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Bladder Cancer - Introduction

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Lineagotica’s Guide to Bladder Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

About the bladder, renal pelvis, and ureter

The bladder is an expandable, hollow organ in the pelvis that stores urine before it leaves the body during urination. This function makes the bladder an important part of the urinary tract. The urinary tract is also made up of the kidneys, ureters, and urethra. The renal pelvis is a funnel-like part of the kidney that collects urine and sends it into the ureter. The ureter is a tube that runs from each kidney into the bladder. The urethra is the tube that carries urine out of the body. In men, the prostate is also part of the urinary tract.

The bladder, like other parts of the urinary tract, is lined with a layer of cells called the urothelium. This layer of cells is separated from the bladder wall muscles, called the muscularis propria, by a thin, fibrous band called the lamina propria.

About bladder cancer

Bladder cancer begins when healthy cells in the bladder lining, most commonly urothelial cells, change and grow out of control, forming a mass called a tumor. Urothelial cells also line the renal pelvis and ureters. Although cancer that develops in the renal pelvis and ureters is considered a type of kidney cancer, it is treated in the same way as bladder cancer and is described in this guide. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Benign bladder tumors are rare.

Types of bladder cancer

The type of bladder cancer depends on how the tumor’s cells look under the microscope. The 3 main types of bladder cancer are:

  • Urothelial carcinoma. Urothelial carcinoma (or UCC) accounts for about 90% of all bladder cancers. It also accounts for 10% to 15% of kidney cancers diagnosed in adults. It begins in the urothelial cells found in the urinary tract. Urothelial carcinoma is sometimes also called transitional cell carcinoma or TCC.

  • Squamous cell carcinoma. Squamous cells develop in the bladder lining in response to irritation and inflammation. Over time, these cells may become cancerous. Squamous cell carcinoma accounts for about 4% of all bladder cancers.

  • Adenocarcinoma. This type accounts for about 2% of all bladder cancers and develops from glandular cells.

There are other, less common types of bladder cancer, including sarcoma and small cell anaplastic cancer. Sarcoma begins in the fat or muscle layers of the bladder. Small cell anaplastic cancer is a rare type of bladder cancer that is likely to spread to other parts of the body.

Other ways of describing bladder cancer

In addition to its cell type, bladder cancer may be described as noninvasive, non-muscle-invasive, or muscle-invasive.

  • Noninvasive. Noninvasive bladder cancer includes noninvasive papillary carcinoma and carcinoma in situ (CIS). Noninvasive papillary carcinoma is a growth found on a small section of tissue that is easily removed. This is called stage 0a. CIS is cancer that is found only on or near the surface of the bladder, which is called stage 0is. See Stages and Grades for more information.   

  • Non-muscle-invasive. Non-muscle-invasive bladder cancer typically has only grown into the lamina propria and not into muscle, also called stage I. Non-muscle invasive cancer may also be called superficial cancer, although this term is being used less often because it may incorrectly suggest that this type of cancer is not serious.

  • Muscle-invasive. Muscle-invasive bladder cancer has grown into the bladder's wall muscle and sometimes into the fatty layers or surrounding tissue outside the bladder.

It is important to note that non-muscle-invasive bladder cancer has the possibility of spreading into the bladder muscle or to other parts of the body. Additionally, all cell types of bladder cancer can spread beyond the bladder to other areas of the body through a process known as metastasis.

If a bladder tumor has spread into the surrounding organs, such as the uterus and vagina in women, the prostate in men, and/or nearby muscles, it is called locally advanced disease. Bladder cancer also often spreads to the lymph nodes in the pelvis. If it has spread into the liver, bones, lungs, lymph nodes outside the pelvis, or other parts of the body, the cancer is called metastatic disease. This is described in more detail in Stages and Grades.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to another section on Lineagotica.

  • ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to this type of cancer. This fact sheet is available as a PDF, so it is easy to print out.

  • Lineagotica Expert Conversations Podcast: Listen to a podcast led by an ASCO expert in this type of cancer that provides basic information and areas of research.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with this disease and general survival rates. You may use the menu to choose a different section to read in this guide.

Bladder Cancer - Statistics

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will find information about the number of people who are diagnosed with bladder cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 81,190 adults (62,380 men and 18,810 women) in the United States will be diagnosed with bladder cancer. Among men, bladder cancer is the fourth most common cancer. Men are 4 times more likely than women to be diagnosed with the disease. In addition, incidence rates in white men are double those of black men.

Bladder cancer mostly affects older people. Ninety percent (90%) of people with bladder cancer are older than 55, and the average age people are diagnosed with bladder cancer is 73. 

It is estimated that 17,240 deaths (12,520 men and 4,720 women) from this disease will occur this year. Among men, bladder cancer is eighth most common cause of cancer death.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The general 5-year survival rate for people with bladder cancer is 77%. The overall 10-year survival rate is 70% and the overall 15-year survival rate is 65%.

However, survival rates depend on many factors, including the type and stage of bladder cancer that is diagnosed. The 5-year survival rate of people with bladder cancer that has not spread beyond the inner layer of the bladder wall is 96%. About half of people are diagnosed with this stage.

If the tumor is invasive but has not yet spread outside the bladder, the 5-year survival rate is 70%. If the cancer extends through the bladder to the surrounding tissue or has spread to nearby lymph nodes or organs, the 5-year survival rate is 35%. If the cancer has spread to distant parts of the body, the 5-year survival rate is 5%. About 4% of people are diagnosed at this stage.

It is important to remember that statistics on the survival rates for people with bladder cancer are an estimate. The estimate comes from annual data based on the number of people with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. People should talk with their doctor if they have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publication, Cancer Facts and Figures 2017: Special Section – Rare Cancers in Adults, and the ACS website (January 2018).

