National Cancer Institute

What You Need 

To Know About TM

Bladder

Cancer

U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES

National Institutes of Health
National Cancer Institute Services

This is only one of many free booklets for

people with cancer.

You may want more information for yourself,

your family, and your doctor.

NCI offers comprehensive research-based

information for patients and their families, health

professionals, cancer researchers, advocates, and

the public.

• Call NCI’s Cancer Information Service at 

1–800–4–CANCER (1–800–422–6237)

• Visit us at http://www.cancer.gov or

http://www.cancer.gov/espanol

• Chat using LiveHelp, NCI’s instant 

messaging service, at http://www.cancer.gov/

livehelp

• E-mail us at cancergovstaff@mail.nih.gov

• Order publications at http://www.cancer.gov/

publications or by calling 1–800–4–CANCER

• Get help with quitting smoking at

1–877–44U–QUIT (1–877–448–7848)
U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES

National Institutes of Health

National Cancer Institute

Contents

About This Booklet 1

The Bladder 2

Cancer Cells 4

Risk Factors 5

Symptoms 8

Diagnosis 9

Staging 11

Treatment 13

Second Opinion 22

Rehabilitation 23

Nutrition 25

Follow-up Care 26

Sources of Support 26

Taking Part in Cancer Research 28

Dictionary 29

National Cancer Institute Publications 37
About This Booklet

This National Cancer Institute (NCI) booklet is

about cancer* that starts in the bladder.

Each year in the United States, more than 52,000

men and 18,000 women are diagnosed with bladder

cancer. Most are over 70 years old.

1

*Words in italics are in the Dictionary on page 29. The Dictionary

explains these terms. It also shows how to pronounce them.

More than 9 of 10 Americans with bladder

cancer have a type called transitional cell cancer

(TCC). This booklet is about TCC of the bladder.

TCC begins in the cells on the surface of the

inner lining of the bladder. These cells are called

transitional cells. They are able to stretch when

the bladder is full and shrink when it’s emptied. 

Learning about medical care for bladder cancer can

help you take an active part in making choices about

your care. This booklet tells about:

• Diagnosis and staging

• Treatment and rehabilitation

• Taking part in research studies

This booklet has lists of questions that you may want

to ask your doctor. Many people find it helpful to take a

list of questions to a doctor visit. To help remember

what your doctor says, you can take notes. You may

also want to have a family member or friend go with

you when you talk with the doctor—to take notes, ask

questions, or just listen.
For the latest information about bladder cancer,

please visit NCI’s Web site at http://www.cancer.gov/

cancertopics/types/bladder. Also, NCI’s Cancer

Information Service can answer your questions about

cancer. We can also send you NCI booklets and fact

sheets. Call 1–800–4–CANCER (1–800–422–6237)

or chat with us online using LiveHelp, NCI’s instant

messaging service at http://www.cancer.gov/livehelp.

The Bladder

Your bladder is a hollow organ in the lower

abdomen. It stores urine, the liquid waste made by the

kidneys. 

Your bladder is part of the urinary tract. Urine

passes from each kidney into the bladder through a

long tube called a ureter. Urine leaves the bladder

through a shorter tube (the urethra).

The wall of the bladder has layers of tissue:

• Inner layer: The inner layer of tissue is also called

the lining. As your bladder fills up with urine, the

transitional cells on the surface stretch. When you

empty your bladder, these cells shrink.

• Middle layer: The middle layer is muscle tissue.

When you empty your bladder, the muscle layer in

the bladder wall squeezes the urine out of your

body.

• Outer layer: The outer layer covers the bladder. It

has fat, fibrous tissue, and blood vessels.

2
3

Kidney

Ureter

Bladder Prostate

Urethra

This picture shows the bladder and nearby organs in a

man.

Kidney

Ureter

Urethra

Bladder

This picture shows the bladder and nearby organs in a

woman.
Cancer Cells

Cancer begins in cells, the building blocks that make

up tissues. Tissues make up the bladder and the other

organs of the body. 

Normal cells grow and divide to form new cells as

the body needs them. When normal cells grow old or

get damaged, they die, and new cells take their place. 

Sometimes, this process goes wrong. New cells

form when the body doesn’t need them, and old or

damaged cells don’t die as they should. The buildup of

extra cells often forms a mass of tissue called a growth

or tumor.

