is in the inner lining of the bladder wall and the connective tissue.
Stage II
This is when the tumor has spread from the connective tissue to the layers of muscle in the bladder. Your doctor may also call this muscle-invasive bladder cancer.
Stage III
This is when the cancer has spread locally. There are two stages of this type of cancer:
- Stage IIIA (3A): The cancer has spread to the fat and nearby reproductive organs, including the prostate and vagina, but not to lymph nodes; or it has spread to a lymph node that is not near a major artery.
- Stage IIIB (3B): The cancer has spread to multiple lymph nodes away from a major artery or to one lymph node near an artery.
Stage IV
This is also known as metastatic cancer, where cancer spreads to other parts of the body through blood or the lymphatic system. It has two grades:
- IVA (4A): The cancer has spread to the wall of the abdomen or pelvis or to the lymph nodes above the arteries in the pelvis.
- IVB (4B): The cancer has spread to organs away from the reproductive system or other parts of the body, such as the lungs.
Bladder Cancer Diagnosis
Your doctor will perform tests for bladder cancer if you have symptoms. Sometimes, bladder cancer can be caught during a regular physical if your doctor takes a urine sample. If your doctor thinks you may have bladder cancer or wants to rule it out, they may suggest the following tests.
- Urinalysis can help your doctor analyze your pee and see if blood is due to an infection.
- Cytology is used to look at cells with a microscope to see if they are cancerous.
- Cystoscopy is when your doctor uses a small tube with a light to see the inside of your bladder and urethra. They may also use fluorescent dye to better see the cancer. This is the most commonly used test to find bladder cancer.
If these tests show that you have bladder cancer, your doctor will perform other tests to find out more about the tumor and if it has spread. These tests include:
- Transurethral resection of bladder tumor. This outpatient procedure lets your doctor remove the tumor before it spreads. It also helps your doctor do other tests on the cancer cells.
- MRI. This test uses a magnet and radio waves to let your doctor get a better view of your bladder.
- CT scan. This test uses X-rays to see your bones and soft tissue. It helps your doctor see if cancer has spread outside of your bladder.
- Chest X-ray. This test lets the doctor see if the cancer has spread to your lungs.
- Bone scan. This test lets the doctor see if the cancer has spread to your bones.
Bladder Cancer Treatments
Many treatments can be used for bladder cancer, though surgery is the most common one. The kind of treatment that your doctor will suggest depends on the kind of tumor, its stage, and if and where it has spread.
Bladder cancer surgery
If you need surgery on a bladder tumor, your doctor may do it alone or with other treatments, such as chemotherapy or radiation. There are several types of treatments that your doctor may recommend. These include:
Transurethral resection (TUR) with fulguration. During this type of surgery, your doctor will use a thin tube with a light that goes through the urethra into the bladder. Your doctor uses either a cystoscope (a tool with a wire loop on the end to remove the cancer) or fulguration (where they burn the cancer away).
Partial cystectomy. In this surgery, a part of the bladder is removed. Also called segmental cystectomy, this is used when the tumor has moved into the wall of the bladder, but is located only in one area.
Radical cystectomy with urinary diversion. This is done when the cancer has moved into the layer of muscle in the bladder wall. Your doctor may also recommend this surgery when the tumor isn't in the layer of muscle but has spread widely across the bladder. Your doctor will remove your bladder, lymph nodes, and any nearby reproductive organs where the cancer has spread, such as the uterus, ovaries, or prostate.
When your doctor removes your bladder, they will create another way for pee to leave the body, known as urinary diversion. Catheters may be used to drain pee through the colon. Or an opening in your abdomen is connected to a bag outside of your body to collect urine.
Radiation therapy. During this therapy, an X-ray, or other type of machine, focuses radiation on your bladder or other area of the body where there is cancer. Radiation can either kill the tumors or keep them from getting bigger.
Chemotherapy. Your doctor will give you medication or injections that can kill cancer cells or keep them from dividing and spreading. The type of chemotherapy you get depends on what kind of tumor you have.
Sometimes, for bladder cancer, your doctor will use intravesical chemotherapy after surgery to kill any remaining cancer cells and help lower the chance of cancer returning. Here, a tube is put in your urethra and then into your bladder, where chemotherapy medications are flushed in.
Immunotherapy. Some people with certain types of bladder cancer may respond to immunotherapy. Immunotherapy medications help your immune system attack and kill cancer cells. Your doctor may give these drugs by injection or through intravesical use.
Targeted therapy. Some people also respond to targeted therapy, which uses medications to target specific parts of cancer cells. These medications target the parts of the cells that change a healthy cell into an unhealthy, or cancerous, one. These drugs help keep the unhealthy cells from growing and multiplying, and some cut off the blood supply or signals they need to live.
Can You Prevent Bladder Cancer?
There is no one way to completely prevent bladder cancer. But some factors can increase your risk. Making some lifestyle changes may help cut your risk of getting bladder cancer. They may also help with early detection if you know you have a risk factor and begin having symptoms.
If you smoke, stop. Doctors believe tobacco products cause about half of all bladder cancer cases. Exposure to secondhand smoke also increases your risk.
Drink lots of fluids. When you pee, you get rid of harmful chemicals that build up in your bladder. So, drink up -- especially water. It may lower your cancer risk and reduce the number of bladder infections you have, which also increases your risk of bladder cancer.
Eat more fruits and veggies. Studies show that eating lots of fruits and green, leafy vegetables lowers your risk for many types of cancer. It may help cut your risk for bladder cancer, too.
Other risk factors include:
Exposure to chemicals. Being exposed to some workplace chemicals, such as arsenic and aniline (a coal tar-derived product used to make drugs, dyes, and plastics), can put you at a higher risk for bladder cancer.
Cancer treatments. Having radiation and some chemotherapy medications for cancer can increase your risk of having bladder cancer.
Bladder cancer. If you've had bladder cancer once, you are at a higher risk of having it again.
Bladder Cancer Survival Rates
The five-year survival rate for bladder cancer is about 77%. That means that about 7 out of 10 people who are diagnosed with the disease will still be alive five years later. But that's just an estimate. Your outcome is based on your unique situation. That includes things such as your age, overall health, how early the cancer was found, and how well it responds to treatment.
Takeaways
Men and people assigned male at birth are much more likely to get bladder cancer than women and people assigned female at birth. The risk increases over the age of 55. But bladder cancer is a very treatable condition, especially when caught early. That's why it's so important to talk to your doctor if you have symptoms like dark pee or blood when you pee.
Bladder Cancer FAQs
Does high water intake cause bladder cancer?
Some older studies have shown that very high water intake (100 oz a day) may increase the risk of bladder cancer, but other studies show that drinking plenty of water helps you pee more and get rid of carcinogens in the bladder.
Can you have bladder cancer for years and not know it?
You can have bladder cancer and not know it in its early stages. Blood in the urine is usually one of the first signs. Women often overlook this, mistaking it for a gynecological cause. If you have any symptoms like bleeding when you pee, dark pee, or unusual abdominal pain, talk to your doctor.
What hurts when you have bladder cancer?
An early sign is pain or burning when you pee. But you may also have lower back pain just on one side.
What causes bladder cancer in females?
There are several risk factors for bladder cancer, with smoking being a major one. But you may also be more likely to get bladder cancer if you have frequent bladder infections.
How serious is bladder cancer?
Bladder cancer is a serious condition, but it is very treatable, especially if it is caught early. For instance, the five-year survival rate for people with the earliest stage of cancer is 97%. When a tumor is just in the bladder and hasn't spread, it's 71%.