The next section in this guide is Medical Illustrations. It offers drawings of the bladder, including its layers of tissue. Use the menu to choose a different section to read in this guide.

Bladder Cancer - Medical Illustrations

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will find drawings of the bladder and its tissue layers. Use the menu to see other pages.

Bladder Anatomy

The image shows the urinary tract. Two kidneys are located on either side of the spine near the bottom of the rib cage. Each kidney connects to a ureter via the renal pelvis and calyx. The ureters run down the body to connect to the bladder, which is located in the pelvic cavity in front of the rectum, and directly above the prostate in men, and under the uterus in women. The urethra extends from the bladder to allow urine to exit the body. The bladder wall is composed of several layers. The inside of the bladder is lined with a layer of cells called the urothelium. The lamina propria separates this layer from the bladder wall muscles (muscularis propria), which are surrounded by perivesical fat, and finally the peritoneum. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors. It explains what factors may increase the chance of developing this disease. You may use the menu to choose a different section to read in this guide.  

Bladder Cancer - Risk Factors

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing bladder cancer:

  • Tobacco use. The most common risk factor is cigarette smoking, although smoking cigars and pipes can also raise the risk of developing bladder cancer. Smokers are 4 to 7 times more likely to develop bladder cancer than nonsmokers. Learn more about tobacco’s link to cancer and how to quit smoking.

  • Age. The chances of being diagnosed with bladder cancer increases with age. More than 70% of people with bladder cancer are older than 65 years old.

  • Gender. Men are 3 to 4 times more likely to develop bladder cancer than women, but women are more likely to die from bladder cancer than men.

  • Race. White people are more than twice as likely to be diagnosed with bladder cancer as black people, but black people are twice as likely to die from the disease.

  • Chemicals. Chemicals used in the textile, rubber, leather, dye, paint, and print industries; some naturally occurring chemicals; and chemicals called aromatic amines can increase the risk of bladder cancer.

  • Chronic bladder problems. Bladder stones and infections may increase the risk of bladder cancer. Bladder cancer may be more common for people who are paralyzed from the waist down who are required to use urinary catheters and have had many urinary infections.

  • Cyclophosphamide (Cytoxan, Clafen, Neosar) use. People who have had chemotherapy with cyclophosphamide have a higher risk of developing bladder cancer.

  • Pioglitazone (Actos) use. In 2011, the U.S. Food and Drug Administration (FDA) warned that people who have taken the diabetes drug pioglitazone for more than 1 year may have a higher risk of developing bladder cancer. However, published studies have shown contradictory results.

  • Personal history. People who have already had bladder cancer once are more likely to develop bladder cancer again.

  • Schistosomiasis. People who have some forms of this parasitic disease, which is found in parts of Africa, South America, Southeast Asia, and the Middle East, are more likely to develop squamous cell bladder cancer.

  • Lynch syndrome. People with an inherited condition called Lynch syndrome, previously called hereditary nonpolyposis colorectal cancer or HNPCC, may have an increased risk of developing bladder cancer.

  • Arsenic exposure. Arsenic is a naturally occurring substance that can cause health problems if consumed in large amounts. When found in drinking water, it has been associated with an increased risk of bladder cancer. The chance of being exposed to arsenic depends on where you live and whether you get your water from a well or from a system that meets the standards for acceptable arsenic levels.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. You may use the menu to choose a different section to read in this guide.  

Bladder Cancer - Symptoms and Signs

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with bladder cancer may experience the following symptoms or signs. Sometimes, people with bladder cancer do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

  • Blood or blood clots in the urine

  • Pain or burning sensation during urination

  • Frequent urination

  • Feeling the need to urinate many times throughout the night

  • Feeling the need to urinate, but not being able to pass urine

  • Lower back pain on 1 side of the body

Most often, bladder cancer is diagnosed after a person tells his or her doctor about blood in the urine, also called hematuria. Gross hematuria means that enough blood is present in the urine that the patient can see it. It is also possible that there are small amounts of blood in the urine that cannot be seen. This is called microscopic hematuria, and it can only be found with a urine test.

General urine tests are not used to make a specific diagnosis of bladder cancer because hematuria can be a sign of several other conditions that are not cancer, such as an infection or kidney stones. One type of urine test that can find out whether there is cancer is cytology, a test in which the urine is studied under a microscope to look for cancer cells (see Diagnosis for more information).

Sometimes when the first symptoms of bladder cancer appear, the cancer has already spread to another part of the body. In this situation, the symptoms depend on where the cancer has spread. For example, cancer that has spread to the lungs may cause a cough or shortness of breath, spread to the liver may cause abdominal pain or jaundice (yellowing of the skin and whites of the eyes), and spread to the bone may cause bone pain or a fracture (broken bone). Other symptoms of advanced bladder cancer may include pain in the back or pelvis, unexplained appetite loss, and weight loss.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help figure out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. You may use the menu to choose a different section to read in this guide.

Bladder Cancer - Diagnosis

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

The earlier bladder cancer is found, the better the chance for successful treatment and cure. However, there is not yet a test accurate enough to screen the general population for bladder cancer, so most people are diagnosed with bladder cancer once they have symptoms. As a result, some people have more advanced (later stage) disease when the cancer is found. Most people, though, are usually diagnosed with noninvasive bladder cancer (see Introduction).

The following tests may be used to diagnose and learn more about bladder cancer:

  • Urine tests. If your doctor has found any amount of blood in the urine, a urine cytology test can be ordered. Urine cytology often uses a random urine sample from normal urination to find out if the urine contains tumor cells. If a patient is undergoing a cystoscopy (see below), an additional test may be performed that involves rinsing the bladder and collecting the liquid through the cystoscope or through another small tube that is inserted into the urethra. The sample can be tested in a variety of ways. The most common way is to look at the cells under a microscope, called urinary cytology. There are other urine tests using molecular analysis that can be done to help find cancer, usually at the same time as urinary cytology.

