Bladder cancer

Expert reviewer, Dr Adam Dangoor, Consultant Medical Oncologist
Next review due April 2021

In bladder cancer, the cells lining your bladder wall grow out of control, forming a tumour (a lump or growth).

About bladder cancer

Bladder cancer is the seventh most common cancer in the UK, and it mainly affects people over 55 years old. It’s also more common in men than women.

Blood in your urine is the most common symptom of bladder cancer, which you can read about in our section: Symptoms of bladder cancer.

Types of bladder cancer

There are different types of bladder cancer. The most common in the UK is called transitional cell carcinoma (TCC) or urothelial cancer.

Transitional cell carcinoma (TCC) of the bladder

This type of cancer starts in the cells that line your bladder wall, and can be non muscle invasive or muscle invasive. This refers to whether or not the cells invade the muscle wall of your bladder. In non-muscle-invasive bladder cancer, the cancer cells have not spread past the inner lining of your bladder wall. There are two types of non-muscle-invasive bladder cancer; they are called carcinoma in situ (CIS) and papillary tumour.

Carcinoma in situ (CIS)

This is where the cancer cells appear as flat patches on the surface of your bladder lining.

Papillary tumour

This form of non-muscle invasive bladder cancer is where the cells appear as a branch-like growth.

Around eight out of 10 people with bladder cancer have the type that doesn’t enter the muscle wall of the bladder. This type can be treated with a procedure called transurethral resection of bladder tumour (TURBT).

Muscle-invasive bladder cancer

Cancer that spreads beyond the bladder wall lining into the muscles of your bladder is called muscle-invasive bladder cancer. This is less common than non-muscle-invasive cancer but there is a higher risk of it spreading to other parts of the body.

Bladder cancer that spreads to other parts of the body is called invasive or advanced bladder cancer.

Other types of bladder cancer

There are other less common types of bladder cancer that involve different types of cell in the lining of the bladder. These include squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma

This type of bladder cancer is not very common. Around five out of every 100 people with bladder cancer have squamous cell cancers. It develops from cells lining your bladder and is usually invasive.


About two in every 100 people with bladder cancer have adenocarcinoma. It’s a very rare cancer that is usually invasive, and develops from cells in the lining of your bladder.

Symptoms of bladder cancer

The most common symptom of bladder cancer is blood in your urine. Although this may not happen every time you urinate, it’s important that you see your GP if it happens.

Other symptoms may include:

  • feeling pain or a burning sensation when urinating (dysuria)
  • needing to urinate urgently or more often than usual
  • pain in the lower part of your tummy or back, but this is less common

These symptoms can be caused by other things. For example, a bladder infection can cause pain when passing urine. An urgency to pass urine can also be caused by an overactive bladder or, for men, an enlarged prostate.

If you have advanced bladder cancer, you may have other symptoms. These include:

  • pelvic pain
  • back pain
  • bone pain
  • swelling in your feet

If you have any of the above symptoms, it’s important to go to your GP. There are many possible causes for these symptoms, so doctors will need to rule out other causes.

Diagnosis of bladder cancer

Your GP will ask about your symptoms, your general health and do urine tests to check for blood and infection before any referral. They may refer you to an urologist for further tests. A urologist specialises in diagnosing and treating conditions that affect your urinary system.

What will the urologist do?

Your urologist will organise a flexible cystoscopy test for you. This procedure uses a camera to look inside your bladder. A small tube-like camera is passed up into your bladder to see if there is anything unusual. If there is, the urologist may take some samples, which are sent to the laboratory and tested. The procedure is done under local anaesthesia, so you don’t feel anything.

To help with your diagnosis, you may be asked to give a sample of your urine. For more information, see our FAQ: Urine tests and diagnosis.

You may also need some scans that produce images of the inside of your bladder and the areas around it or, sometimes, your whole body. These scans may include:

If you’re unsure how any of these tests relate to your diagnosis, ask your specialist for advice.

Grading and staging of bladder cancer

When bladder cancer is diagnosed it is given a grade and stage. This helps your doctor to decide what treatment and follow-up care you may need.