Tumors in the bladder can be benign (not cancer) or

malignant (cancer). Benign tumors are not as harmful

as malignant tumors:

• Benign tumors:

—are usually not a threat to life

—can be treated or removed and usually don’t grow

back

—don’t invade the tissues around them

—don’t spread to other parts of the body

• Malignant growths: 

—may be a threat to life 

—usually can be removed but can grow back 

—can invade and damage nearby tissues and organs

(such as the prostate in a man, or the uterus or

vagina in a woman) 

—can spread to other parts of the body.

4
5

Bladder cancer cells can spread by breaking away

from the original tumor. They can spread through the

blood vessels to the liver, lungs, and bones. In addition,

bladder cancer cells can spread through lymph vessels

to nearby lymph nodes. After spreading, the cancer

cells may attach to other tissues and grow to form new

tumors that may damage those tissues. See the Staging

section on page 11 for information about bladder

cancer that has spread.

Risk Factors

When you get a diagnosis of bladder cancer, it’s

natural to wonder what may have caused the disease.

Doctors can’t always explain why one person gets

bladder cancer and another doesn’t. 

However, we do know that people with certain risk

factors may be more likely than others to develop

bladder cancer. A risk factor is something that may

increase the chance of getting a disease.

Studies have found the following risk factors for

bladder cancer:

• Smoking: Smoking tobacco is the most important

risk factor for bladder cancer. Smoking causes most

of the cases of bladder cancer. People who smoke

for many years have a higher risk than nonsmokers

or those who smoke for a short time.
6

How to Quit Tobacco

Quitting is important for anyone who uses

tobacco. Quitting at any time is good for your

health. 

For people who already have bladder cancer,

quitting may reduce the chance of getting another

type of cancer (such as lung, esophagus, or oral

cancer), lung disease, or heart disease caused by

tobacco. Quitting can also help cancer treatments

work better.

There are many ways to get help:

• Ask your doctor about medicine or nicotine

replacement therapy. Your doctor can suggest a

number of treatments that help people quit.

• Ask your doctor or dentist to help you find

local programs or trained professionals who

help people stop using tobacco.

• Call NCI’s Smoking Quitline at

1–877–44U–QUIT (1–877–448–7848) or

instant message us through LiveHelp

(http://www.cancer.gov/livehelp). We can tell

you about:

—Ways to quit smoking

—Groups that help smokers who want to quit

—NCI publications about quitting smoking

—How to take part in a study of methods to

help smokers quit

• Go online to Smokefree.gov (http://www.

smokefree.gov), a Federal Government Web

site. It offers a guide to quitting smoking and a

list of other resources.
• Chemicals in the workplace: Some people have a

higher risk of bladder cancer because of cancercausing chemicals in their workplace. Workers in

the dye, rubber, chemical, metal, textile, and leather

industries may be at risk of bladder cancer. Also at

risk are hairdressers, machinists, printers, painters,

and truck drivers.

• Personal history of bladder cancer: People who

have had bladder cancer have an increased risk of

getting the disease again.

• Certain cancer treatments: People with cancer

who have been treated with certain drugs (such as

cyclophosphamide) may be at increased risk of

bladder cancer. Also, people who have had radiation

therapy to the abdomen or pelvis may be at

increased risk.

• Arsenic: Arsenic is a poison that increases the risk

of bladder cancer. In some areas of the world,

arsenic may be found at high levels in drinking

water. However, the United States has safety

measures limiting the arsenic level in public

drinking water.

• Family history of bladder cancer: People with

family members who have bladder cancer have a

slightly increased risk of the disease.

Many people who get bladder cancer have none of

these risk factors, and many people who have known

risk factors don’t develop the disease.

7
8

Symptoms

Bladder cancer may cause these common

symptoms:

• Finding blood in your urine (which may make the

urine look rusty or darker red)

• Feeling an urgent need to empty your bladder

• Having to empty your bladder more often than you

used to

• Feeling the need to empty your bladder without

results

• Needing to strain (bear down) when you empty your

bladder

• Feeling pain when you empty your bladder

These symptoms may be caused by bladder cancer

or by other health problems, such as an infection.

People with these symptoms should tell their doctor so

that problems can be diagnosed and treated as early as

possible. 
9

Diagnosis

If you have symptoms that suggest bladder cancer,

your doctor will try to find out what’s causing the

problems.