  • Cystoscopy. Cystoscopy is the key diagnostic procedure for bladder cancer. It allows the doctor to see inside the body with a thin, lighted, flexible tube called a cystoscope. Flexible cystoscopy is performed in a doctor's office and does not require anesthesia, which is medication that blocks the awareness of pain. This short procedure can detect growths in the bladder and determine the need for a biopsy or surgery.

  • Biopsy/Transurethral resection of bladder tumor (TURBT). If abnormal tissue is found during a cystoscopy, the doctor will do a biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. This surgical procedure is called a transurethral bladder tumor resection or TURBT.

    During a TURBT, the doctor removes the tumor and a sample of the bladder muscle near the tumor. The doctor can also decide to do additional biopsies of other parts of the bladder based on the results of the cystoscopy. Another procedure often done before completing a TURBT is called EUA (exam under anesthesia). In this procedure, the urologist evaluates the bladder to see if any masses can be felt. Any tissue sample removed during the TURBT is then analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

    A TURBT is used to diagnose bladder cancer and find out the type of tumor, how deeply it has grown into the layers of the bladder, and identify any additional microscopic cancerous changes, called carcinoma in situ (CIS) (see Stages and Grades). A TURBT can also be used as a treatment for a non-muscle-invasive tumor (see Treatment Options).

The following imaging tests may be used to find out if the bladder cancer has spread and to help with staging.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these images into a detailed, cross-sectional view that shows abnormalities or tumors. A CT scan can be used to measure the tumor’s size and to identify enlarged lymph nodes, which may indicate that cancer has spread. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow. Before taking this test, patients should tell the staff giving this test if they are allergic to iodine or other contrast media. The intravenous contrast dye used in a CT scan can cause renal problems, so patients with any kind of kidney problems should tell the staff before the scan is done.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size and to identify enlarged lymph nodes, which may indicate that cancer has spread.. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into the patient’s body. This substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

    Ongoing research suggests that a PET scan may help find bladder cancer that has spread better than a CT scan or MRI alone. Despite this, PET scans are not considered standard imaging for bladder cancer.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. It can help find out if the kidneys or ureters are blocked. This test does not require any type of contrast medium.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging and grading.

The next section in this guide is Stages and Grades. It explains the systems doctors use to describe the extent of the disease and the way cancer cells look under a microscope. You may use the menu to choose a different section to read in this guide.  

Bladder Cancer - Stages and Grades

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as the way the tumor cells look when viewed under a microscope. This is called the stage and grade. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has invaded or spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

For bladder cancer, the stage is determined based on examining the sample removed during a TURBT (see Diagnosis) and finding out whether the cancer has spread to other parts of the body.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Staging can be clinical or pathological. Clinical staging is based on the results of physical examinations, imaging scans, and biopsies. Pathological staging is based on what is found during surgery plus the results of physical examinations, imaging scans, and biopsies. Pathological staging gives the health care team the most amount of information to make a prognosis. Here are more details on each part of the TNM system for bladder cancer.

Tumor (T)

Using the TNM system, the "T" plus a letter and/or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. If there is more than 1 tumor, the lowercase letter "m" (multiple) is added to the "T" stage category. If the “T” stage starts with a lowercase “c,” it means that the tumor was staged clinically. If it starts with a lowercase “p,” it means that the tumor was staged pathologically. If a patient’s tumor is removed, specific tumor stage information is listed below.

Bladder cancer

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a primary tumor in the bladder.

Ta: This refers to noninvasive papillary carcinoma. This type of growth often is found on a small section of tissue that easily can be removed with TURBT.

Tis: This stage is carcinoma in situ (CIS) or a "flat tumor." This means that the cancer is only found on or near the surface of the bladder. The doctor may also call it non-muscle-invasive bladder cancer, superficial bladder cancer, or noninvasive flat carcinoma. This type of bladder cancer often comes back after treatment, usually as another noninvasive cancer in the bladder.

T1: The tumor has spread to the connective tissue (called the lamina propria) that separates the lining of the bladder from the muscles beneath, but it does not involve the bladder wall muscle.

T2: The tumor has spread to the muscle of the bladder wall.

  • T2a: The tumor has spread to the inner half of the muscle of the bladder wall, which may be called the superficial muscle.

  • T2b: The tumor has spread to the deep muscle of the bladder (the outer half of the muscle).

T3: The tumor has grown into the perivesical tissue (the fatty tissue that surrounds the bladder).

  • T3a: The tumor has grown into the perivesical tissue, as seen through a microscope.

  • T3b: The tumor has grown into the perivesical tissue macroscopically. This means that the tumor(s) is large enough to be seen during imaging tests or to be seen or felt by the doctor.

T4: The tumor has spread to any of the following: the abdominal wall, the pelvic wall, a man’s prostate or seminal vesicle (the tubes that carry semen), or a woman’s uterus or vagina.

  • T4a: The tumor has spread to the prostate, seminal vesicles, uterus, or vagina.

  • T4b: The tumor has spread to the pelvic wall or the abdominal wall.

Renal pelvis and ureter

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a primary tumor in the bladder.

Ta: This refers to noninvasive papillary carcinoma. This type of growth often is found on a small section of tissue that easily can be removed with TURBT.

Tis: This stage is carcinoma in situ (CIS) or a "flat tumor."

T1: The tumor has spread to the connective tissue beneath the lining of the renal pelvis or ureter.

T2: The tumor has spread to the muscle.

T3: The tumor has grown into the peripelvic fat (layers of fat around the kidney), into the renal parenchyma (the part of the kidney that filters blood and makes urine), or into the fat around the ureter.