The grade shows how different the cancer cells are when compared to those that normally line your bladder wall, and if they are likely to spread. The grade is in the form of a number from one to three.

Grade 1 cells are called low-grade or well-differentiated cells. They usually grow slowly in the bladder lining, and are less likely to spread. Most people with bladder cancer have the low-grade, non-muscle-invasive type.

Grade 2 cells are called moderately differentiated cells and look abnormal. They spread more quickly than grade 1 cancer cells, and are more likely to spread beyond the bladder lining.

Grade 3 cells are called high-grade or poorly differentiated cells. They don’t look or work how they should. They grow much faster than grade 1 and grade 2 cells, and are more likely to spread.


Bladder cancer is given a stage using a system of numbers and letters. These describe the size of your cancer, if it has spread, and how far it has spread. Knowing the stage of your cancer can help your doctor to decide on the best treatment options for you.

Your test results should provide some information about the stage of your cancer. The full results are usually given after surgery to remove the cancer.

Treatment for bladder cancer

The treatments you’ll be offered will depend on whether your bladder cancer is early stage, non-muscle-invasive cancer, or more advanced muscle-invasive bladder cancer.

Treatment usually involves both surgical and non-surgical treatments. Your doctor will discuss your treatment options with you.

Surgical treatments

Transurethral resection of a bladder tumour (TURBT)

TURBT is the best way to diagnose and treat non-muscle-invasive bladder cancer. This procedure is done under general anaesthesia, and allows your surgeon to remove any unusual growths or tumours from your bladder wall. TURBT is often followed by chemotherapy or immunotherapy treatment which destroys any remaining cancer cells, and reduces the chance of your cancer coming back.

After TURBT, you might find it a little uncomfortable to pass urine, and you might also see some blood in your urine. Try not to worry as this usually settles shortly after the procedure.

You can find out more about the procedure and its side-effects in our information on TURBT.


If you have more advanced muscle-invasive bladder cancer, your doctor will recommend that you have your bladder surgically removed (cystectomy). Your doctor may also give you the option to have this treatment if you have high-risk non-muscle-invasive bladder cancer, but it’s not usually necessary.

If you have the muscle-invasive type of cancer but it has not spread beyond your bladder, you may be able to have a partial cystectomy. This is when only some of your bladder is removed. However, having the whole of your bladder and surrounding areas removed (radical cystectomy) is usually the best option. Any affected areas are taken away to stop your cancer from spreading.

After removing your bladder, your surgeon will discuss with you the different options available for you to pass urine. These are:

  • having a bag on the outside of your body to collect your urine
  • using a catheter to drain urine from a new area inside your tummy
  • having a new bladder created – allowing you to pass urine by tensing your tummy muscles

If you have a cystectomy, you may be offered chemotherapy with or without radiotherapy. Chemotherapy uses drugs to damage and kill cancer cells. Chemotherapy and radiotherapy can be used in a variety of ways depending on how far the cancer has spread, and your general health.

Your urologist will talk to you about the benefits and risks of these treatments, including the best treatment option for you.

Non-surgical treatments

Localised chemotherapy

If you have non-muscle-invasive bladder cancer, your doctor will recommend that you have a special type of chemotherapy after having TURBT.

This type of chemotherapy involves putting medicines straight into your bladder (intravesical). Mitomycin C (MMC) is the most commonly used medicine. It works by destroying any cancer cells that remain in your bladder after TURBT. This helps to stop your bladder cancer from coming back. Depending on the risk of your cancer coming back, you may have one or several doses of Mitomycin C (sometimes around six or more).

Whole body chemotherapy

If you have muscle-invasive bladder cancer, you may have chemotherapy that treats your whole body (systemic chemotherapy) not just your bladder. This type of chemotherapy may be given before or after you have other treatments. Having it before other treatments will help to shrink your cancer. Having it after will reduce the risk of the cancer coming back. You’ll also be offered this type of treatment if your bladder cancer has spread (metastasised) to other parts of your body.

