Bladder cancer

What is it?

The bladder is a hollow organ low in your tummy that collects and stores pee.^1,4 Bladder cancer occurs in the lining of the bladder.^1,5 There are different types, depending on where in the bladder it starts.⁴ Some stay in the lining; others grow into the muscle of the bladder wall.⁵

It is more common in men and in people over 60. It is most often found in people aged 65 to 74.^4,5 Smoking is one of the main causes. You are more likely to get bladder cancer if you smoke or use chewing tobacco.^4,6 Working with certain chemicals (for example in the textile industry, or with carbon or crude oil), a long-term urinary catheter, earlier radiotherapy, being overweight and diabetes also raise the risk.⁶ It is more likely if a close relative has had bladder cancer.⁶ Stopping smoking, losing weight if you need to and wearing protection at work against harmful chemicals lower your chances.⁶

The first signs

The main sign is blood in your pee.² It can look bright pink, red or dark brown.²

• pain, burning or stinging when you pee;²
• needing to pee more often, or sudden urges to pee;²
• getting lots of urine infections;²
• pain in your back or lower tummy, or in your bones;²
• losing weight without trying, or feeling tired and unwell.²

These signs often have other causes, but finding cancer early can make it easier to treat.²

How doctors find out

Your family doctor may examine you, check a urine sample and do a blood test, then send you to a bladder specialist (urologist).^2,7 The main test is a cystoscopy: a thin camera is passed up the tube you pee through to look inside the bladder.⁷ You have painkilling medicine or are put to sleep, so it should not hurt.⁷ A small sample of the lining may be taken (biopsy).⁷

If you have cancer, an ultrasound, CT or MRI scan, blood tests and sometimes a bone scan show its size, type and how far it has spread.⁷ Results may come the same day or within a few days.⁷ A specialist nurse is your main contact.⁷

Current treatment

Surgery is the main treatment, from removing the cancer from the bladder lining to removing the bladder. You may also have chemotherapy, radiotherapy, immunotherapy or targeted medicines, and chemotherapy or BCG can be put into the bladder.Source: NHS

Will it get worse?

Bladder cancer can often be treated.³ How serious bladder cancer is depends on how big it is, if it has spread, and your general health.⁴ About half of bladder cancers are found while they are still only in the layer of cells where they started.⁵

You will have regular check-ups during and after treatment. You may also have tests and scans.³ Advanced bladder cancer may be hard to treat and may not be curable.³ Treatment then aims to slow it, ease symptoms and help you live longer, and a palliative care team helps you and your family.³

Medicines: what helps, and what to watch for

Chemotherapy kills cancer cells.³ For bladder cancer it can be put straight into the bladder through a thin tube, or given into a vein.^3,8 It can be used before surgery or radiotherapy, together with radiotherapy, after surgery to lower the chance of the cancer coming back, or when the cancer has spread.³ BCG is an immunotherapy that is put into the bladder. Immunotherapy uses your immune system to fight cancer.⁸ Targeted medicines or immunotherapy are sometimes used if the cancer is more likely to come back after surgery, if the cancer has spread, if you have side effects from chemotherapy, or if the tumour comes back during chemotherapy.³

Good to know:

• Your team explains the benefits and side effects of each treatment and helps you manage side effects;³

Exercise and recovery help too

After surgery to remove the bladder, you are encouraged to get up and move as soon as you can.⁹ A physiotherapist shows you breathing and leg exercises, and before going home you should be able to walk the length of the ward and climb a flight of stairs.⁹ Heavy lifting should be possible after about 6 weeks.⁹

Surgery, for most people

Cancer in the lining can be removed through a cystoscope passed up the tube you pee through: the tumour is cut away with a wire loop or burned away.⁸ Sometimes only part of the bladder is removed, so you can pee normally afterwards.⁸

If the whole bladder is removed, nearby lymph nodes and organs that contain cancer are removed too, and the surgeon makes a new way for pee to leave the body, for example through an opening on your tummy into a bag (urostomy).^8,9 In men the prostate is removed as well: erections are usually affected and you cannot father children afterwards.^8,9 The hospital stay is about a week, and full recovery takes at least 3 to 6 months.⁹ Radiotherapy, sometimes with chemotherapy, can be used instead of surgery or when the cancer has spread.³

Is there a cure?

Bladder cancer can often be treated. Finding it early may mean it is easier to treat.^3,2 Advanced bladder cancer may not be curable, but treatment can help you live longer.³ Clinical trials test new treatments and new ways of using today's treatments, and may be an option for some people.⁸

Median survival

About 31.5 months in a trial of enfortumab vedotin plus pembrolizumabSource: NCI PDQ, 2025

Measured in: People in the EV-302 trial (886 patients), with enfortumab vedotin plus pembrolizumab

Sources

1. MedlinePlus: Bladder Cancer
2. NHS: Bladder cancer – Symptoms
3. NHS: Bladder cancer – Treatment
4. NHS: Bladder cancer – What is bladder cancer?
5. NCI SEER: Cancer Stat Facts: Bladder Cancer
6. NHS: Bladder cancer – Causes
7. NHS: Bladder cancer – Tests and next steps
8. NCI PDQ: Bladder Cancer Treatment (PDQ) – Patient Version
9. Cambridge University Hospitals NHS: Radical removal of the bladder and fashioning of an ileal conduit (male) – patient information