T4: The tumor has spread to nearby organs or into the outer layer of fat on the kidney.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near where the cancer started, within the true pelvis (called hypogastric, obturator, iliac, perivesical, pelvic, sacral, and presacral lymph nodes), are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

Bladder cancer

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to a single regional lymph node in the pelvis.

N2: The cancer has spread to 2 or more regional lymph nodes in the pelvis.

N3: The cancer has spread to the common iliac lymph nodes, which are located behind the major arteries in the pelvis, above the bladder.

Renal pelvis and ureter

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer is 2 centimeters (cm) or smaller in a single lymph node.

N2: The cancer is larger than 2 cm in a single lymph node, or it has spread to more than 1 lymph node.

Metastasis (M)

The "M" in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis.

Bladder cancer

M0 (M plus zero): The disease has not metastasized.

M1: There is distant metastasis.

  • M1a: The cancer has spread only to lymph nodes outside of the pelvis.

  • M1b: The cancer has spread other parts of the body.

Renal pelvis and ureter

M0 (M plus zero): The disease has not metastasized.

M1: There is distant metastasis.

Cancer stage grouping

Doctors assign the stage of the bladder cancer by combining the T, N, and M classifications.

Bladder cancer

Stage 0a: This is an early cancer that is only found on the surface of the inner lining of the bladder. Cancer cells are grouped together and can often be easily removed. The cancer has not invaded the muscle or connective tissue of the bladder wall. This type of bladder cancer is also called noninvasive papillary urothelial carcinoma (Ta, N0, M0).

Stage 0is: This stage of cancer, also known as a flat tumor or carcinoma in situ (CIS), is found only on the inner lining of the bladder. It has not grown in toward the hollow part of the bladder, and it has not spread to the thick layer of muscle or connective tissue of the bladder (Tis, N0, M0). This is always a high-grade cancer (see “Grades,” below) and is considered an aggressive disease because it can often lead to muscle-invasive disease.

Stage I: The cancer has grown through the inner lining of the bladder and into the lamina propria. It has not spread to the thick layer of muscle in the bladder wall or to lymph nodes or other organs (T1, N0, M0).

Stage II: The cancer has spread into the thick muscle wall of the bladder. It is also called invasive cancer or muscle-invasive cancer. The tumor has not reached the fatty tissue surrounding the bladder and has not spread to the lymph nodes or other organs (T2, N0, M0).

Stage III: The cancer has spread throughout the muscle wall to the fatty layer of tissue surrounding the bladder (perivesical tissue) or to the prostate in a man or the uterus and vagina in a woman. Or, the cancer has spread to the regional lymph nodes.

  • Stage IIIA: The tumor has grown into the perivesical tissue or has spread to the prostate, uterus, or vagina, but has not spread to the lymph nodes or other organs (T3a, T3b, or T4a; N0; M0), or the cancer has spread to a single regional lymph node (T1 to T4a, N1, M0).

  • Stage IIIB: The cancer has spread to 2 or more regional lymph nodes or to the common iliac lymph nodes (T1 to T4a, N2 or N3, M0).

Stage IV: The tumor has spread into the pelvic wall or abdominal wall, or the cancer has spread to lymph nodes outside of the pelvis or to other parts of the body.

  • Stage IVA: The tumor has spread to the pelvic wall or the abdominal wall but not to other parts of the body (T4b, any N, M0), or the cancer has spread to lymph nodes located outside of the pelvis (any T, any N, M1a).

  • Stage IVB: The cancer has spread other parts of the body (any T, any N, M1b).

Renal pelvis and ureter

Stage 0a: This is an early cancer that is only found on the surface of the inner lining of the renal pelvis or ureter. Cancer cells are grouped together and can often be easily removed. This type of cancer is also called noninvasive papillary carcinoma (Ta, N0, M0).

Stage 0is: This stage of cancer, also known as a flat tumor or carcinoma in situ (CIS), is found only on the inner lining of the renal pelvis or ureter (Tis, N0, M0).

Stage I: The cancer has grown into the inner lining of the renal pelvis or ureter. The cancer has not spread to the lymph nodes or other parts of the body (T1, N0, M0).

Stage II: The cancer has grown into the muscle behind the inner lining of the renal pelvis or ureter. The cancer has not spread to the lymph nodes or other parts of the body (T2, N0, M0).

Stage III: The cancer has grown past the muscle and into the fat surrounding the kidney or ureter or into the renal parenchyma. The cancer has not spread to the lymph nodes or other parts of the body (T3, N0, M0).

Stage IV: The tumor has invaded nearby organs or to the outer layer of fat of the kidney (T4, NX or N0, M0), or the cancer involves the lymph nodes (any T, N1 or N2, M0), or there is distant metastasis (any T, any N, M1).

Recurrent cancer

Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Grade (G)

Doctors also describe this type of cancer by its grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope.

The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor.

Many urologic surgeons classify a tumor’s grade based on the chance that the cancer will recur or grow and spread, called progression. They often plan treatment based on the grade, using the following categories:

  • Low grade. This type of cancer may recur.

  • High grade. This type of cancer is more likely to recur and grow.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

Doctors have different ways to treat bladder cancer. The next section in this guide is Treatment Options. You may use the menu to choose a different section to read in this guide.

Bladder Cancer - Treatment Options

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will learn the basics about the different ways doctors can treat people with this type of cancer. Use the menu to see other pages.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, the About Clinical Trials and Latest Research sections.