If you have systemic chemotherapy, you may get some of the well-known side-effects, such as feeling sick, tiredness and losing your hair. This will depend on the type of treatment that you have. Speak to your oncologist to find out about any possible side-effects. If you have intravesical chemotherapy, you won’t get these side-effects because the chemotherapy only goes into your bladder, not your whole body.


There are two main types of immunotherapy: Bacillus Calmette–Guérin (BCG) and a new form of treatment known as a checkpoint inhibitor.

Bacillus Calmette–Guérin (BCG)

BCG is a type of immunotherapy drug used to treat non-invasive bladder cancer. It was first developed as a tuberculosis vaccine. It’s usually given after a transurethral resection of a bladder tumour (TURBT) procedure to try and reduce the chances of the cancer coming back. It works by stimulating your body’s immune system to attack the cancer cells.

A nurse will pass the BCG vaccine into your bladder through a catheter (a thin tube passing into your bladder). It will stay in your bladder for around two hours, and is then flushed out when you urinate. You’ll have one dose every week for around six weeks.

Possible side-effects are rare, but after the first few doses may include:

  • pain when urinating
  • blood in your urine (haematuria)
  • needing to urinate often
  • flu-like symptoms, such as a raised temperature and tiredness

If you have any of these side-effects, speak to your specialist medical team.

Checkpoint inhibitors

Checkpoint inhibitors encourage the body’s immune system to act against the cancer, and may be used for treating advanced bladder cancer. Checkpoint inhibitors may be available as part of a clinical trial or in certain clinical situations. Clinical trials are medical research studies that support the development of new, more effective treatments. They can also show researchers which treatments are less effective.


Radiotherapy uses high-energy X-rays (radiation) to destroy cancer. It’s usually given in combination with chemotherapy (chemoradiation) to get the best results when treating muscle-invasive bladder cancer. If you can’t have surgery, you may be offered radiotherapy on its own.

Radiotherapy usually involves a number of short painless treatments given five days a week, over six or seven weeks. It does cause side-effects although they affect everyone differently. Feeling tired after radiotherapy is the most common side-effect. Even though you may feel tired, try to keep as active as you can. Other possible side-effects include:

  • passing urine more frequently
  • some discomfort when passing urine
  • loose watery poo (diarrhoea)

Speak to your specialist about the best treatment option for you. You can discuss the benefits and risks, how these will be monitored, and how they will be managed.

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Causes of bladder cancer

Although we don’t know all of the causes of bladder cancer, there are certain things that can increase your chances of developing it. These are called risk factors. But having a risk factor doesn’t mean that you’ll definitely get bladder cancer.


The risk of developing bladder cancer increases with age, as is the case with many cancers. In the UK, around nine out of 10 people diagnosed with bladder cancer are aged 55 or over.


Tobacco smoke contains harmful chemicals that can damage the cells that line your bladder wall. In men, half of all bladder cancers are linked to smoking. For women, a third of all bladder cancers are linked to smoking. Read our blog on giving up smoking.

Contact with industrial chemicals

Certain industrial chemicals used in the rubber, dye, aluminium, coal and roofing industries can increase your risk of developing bladder cancer.

Family history of bladder cancer

Bladder cancer isn’t thought to be hereditary. This means there isn’t a specific gene that you can inherit or pass onto your children that will increase their risk of developing bladder cancer. But there may be a family link due to sharing certain risk factors such smoking or being in contact with certain chemicals. Scientists have also found some differences in people’s genes that make them less able to deal with certain chemicals that can cause bladder cancer.

Medical treatments

Some types of chemotherapy and radiotherapy treatment may increase your risk of developing bladder cancer. These include:

  • having radiotherapy to your pelvis to treat other cancers
  • treatment with a medicine called pioglitazone, which is used to treat type 2 diabetes

But it’s important to remember that the benefits of these treatments may well outweigh the risk of developing bladder cancer in the future.

Inflamed bladder lining

Having an inflamed bladder lining is another risk factor. Such inflammation may be caused by:

  • an infection – for example, with the parasite Schistosoma which causes schistosomiasis, which is most common in Africa, Asia, and South America
  • having a permanent catheter inserted into your bladder– this might apply to you if you have a spinal injury.