You may have a physical exam. Also, you may have

one or more of the following tests:

• Urine tests: The lab checks your urine for blood,

cancer cells, and other signs of disease. 

• Cystoscopy: Your doctor uses a thin, lighted tube (a

cystoscope) to look directly into your bladder. It

may be done at your doctor’s office. This test can be

uncomfortable because the doctor will insert the

cystoscope into the bladder through your urethra.

You may need local anesthesia for this test.

• Biopsy: Your doctor can remove samples of tissue

with the cystoscope. A pathologist then examines

the tissue under a microscope. The removal of tissue

to look for cancer cells is called a biopsy. In most

cases, a biopsy is the only sure way to tell whether

cancer is present.

For a small number of patients, the doctor removes

the entire area with cancer during the biopsy. For

these patients, bladder cancer is diagnosed and

treated at the same time.
Grade

If cancer cells are found in the tissue sample from

the bladder, the pathologist studies the sample under a

microscope to learn the grade of the tumor. The grade

tells how much the tumor tissue differs from normal

bladder tissue. It may suggest how fast the tumor is

likely to grow.

Tumors with higher grades tend to grow faster than

those with lower grades. They are also more likely to

spread. Doctors use tumor grade along with other

factors to suggest treatment options.

10

You may want to ask the doctor these

questions before having a biopsy:

• Why do I need a biopsy?

• How long will it take? Will I be awake? Will it

hurt?

• What are the chances of infection or bleeding

after the biopsy? Are there any other risks?

• How soon will I know the results? How do I

get a copy of the pathology report?

• If I do have cancer, who will talk with me

about treatment? When?
11

Staging

If bladder cancer is diagnosed, your doctor needs to

learn the extent (stage) of the disease to help you

choose the best treatment. 

Staging is a careful attempt to find out the following:

• Whether the tumor has invaded the muscle layer of

the bladder

• Whether the tumor has invaded nearby tissues 

• Whether the cancer has spread, and if so, to what

parts of the body 

Your doctor may order these tests:

• Blood tests: Blood tests can show how well the liver

and kidneys are working.

• Chest x-ray: An x-ray of the chest can show a tumor

in the lung.

• IVP: A dye that shows up on x-rays is injected into

your blood vessel. The dye collects in your urine,

which makes the bladder and the rest of the urinary

tract show up on x-rays.

• CT scan: An x-ray machine linked to a computer

takes a series of detailed pictures of your abdomen.

You may receive an injection of contrast material so

your urinary tract and lymph nodes show up clearly

in the pictures. The CT scan can show cancer in the

bladder, lymph nodes, or elsewhere in the abdomen.
• MRI: A large machine with a strong magnet linked

to a computer is used to make detailed pictures of

your urinary tract and lymph nodes. You may

receive an injection of contrast material. MRI can

show cancer in the bladder, lymph nodes, or other

tissues in the abdomen.

• Ultrasound: The ultrasound device uses sound

waves that can’t be heard by humans. The sound

waves make a pattern of echoes as they bounce off

internal organs. The echoes create a picture of your

kidneys and other organs in the abdomen. The

picture can show a tumor or blockage in the urinary

tract. 

When cancer spreads from its original place to

another part of the body, the new tumor has the same

kind of abnormal cells and the same name as the

original (primary) tumor. For example, if bladder

cancer spreads to the liver, the cancer cells in the liver

are actually bladder cancer cells. The disease is

metastatic bladder cancer, not liver cancer. It’s treated

as bladder cancer, not as liver cancer. Doctors

sometimes call the new tumor in the liver “distant”

disease.

These are the stages of bladder cancer:

• Stage 0: The cancer cells are found only on the

surface of the inner lining of the bladder. The doctor

may call this carcinoma in situ.

• Stage I: The tumor has grown deeper into the inner

lining of the bladder. But it hasn’t invaded the

muscle layer of the bladder.

• Stage II: The tumor has invaded the muscle layer of

the bladder.

• Stage III: The tumor has grown through the muscle

layer to reach tissues near the bladder, such as the

prostate, uterus, or vagina.