Treatment overview

Basic descriptions of the most common treatment options for bladder cancer are listed below. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

To see general treatment options based on the extent of the bladder cancer, read the next section in this guide, Treatment Options by Stage.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. There are different types of surgery for bladder cancer. Your health care team will recommend a specific surgery based on the stage and grade of the disease. Surgical options to treat bladder cancer include:

  • Transurethral bladder tumor resection (TURBT). This procedure is used for diagnosis and staging, as well as treatment. During TURBT, a surgeon inserts a cystoscope through the urethra into the bladder. The surgeon then removes the tumor using a tool with a small wire loop, a laser, or fulguration (high-energy electricity). The patient is given an anesthetic, medication to block the awareness of pain, before the procedure begins.

    For people with non-muscle-invasive bladder cancer, TURBT may be able to eliminate the cancer. However, the doctor may recommend additional treatments to lower the risk of the cancer returning, such as intravesical chemotherapy or immunotherapy (see below).  For people with muscle-invasive bladder cancer, additional treatments involving surgery to remove the bladder or, less commonly, radiation therapy are usually recommended.

  • Cystectomy and lymph node dissection. A radical cystectomy is the removal of the whole bladder and possibly nearby tissues and organs. For men, the prostate and urethra also may be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may be removed. For all patients, lymph nodes in the pelvis are removed. This is called a pelvic lymph node dissection. An extended pelvic lymph node dissection is the most accurate way to find cancer that has spread to the lymph nodes. Rarely, for some specific cancers, it may appropriate to remove only part of the bladder, which is called partial cystectomy.

    During a laparoscopic or robotic cystectomy, the surgeon makes several small incisions, or cuts, instead of the 1 larger incision used for traditional surgery. The surgeon then uses telescoping equipment with or without robotic assistance to remove the bladder. The surgeon must make an incision to remove the bladder and surrounding tissue. This type of operation requires a surgeon who is very experienced in minimally invasive surgery. Several studies are still in progress to determine whether laparoscopic or robotic cystectomy is as safe as the standard surgery and whether it is able to eliminate bladder cancer as successfully as standard surgery.

  • Urinary diversion. If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.

    Increasingly, surgeons can use part of the small or large intestine to make a urinary reservoir, which is a storage pouch that sits inside the body. With these procedures, the patient does not need a urinary bag. For some patients, the surgeon is able to connect the pouch to the urethra, creating what is called a neobladder, so the patient can pass urine out of the body normally. However, the patient may need to insert a thin tube called a catheter if urine does not empty through the neobladder. Also, patients with a neobladder will no longer have the urge to urinate and will need to learn to urinate on a consistent schedule.

    For other patients, an internal (inside the abdomen) pouch made of small intestine is created and connected to the skin on the abdomen or umbilicus (belly button) through a small stoma. With this approach, patients do not need to wear a bag. Patients drain the internal pouch multiple times a day by inserting a catheter through the small stoma and immediately removing the catheter.

Living without a bladder can affect a patient’s quality of life. Finding ways to keep all or part of the bladder is an important treatment goal. For some patients with muscle-invasive bladder cancer, certain treatment plans involving chemotherapy and radiation therapy (see below) may be used as an alternative to removing the bladder.

The side effects of bladder cancer surgery depend on the procedure. Research has shown that having a surgeon with bladder cancer expertise can improve the outcome of people with bladder cancer. Patients should talk with their doctor in detail to understand exactly what side effects may occur, including urinary and sexual side effects, and how they can be managed. In general, side effects may include:

  • Longer healing time

  • Infection

  • Mild bleeding and discomfort after surgery

  • Infections or urine leaks after cystectomy or a urinary diversion. If a neobladder has been created, a patient may sometimes be unable to urinate or completely empty the bladder

  • Men may be unable to have an erection, called erectile dysfunction, after cystectomy. Sometimes, a nerve-sparing cystectomy can be performed. When this is done successfully, men may be able to have a normal erection.

  • Damage to the nerves in the pelvis and loss of sexual feeling and orgasm for both men and women. Often, these problems can be fixed with further treatment.

Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by ending the cancer cells’ ability to grow and divide. A chemotherapy regimen, or schedule, typically consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs given at the same time.

There are 2 types of chemotherapy that may be used to treat bladder cancer. The type the doctor recommends and when it is given depends on the stage of the cancer. Patients should talk with their doctor about chemotherapy before surgery.

  • Intravesical chemotherapy. Intravesical, or local, chemotherapy is usually given by a urologist. During this type of therapy, drugs are delivered into the bladder through a catheter that has been inserted through the urethra. Local treatment only destroys superficial tumor cells that come in contact with the chemotherapy solution. It cannot reach tumor cells in the bladder wall or tumor cells that have spread to other organs. Mitomycin (Mitozytrex, Mutamycin) and thiotepa (multiple brand names) are the drugs used most often for intravesical chemotherapy. Other drugs that are used include cisplatin (Platinol), doxorubicin (Adriamycin), gemcitabine (Gemzar), and valrubicin (Valstar).

  • Systemic chemotherapy. Systemic, or whole-body, chemotherapy is usually prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

    The most common chemotherapy regimens for bladder cancer are:

    • Cisplatin and gemcitabine

    • Carboplatin (Paraplatin) and gemcitabine

    • MVAC, which combines 4 drugs: methotrexate (multiple brand names), vinblastine (Velban, Velsar), doxorubicin, and cisplatin

    • Dose dense (DD)-MVAC

Many systemic chemotherapies continue to be tested in clinical trials to help find out which drugs or combinations or drugs work best to treat bladder cancer. Usually a combination of drugs works better than 1 drug alone. Researchers are also studying when it is best to use chemotherapy, either before or after surgery.

Side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

  • Bacillus Calmette-Guerin (BCG). The standard immunotherapy drug for bladder cancer is a weakened bacterium called BCG, which is similar to the bacteria that causes tuberculosis. BCG is placed directly into the bladder through a catheter. This is called intravesical therapy. BCG attaches to the inside lining of the bladder and stimulates the immune system to destroy the tumor. BCG can cause flu-like symptoms, chills, mild fever, fatigue, a burning sensation in the bladder, and bleeding from the bladder.