Other possible risk factors

It’s unlikely to affect you, but if you drink water that contains a chemical called arsenic, it can increase your risk of developing cancer.

Urine infections, kidney and bladder stones, and other causes of severe bladder irritation have been linked to bladder cancer. However, there’s no evidence to suggest that they cause bladder cancer.

Prevention of bladder cancer

There are things you can do that might lower your risk of getting bladder cancer.

  • Give up smoking: if you smoke, stopping smoking can reduce your risk of bladder cancer. You might find our tips on giving up smoking helpful. Or speak to your GP for advice on the support available on the NHS to help you to give up smoking.
  • Reduce your contact with chemicals: try to limit your contact with chemicals that are known to cause bladder cancer. For more information, see our section: Causes of bladder cancer.
  • Eat lots of healthy foods: some evidence suggests that eating plenty of fresh fruit, vegetables and whole grains can help prevent bladder cancer from coming back. So try to incorporate some of these foods into your meal plans. Read more about having a healthy diet during and after cancer.

Frequently asked questions

  • Although a urine test can help with your diagnosis, cystoscopy is the recommended procedure for diagnosing bladder cancer. Urinary tests should only be used with cystoscopy to help with your diagnosis. Bladder cancer is diagnosed by doing a cystoscopy and taking a biopsy (small sample of tissue) from your bladder wall.

    Urine tests are usually done to check for any blood in your urine that you may not be able to see, and to look for any signs of infection. Blood in your urine is one of the key symptoms of bladder cancer, so checking for this is important. Your urine should also be tested for infection because this, rather than bladder cancer, could be causing your symptoms.

    Urine tests can also be used to help diagnose bladder cancers that may be hard to see during a cystoscopy. To help diagnose these types of bladder cancer, a sample of your urine is taken and tested by a specialist to see if there are any cancerous cells in it.

  • It’s possible that you may be affected by your treatment, but how will depend on which type of treatment you’ve had.

    Most people with bladder cancer have the non-invasive type of cancer, so treatment involves having chemotherapy put inside your bladder. You shouldn’t have any major problems with this type of treatment, but it may cause some irritation. This should usually get better within a few days, but if not contact your ward or doctor for advice.

    If you have muscle-invasive bladder cancer, you’ll need whole body chemotherapy. This may cause you to lose your hair. Some people find this affects their confidence. You might prefer to change your hairstyle before you begin to lose your hair. You may choose to wear a wig, headscarf or soft hat. In the summer, this can help to protect your head from the sun; in the winter, it provides extra warmth.

    Both chemotherapy and radiotherapy treatment can also make you feel tired. Try to be as active as possible. Using exercise programmes can be a good way to help you stay active through your treatment.

  • If you have a cystectomy as part of your treatment, you will no longer have a bladder. Your surgeon will need to divert your urine so it can leave your body. There are different ways to do this. You may need to wear a bag (urostomy bag) on the outside of your body. Or you might have to drain your urine from a new area inside your abdomen (tummy), using a catheter.

    These treatments will make you feel and look a bit different after surgery. Most urostomy bags can’t be seen under clothing, so try not to let this affect you. If you like to swim, there’s no reason why you should stop because waterproof dressings are available. Getting into a good routine to make emptying your urine a more natural part of your day may also help.

    Treatment for bladder cancer may affect your sex life. You’ll feel tired and if you have a cystectomy, you may have some physical changes after the procedure as well. If you’re a woman, your vagina might be shortened. This could make sex slightly painful. You may not feel like having sex and, for men, getting an erection after surgery may be difficult. If you have erectile dysfunction, ask your GP for advice on the different options available to you.

    Coping with cancer can be hard, but there are specialist cancer doctors and nurses who are experts in providing the care and support you need. For links to organisations that can offer more advice, see our section: Other helpful websites.

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  • Reviewed by Marcella McEvoy, Bupa Health Content Team, April 2018
    Expert reviewer, Dr Adam Dangoor, Consultant Medical Oncologist
    Next review due April 2021