12
• Stage IV: The tumor has invaded the wall of the

pelvis or abdomen, but cancer is not found in any

lymph nodes. Or, the cancer cells have spread to at

least one lymph node or to parts of the body far

away from the bladder, such as the liver, lungs, or

bones.

Treatment

Treatment options for people with bladder cancer

are surgery, chemotherapy, biological therapy, and

radiation therapy. You may receive more than one type

of treatment. 

The treatment that’s right for you depends mainly on

the following:

• The location of the tumor in the bladder 

• Whether the tumor has invaded the muscle layer or

tissues outside the bladder

• Whether the tumor has spread to other parts of the

body

• The grade of the tumor

• Your age and general health

You may have a team of specialists to help plan

your treatment. Your doctor may refer you to a

specialist, or you may ask for a referral. You may want

to see a urologist, a surgeon who specializes in treating

problems in the urinary tract. Other specialists who

treat bladder cancer include urologic oncologists

(surgeons who specialize in cancers of the urinary

tract), medical oncologists, and radiation oncologists. 

Your health care team may also include an oncology

nurse and a registered dietitian. If your treatment

involves surgery to remove the bladder, a wound,

ostomy and continence nurse may also be part of your

team.

13
14

Your health care team can describe your treatment

choices, the expected results of each, and the possible

side effects. Because cancer therapy often damages

healthy cells and tissues, side effects are common.

These side effects depend on many factors, including

the type and extent of treatment. Side effects may not

be the same for each person, and they may even

change from one treatment session to the next. Before

treatment starts, ask your health care team about

possible side effects and how treatment may change

your normal activities. You and your health care team

can work together to develop a treatment plan that

meets your needs. 

At any stage of disease, supportive care is available

to control pain and other symptoms, to relieve the side

effects of treatment, and to ease emotional concerns.

Information about such care is available on NCI’s Web

site at http://www.cancer.gov/cancertopics/

coping and from NCI’s Cancer Information Service at

1–800–4–CANCER (1–800–422–6237) or at

LiveHelp (http://www.cancer.gov/help).

You may want to talk with your doctor about taking

part in a clinical trial. Clinical trials are research

studies testing new treatments. They are an important

option for people with all stages of bladder cancer. See

the Taking Part in Cancer Research section on page 28.
15

You may want to ask your doctor these

questions before you begin treatment:

• What is the stage of the disease? Has the tumor

invaded the muscle layer of the bladder or

spread to other organs?

• What are my treatment choices? Which do you

suggest for me? Why?

• What are the expected benefits of each kind of

treatment?

• What can I do to prepare for treatment?

• Will I need to stay in the hospital? If so, for

how long?

• What are the risks and possible side effects of

each treatment? How can side effects be

managed?

• What is the treatment likely to cost? Will my

insurance cover it?

• How will treatment affect my normal

activities?

• Would a research study (clinical trial) be a

good choice for me?

• Can you recommend other doctors who could

give me a second opinion about my treatment

options?

• How often should I have checkups?
16

Surgery

Surgery is an option for most people with bladder

cancer. You and your surgeon can talk about the types

of surgery and which may be right for you:

• Transurethral resection (TUR): The doctor uses a

cystoscope to treat early bladder cancer (Stage 0 or

Stage I). No incision (cut) into your body is needed,

but general anesthesia or spinal anesthesia is

usually given. 

The doctor inserts the cystoscope into the bladder

through your urethra. The cutting tool is slipped

through the cystoscope. A small wire loop at the end

of the tool removes the cancer and burns away

remaining cancer cells with an electric current.

TUR may need to be repeated. Also, chemotherapy

or biological therapy may be given after this type of

surgery.

For a few days after TUR, you may have some

blood in your urine and difficulty or pain when

passing urine. Otherwise, TUR generally causes few

problems.

• Open surgery: The surgeon makes an incision into

your body to remove the cancer from your bladder.

—Part of the bladder (called a partial cystectomy):

For some people with a single, small tumor in the

bladder, the surgeon does not remove the entire

bladder. The surgeon removes the tumor, the part

of the bladder containing the tumor, and nearby

lymph nodes.

After part of the bladder is removed, you may not

be able to hold as much urine in your bladder as

before surgery. You may need to empty your

bladder more often. This problem usually gets

better with time. 
—All of the bladder (called a radical cystectomy):

For bladder cancer that has invaded the muscle

layer (Stage II or some Stage III), the most

common type of surgery is radical cystectomy.