  • Interferon (Roferon-A, Intron A, Alferon). Interferon is another type of immunotherapy that can be given as intravesical therapy. It is sometimes combined with BCG if using BCG alone does not help treat the cancer.

  • Immune checkpoint inhibitors. An active area of immunotherapy research is looking at drugs that block a protein called PD-1. PD-1 is found on the surface of T cells, which are a type of white blood cell that directly helps the body’s immune system fight disease. Because PD-1 keeps the immune system from destroying cancer cells, stopping PD-1 from working allows the immune system to better eliminate the disease. Atezolizumab (Tecentriq), nivolumab (Opdivo), avelumab (Bavencio), durvalumab (Imfinzi), and pembrolizumab (Keytruda) are all used to treat advanced or metastatic urothelial carcinoma that was not stopped by platinum-containing chemotherapy. Atezolizumab, durvalumab, and avelumab are PD-L1 inhibitors, which also interact with the PD-1 protein on T cells. Pembrolizumab, like nivolumab, is a PD-1 inhibitor and is approved to treat patients who cannot receive cisplatin-based chemotherapy. It is the only immunotherapy that has been shown to help people live longer after a first treatment did not work. Several other immune checkpoint inhibitors are currently being studied in a number of clinical trials.

Different types of immunotherapy can cause different side effects. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

Radiation therapy is usually not used by itself as a primary treatment for bladder cancer, but it may be given in combination with chemotherapy. Some people who cannot receive chemotherapy might receive radiation therapy alone. The following reasons describe why a combination of radiation therapy and chemotherapy may be used to treat cancer that is located only in the bladder:

  • To destroy any cancer cells that may remain after TURBT so all or part of the bladder does not have to be removed.

  • To relieve symptoms caused by a tumor, such as pain, bleeding, or blockage.

  • To treat a metastasis located in 1 area, such as the brain or bone.

Side effects from radiation therapy may include fatigue, mild skin reactions, and loose bowel movements. For bladder cancer, side effects most commonly occur in the pelvic or abdominal area and may include bladder irritation, with the need to pass urine frequently during the treatment period, and bleeding from the bladder or rectum. Most side effects go away soon after treatment is finished.

Learn more about the basics of radiation therapy.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatments intended to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. People often receive treatment for the cancer at the same time that they receive treatment to ease side effects. In fact, patients who receive both at the same time often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. During and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.   

Hospice care is a specific type of palliative care designed to provide the best possible quality of life for people who are near the end of life. It is described in “If treatment doesn’t work” section, below.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence, also known as metastasis).

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about your treatment options.

In general, non-muscle-invasive bladder cancers that come back in the same location as the original tumor or somewhere else in the bladder are treated in the same way as the first cancer. However, if the cancer continues to return after treatment, a cystectomy may be recommended. Bladder cancers that recur outside the bladder are more difficult to eliminate with surgery and are often treated with chemotherapy, radiation therapy, or both. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment doesn’t work

Recovery from bladder cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is a specific type of palliative care designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatments by Stage. You may use the menu to choose a different section to read in this guide.

Bladder Cancer - Treatments by Stage

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will learn about the general treatments doctors use to treat people with this type of cancer based on the stage of the disease. Use the menu to see other pages.

The information below outlines common treatments that may be part of your treatment plan, depending on the cancer’s stage (see Stages and Grades). Please note that your doctor will recommend a personalized treatment plan for you based on the stage and other factors.

In general, the main treatment options for bladder cancer are:

  • Surgery

  • Chemotherapy

  • Immunotherapy

  • Radiation therapy

To learn more about the basics of each treatment option, read this guide’s Treatment Options section.

Developing a treatment plan

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. This team is usually led by a urologist, a doctor who specializes in the genitourinary tract, which includes the kidneys, bladder, genitals, prostate, and testicles, or a urologic oncologist, a doctor who specializes in treating cancers of the urinary tract. Cancer care teams include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors, including:

  • The type, stage, and grade of bladder cancer

  • Possible side effects

  • The patient’s preferences and overall health

Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

The first treatment a person is given is called first-line therapy. If that treatment stops working, then a person receives second-line therapy. In some situations, third-line therapy may also be available.

Adjuvant systemic therapy is treatment that is given after surgery has been completed. In bladder cancer, adjuvant therapy is usually chemotherapy or treatment in a clinical trial. Neoadjuvant therapy is treatment that is given before surgery, such as chemotherapy.

The treatment options your doctor recommends mainly depend on the stage of bladder cancer. Treatment for cancer in the renal pelvis and/or ureter follow the same treatment plans based on the stage of the disease. However, the tumor’s size and grade may also affect which treatment options are recommended for you. Talk with your doctor about the risks and benefits of all the available treatment options and when treatment should begin. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects (see “Getting care for symptoms and side effects” in Treatment Options).

Treatments by type and stage of disease

Noninvasive and non-muscle-invasive bladder cancer (stages 0a, 0is, and I)

People with noninvasive bladder cancer (stage 0a) that is low grade are treated with TURBT first. Low-grade noninvasive bladder cancer rarely turns into aggressive or metastatic disease, but patients are at risk for developing more low-grade cancers throughout their life. This requires lifelong checkups, called surveillance, using cystoscopy (see Diagnosis). To reduce the risk of future tumors developing, people may receive intravesical chemotherapy or immunotherapy after TURBT.

Most commonly, people with high-grade noninvasive (stage 0a), carcinoma in situ (stage 0is), or non-muscle-invasive (stage I) bladder cancer are treated with TURBT, followed by intravesical immunotherapy using Bacillus Calmette-Guerin (or BCG, see “Immunotherapy” in Treatment Options). This combination of treatments is given to reduce the risk of the cancer from coming back, called recurrence, and the development of muscle-invasive disease. Before treatment with BCG, patients will need to have another TURBT to make sure that the cancer has not spread to the muscle. The first round of BCG treatment is given every week for 6 weeks. After that, the doctor performs a cystoscopy and sometimes a bladder biopsy (see Diagnosis) to see if all of the cancer has been eliminated. If the cancer is gone, patients usually have maintenance therapy with BCG, which may be given once every 3 months for the first 6 months and then once every 6 months after that, for 1 to 3 years. This will then be followed with lifelong surveillance.

People with high-grade, non-muscle-invasive bladder cancer are at higher risk for the tumor returning, called a recurrent tumor. Sometimes a tumor comes back at a more advanced stage, with a risk of developing into metastatic bladder cancer. To help prevent this from happening, the urologist may recommend removing the whole bladder, called radical cystectomy (see “Surgery” in Treatment Options), especially if the person is young and/or has a large tumor or a number of tumors at the time of diagnosis.

Muscle-invasive bladder cancer (stage II and stage III)

Muscle-invasive bladder cancer has grown into the muscle layer of the bladder wall. Surgery is often among the first treatments, and the standard treatment is a radical cystectomy (see “Surgery” in Treatment Options). Lymph nodes near the bladder are usually removed as well. A TURBT may still be done, but it usually is used to help the doctor figure out the extent of the cancer, rather than as a treatment option.

Sometimes, people with muscle-invasive bladder cancer receive systemic chemotherapy first, before surgery. Then they may have a radical cystectomy and urinary diversion or be given a combination of chemotherapy and radiation therapy. Giving chemotherapy before surgery, called neoadjuvant chemotherapy, may shrink the tumor in the bladder, destroy microscopic cancer cells that have spread beyond the bladder, and ultimately help people live longer. An important clinical trial showed that a specific combination of systemic chemotherapy called MVAC given before a radical cystectomy helped patients with muscle-invasive bladder cancer live longer. This approach is now considered a standard treatment for people whose overall health allows it. The combination of 2 other chemotherapies, cisplatin and gemcitabine, is considered a standard treatment as well, even though it has not been compared to MVAC in muscle-invasive disease.

It is important to note that neoadjuvant chemotherapy with 1 drug alone or when cisplatin is replaced with other drugs, such as carboplatin, does not seem to help patients with locally advanced bladder cancer live longer, so it is not often recommended. People whose health does not allow them to receive neoadjuvant chemotherapy should receive surgery first. Anyone who has been diagnosed with muscle-invasive bladder cancer should talk with a urologist and a medical oncologist about all of their treatment options, including the risks and benefits of chemotherapy.

An approach using chemotherapy with radiation therapy may provide the same benefits as removing the bladder. This is also known as the bladder preservation approach or trimodal therapy. The type of chemotherapy used for patients undergoing bladder radiation therapy can include cisplatin alone or a combination of a drug called mitomycin-C (Mitomycin) and fluorouracil (5-FU). It is important to talk with your doctor about the difference between these 2 different chemotherapy regimens. Be sure to discuss the differences between surgery and bladder preservation approaches, too.

Metastatic bladder cancer (stage IV)

If bladder cancer has spread to another part of the body, doctors call it metastatic bladder cancer. If this happens, it is a good idea to talk with doctors, usually medical oncologists, who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

A combination of treatments may be used to help manage the cancer. There are no methods to permanently cure metastatic bladder cancer for most people. The goals of treatment are to slow the spread of cancer, shrink the tumor (called remission), and extend life for as long as possible. Palliative care is also important to help relieve symptoms and side effects.

Since there are relatively few treatment options for metastatic bladder cancer, clinical trials are often the best treatment option for most patients. Currently, the standard first-line treatment options include chemotherapy regimens that contain cisplatin- or carboplatin-based chemotherapy. These regimens include MVAC, dose-dense MVAC, and gemcitabine-cisplatin. Carboplatin-containing regimens can be used to treat patients with metastatic cancer who cannot take cisplatin. Until recently, chemotherapy with docetaxel and paclitaxel were options for second-line treatment.

Immunotherapy has changed how metastatic bladder cancer is managed. The U.S. Food and Drug Administration (FDA) recently approved 5 immune checkpoint inhibitors (see “Immunotherapy” in Treatment Options) for the treatment of people with metastatic disease who are unable to receive platinum-based chemotherapy and for those whose disease is not stopped by chemotherapy. However, the only immunotherapy that has shown to help people live longer is pembrolizumab (Keytruda). People are strongly encouraged to talk with their doctors about whether immunotherapy is right for them. Changes to these regimens or the use of new treatment regimens aimed at helping patients live longer and improve their quality of life are being studied in clinical trials.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. You may use the menu to choose a different section to read in this guide.  

Bladder Cancer - About Clinical Trials

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. Use the menu to see other pages.

What are clinical trials?

Doctors and scientists are always looking for better ways to treat patients with bladder cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the FDA was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are a way to contribute to the progress is treating bladder cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with bladder cancer.

Insurance coverage of clinical trials costs differs by location and by study. In some programs, some of the patient’s expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” Placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for bladder cancer, learn more in the Latest Research section.

Lineagotica offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.  

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest ResearchIt explains areas of scientific research currently going on for this type of cancer. You may use the menu to choose a different section to read in this guide.

Bladder Cancer - Latest Research

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about bladder cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Minimally invasive cystectomy. Several studies are underway to find out whether laparoscopic or robotic bladder removal is as safe and effective as standard surgery. Learn more about this type of surgery in the Treatment Options section.