The surgeon removes the entire bladder, nearby

lymph nodes, and part of the urethra. In addition,

the surgeon usually removes the prostate from a

man and may remove the uterus from a woman.

Other nearby tissues may also be removed.

—When the entire bladder is removed, the surgeon

makes another way for urine to be collected from

the kidneys and stored. You may wear a flat bag

outside the body under your clothes, or the

surgeon may use part of your intestine to create a

pouch inside the body. The Rehabilitation section

on page 23 has more information. 

—When the prostate or uterus is removed, a man

can no longer father a child and a woman can no

longer get pregnant. Also, a man may be unable

to have sex after surgery. If the surgeon removes

part of a woman’s vagina, sex may be difficult. 

—Because bladder cancer surgery may affect your

sex life, it may help you and your partner to talk

about your feelings and help one another find

ways to share intimacy during and after

treatment. See Sources of Support on page 26 for

more information.

It takes time to heal after surgery, and the time

needed to recover is different for each person. It’s

common to feel weak or tired for a while. 

Also, you may have pain or discomfort for the first

few days. Medicine can help control your pain. Before

surgery, you should discuss the plan for pain relief with

your doctor or nurse. After surgery, your doctor can

adjust the plan if you need more pain control.

17
18

After TUR or partial cystectomy, the urethra needs

time to heal. You’ll have a catheter. A catheter is a tube

put through the urethra into the bladder to drain urine.

You’ll have the catheter for 5 days to 3 weeks. Your

nurse or doctor will show you how to care for it.

You may want to ask your doctor these

questions before having surgery:

• What type of surgery do you recommend for

me? Why?

• Will lymph nodes and other tissues be

removed? Why?

• How will I feel after surgery?

• If I have pain, how will you control it?

• How long will I be in the hospital?

• Will I have any long-term effects because of

the surgery? 

• If my bladder is removed, who will teach me

how to store urine in a pouch or bag?

• If my bladder is removed, will I need to wear a

medical alert bracelet for the rest of my life?

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may

be used to treat bladder cancer before or after surgery. 

You may receive chemotherapy in different ways:

• Into the bladder: After TUR for early bladder

cancer, the doctor inserts a tube (catheter) through

your urethra to put a liquid drug in the bladder. The

drug remains in your bladder for several hours. This

treatment may be given once a week for six weeks.
• By mouth: Some drugs are pills that you can

swallow. They may be given before or after surgery.

• Into a vein: For cancer that has invaded the muscle

of the bladder or spread to other tissues, drugs are

usually given by vein (intravenous). The drugs enter

the bloodstream and travel throughout your body.

Chemotherapy may be given before or after surgery.

You may have your treatment in an outpatient part

of the hospital, at the doctor’s office, or at home.

Rarely, you may need to stay in the hospital.

Chemotherapy is usually given in cycles. Each cycle

has a treatment period followed by a rest period.

The side effects depend mainly on how the drug is

given. If the drugs are given into the bladder, the side

effects are usually mild. For a few days after treatment,

you may need to empty your bladder more often. You

may have blood in your urine. Also, you may have

pain when emptying your bladder. Some people get a

rash. These problems usually go away after treatment.

If the drugs are given by vein or taken by mouth, the

side effects depend mainly on which drugs are given

and how much. Chemotherapy kills fast-growing

cancer cells, but the drugs can also harm normal cells

that divide rapidly: 

• Blood cells: When drugs lower the levels of healthy

blood cells, you’re more likely to get infections,

bruise or bleed easily, and feel very weak and tired.

Your health care team will check for low levels of

blood cells. If your levels are low, your health care

team may stop the chemotherapy for a while or

reduce the dose of the drug. There are also

medicines that can help your body make new blood

cells. 

• Cells in hair roots: Chemotherapy may cause hair

loss. If you lose your hair, it will grow back after

treatment, but the color and texture may be changed.

19
20

• Cells that line the digestive system: Chemotherapy

can cause a poor appetite, nausea and vomiting,

diarrhea, or mouth and lip sores. Your health care

team can give you medicines and suggest other

ways to help with these problems. They usually go

away when treatment ends.

Some drugs used for bladder cancer may also cause

tingling or numbness in your hands and feet. Your

health care team can suggest ways to control many of

these side effects.

You may wish to read the NCI booklet

Chemotherapy and You. 

Biological Therapy 

People with early bladder cancer may receive a

treatment called biological therapy. The treatment is

BCG solution, which is a liquid containing weakened

bacteria. The bacteria help your body’s natural

defenses (the immune system) to kill cancer cells in the

bladder.

Several weeks after TUR, the doctor inserts a tube

through your urethra to put a liquid treatment in your

bladder. You’ll be asked to hold the liquid treatment in

your bladder for about two hours. 

BCG solution is usually given once a week for six

weeks. This treatment helps keep the cancer from

coming back.

You may feel unusually tired during the treatment

period. Also, BCG solution can irritate the bladder. You

may feel an urgent need to empty your bladder, and

you may need to empty your bladder more often. Also,

you may have pain, especially when emptying your

bladder. You may have blood in your urine, nausea, a

fever, or chills. Tell your health care team about any

problems that you have during the treatment period.
21

It may help to know that the side effects usually go

away when treatment is over. You may want to read the

NCI fact sheet Biological Therapies for Cancer.

You may want to ask your doctor these

questions about chemotherapy or biological

therapy:

• Why do I need this treatment?

• Which drug or drugs will I have?

• How do the drugs work?

• When will treatment start? When will it end?

• Will I have any long-term side effects?

Radiation Therapy

Radiation therapy uses high-energy rays to kill

cancer cells. It may be given after surgery. Usually it’s

given along with chemotherapy for cancer that has

invaded the muscle layer of the bladder. However, it is

sometimes given instead of surgery or chemotherapy.

The radiation comes from a large machine. The

machine aims beams of radiation at the bladder area in

the abdomen. 

You’ll go to a hospital or clinic 5 days a week for

several weeks to receive radiation therapy. Each

treatment session takes about 30 minutes. 

Although radiation therapy is painless, it may cause

other side effects. The side effects include nausea,

vomiting, or diarrhea. Also, you may feel very tired

during radiation therapy. Your health care team can

suggest ways to treat or control these side effects. 

You may find it helpful to read the NCI booklet

Radiation Therapy and You.
22

You may want to ask your doctor these

questions about radiation therapy:

• Why do I need this treatment?

• When will the treatments begin? When will

they end?

• How will I feel during treatment?

• How will we know if the radiation treatment is

working?

• Will I have any long-term side effects?

Second Opinion

Before starting treatment, you may want a second

opinion about your diagnosis, the stage of cancer, and

the treatment plan. Some people worry that the doctor

will be offended if they ask for a second opinion.

Usually the opposite is true. Most doctors welcome a

second opinion. And many health insurance companies

will pay for a second opinion if you or your doctor

requests it. Some companies require a second opinion.

If you get a second opinion, the second doctor may

agree with your first doctor’s diagnosis and treatment

plan. Or the second doctor may suggest another

approach. Either way, you have more information and

perhaps a greater sense of control. You can feel more

confident about the decisions you make, knowing that

you’ve looked at all of your options. 
It may take some time and effort to gather your

medical records and see another doctor. In most cases,

it’s not a problem to take several weeks to get a second

opinion. The delay in starting treatment usually will

not make treatment less effective. To make sure, you

should discuss this delay with your doctor.

There are many ways to find a doctor for a second

opinion. You can ask your doctor, a local or state

medical society, or a nearby hospital or medical school

for names of specialists. 

Also, you can get information about treatment

centers near you from NCI’s Cancer Information

Service at 1–800–4–CANCER (1–800–422–6237)

or LiveHelp (http://www.cancer.gov/livehelp).

Other sources can be found in the NCI fact sheet

How To Find a Doctor or Treatment Facility If You

Have Cancer. 

Rehabilitation

Your health care team will help you return to normal

activities as soon as possible. The goals of

rehabilitation depend on the extent of disease and

surgery.

If the surgeon removes your bladder, you’ll need a

new way to store urine. After your bladder is removed,

the surgeon uses a piece of your small intestine or

large intestine to make a new path for urine to exit the

body or be stored. With this piece of intestine, the

surgeon can either make a tube that carries urine from

the ureters to the outside of the body or create a new

bladder that holds urine inside the body.