  • Lymph node dissection. A study sponsored by the Southwest Oncology Group (SWOG) is looking at whether removing more lymph nodes than is standard practice, called extended lymph node dissection, can improve a patient’s prognosis and outcome.

  • Molecular tumor testing. Tests to identify changes to genes or proteins that could be a sign of bladder cancer may help predict a bladder cancer recurrence or predict which patients may need more intense treatment. DNA changes may also help predict prognosis for people with bladder cancer. Tumor genetics are becoming more and more important for the treatment of people with bladder cancer because test results may help doctors choose the best treatment options. Which new treatments are available depends on the genetic changes found in the tumor. (see “Targeted therapy” below.)

  • Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. Research is underway to find out how targeted therapy may be used to treat bladder cancer. For instance, a clinical trial is looking at combining targeted therapy with radiation therapy to help preserve bladder function. Learn more about the basics of targeted therapy.

  • Immunotherapy. As mentioned in Treatment Options, immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. An active area of immunotherapy research is looking at drugs called immune checkpoint inhibitors to treat advanced cancer. These drugs block proteins called PD-1, PD-L1, and CTLA-4. These proteins are found on the surface of T cells, which are a type of white blood cell that directly helps the body’s immune system fight disease. Because PD-1, PD-L1, and CTLA-4 keep the immune system from destroying cancer cells, stopping them from working allows the immune system to better eliminate the disease. Several drugs that block the PD-1/PD-L1 pathway have received FDA approval to treat bladder cancer (see Treatment Options). Other research is underway in this area. Learn more about the basics of immunotherapy.

  • New drug combinations. As described in the Treatment Options section, researchers are studying new combinations of chemotherapies and other drugs.

  • Palliative care. Clinical trials are underway to find a better way of reducing symptoms and side effects of current bladder cancer treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding bladder cancer, explore these related items:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now.

  • Visit the Lineagotica Blog to read reviews of recent research in bladder cancer and to listen to podcasts with expert perspectives on the topic.

  • Visit the website of the Conquer Cancer Foundation to find out how to help support cancer research. Please note that this link takes you to a separate ASCO website. 

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. You may use the menu to choose a different section to read in this guide.  

Bladder Cancer - Coping with Treatment

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for bladder cancer are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in response.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with bladder cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of checkups after you finish cancer treatment. You may use the menu to choose a different section to read in this guide.  

Bladder Cancer - Follow-Up Care

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with bladder cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. For people treated for bladder cancer, follow-up care typically includes a general physical examination, cystoscopy (if the bladder has not been removed), urine cytology, x-rays, and routine blood tests to make sure the bladder is working well and to check for any signs that the cancer has come back.

For people with a urinary diversion, follow-up care may include checking for infection with urine tests, checking and fixing problems with controlling urination, checking for recurrent cancer in the upper urinary tract, and checking for changes in kidney function with blood tests and x-rays.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence.

Tell your doctor about any new symptoms, such as pain during urination, blood in the urine, frequent urination, or an immediate need to urinate. These symptoms may be signs that the cancer has come back or signs of another medical condition.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist or urologist, while others transition back to the care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of bladder cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. You may use the menu to choose a different section to read in this guide.

Bladder Cancer - Survivorship

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the place where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from bladder cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Lineagotica:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Lineagotica Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Lineagotica offers an entire area of this website with resources to help survivors, including for those in different age groups.

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. You may use the menu to choose a different section to read in this guide.

Bladder Cancer - Questions to Ask The Health Care Team

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with your health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Lineagotica’s free mobile app for a digital list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of bladder cancer do I have?

  • Is it noninvasive or invasive? What does this mean?

  • If the cancer is invasive, does it involve the muscle?

  • Can you explain my pathology report (laboratory test results) to me?

  • What is the stage of my cancer? What does this mean?

  • What is the grade? What does this mean?

  • Should I seek a second opinion?

Questions to ask about choosing a treatment and managing side effects

  • Do I need to start treatment right away?

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • What are the possible side effects of each treatment, both in the short term and the long term?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long? How can we manage any sexual side effects that may occur?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • Whom should I call with questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will I have?

  • How many procedures of this type has the surgeon done?

  • Will my entire bladder be removed?

  • Do you have experience making urinary reservoirs? Can I have this type of surgery?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term side effects of having this surgery?

  • How will the surgery affect my ability to urinate?

  • Will I need to use a catheter?

  • Will I need to have a urostomy? If so, how do I care for my urostomy?

  • If I have a neobladder, how will I know when I need to empty it?

Questions to ask about having chemotherapy

  • What type of chemotherapy do you recommend?

  • What is the goal of this treatment?

  • How will it be delivered? Through an IV, a catheter, or a pill?

  • How long will it take to give this treatment?

  • How can I prepare for this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of this type of chemotherapy?

  • What can be done to prevent or manage these side effects?

Questions to ask about having immunotherapy

  • What type of immunotherapy do you recommend?

  • What is the goal of this treatment?

  • How can I prepare for this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to prevent or manage these side effects?

Questions to ask about having radiation therapy

  • What type of radiation therapy do you recommended?

  • What is the goal of radiation therapy?

  • How long will it take to give radiation therapy?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to prevent or manage these side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. You may use the menu to choose a different section to read in this guide.

Bladder Cancer - Additional Resources

Approved by the Lineagotica Editorial Board, 10/2017

ON THIS PAGE: You will find some helpful links to other areas of Lineagotica that provide information about cancer care and treatment. This is the final page of Lineagotica’s Guide to Bladder Cancer. Use the menu to go back and see other pages.

Lineagotica includes many other sections about the medical and emotional aspects of cancer for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Lineagotica:

This is the end of Lineagotica’s Guide to Bladder Cancer. You may use the menu to choose a different section to read in this guide.