23
Your health care team can tell you more about the

following options: 

• Bag worn outside your body under your clothing:

The surgeon can attach a small piece of intestine to

the ureters and to a stoma (an opening in the wall of

the abdomen). Urine drains from the ureters through

the piece of intestine to the stoma. A flat bag fits

over the stoma to collect urine, and special glue

holds the bag in place. The bag is emptied several

times a day.

• New bladder or pouch inside your body: The

surgeon can create a new bladder or pouch made

from a piece of your intestine. The surgeon connects

the pouch to the ureters so that urine can flow from

the ureters and can be stored in the pouch in the

pelvis. The surgeon also connects the pouch either

to your urethra or to a stoma in the wall of your

abdomen:

—New bladder connected to your urethra:

Because the pouch is joined to your urethra, you

will be able to empty your new bladder much as

you did before.

—New bladder connected to a stoma: The

surgeon creates a new path for urine to leave your

body. The pouch is joined to the stoma, and you

will use a catheter (a soft tube) to empty your

bladder several times a day. You will not need to

wear a bag over the stoma.

At first, you will empty your bladder every two or

three hours. But later on, you should be able to hold

the urine for four to six hours. 

A wound, ostomy and continence nurse or another

member of your health care team will visit you before

surgery to describe what to expect. The nurse or doctor

will teach you how to care for yourself after surgery. If

24
you need an ostomy, the nurse or doctor will help you

decide where the opening should be on your abdomen

and will teach you how to care for the stoma after

surgery.

Ask your health care team about your physical,

emotional, or sexual concerns. Often they can provide

information about resources and support groups.

Nutrition

It’s important for you to take very good care of

yourself before, during, and after cancer treatment.

Taking care of yourself includes eating well so you get

the right amount of calories to maintain a good weight.

You also need enough protein to keep up your strength.

Eating well may help you feel better and have more

energy.

Sometimes, especially during or soon after

treatment, you may not feel like eating. You may be

uncomfortable or tired. You may find that foods don’t

taste as good as they used to. In addition, the side

effects of treatment (such as poor appetite, nausea,

vomiting, or mouth blisters) can make it hard to eat

well. 

Your doctor, a registered dietitian, or another health

care provider can suggest ways to help you meet your

nutrition needs. Also, the NCI booklet Eating Hints has

many useful ideas and recipes. 

25
Follow-up Care

You’ll need regular checkups (such as every 3 to 6

months) after treatment for bladder cancer. Checkups

help ensure that any changes in your health are noted

and treated if needed. 

If you have any health problems between checkups,

you should contact your doctor.

Bladder cancer may come back after treatment. Your

doctor will check for return of cancer. Checkups may

include a physical exam, blood tests, urine tests,

cystoscopy, or CT scans.

NCI has publications to help answer questions about

follow-up care and other concerns. You may find it

helpful to read the NCI booklet Facing Forward: Life

After Cancer Treatment. You may also want to read the

NCI fact sheet Follow-up Care After Cancer

Treatment. 

Sources of Support 

Learning that you have bladder cancer can change

your life and the lives of those close to you. These

changes can be hard to handle. It’s normal for you,

your family, and your friends to need help coping with

the feelings that a diagnosis of cancer can bring.

Concerns about treatments and managing side

effects, hospital stays, and medical bills are common.

You may also worry about caring for your family,

keeping your job, or continuing daily activities. 

26
Here’s where you can go for support:

• Doctors, nurses, and other members of your health

care team can answer questions about treatment,

working, or other activities. 

• Social workers, counselors, or members of the

clergy can be helpful if you want to talk about your

feelings or concerns. Often, social workers can

suggest resources for financial aid, transportation,

home care, or emotional support.

• Support groups also can help. In these groups,

patients or their family members meet with other

patients or their families to share what they have

learned about coping with the disease and the effects

of treatment. Groups may offer support in person,

over the telephone, or on the Internet. You may want

to talk with a member of your health care team

about finding a support group. 

• NCI’s Cancer Information Service at

1–800–4–CANCER (1–800–422–6237) and at

LiveHelp (http://www.cancer.gov/livehelp) can

help you locate programs, services, and NCI

publications. They can send you a list of

organizations that offer services to people with

cancer. 

• Your doctor or a sex counselor may be helpful if

you and your partner are concerned about the effects

of bladder cancer on your sex life. Ask your doctor

about possible treatment of side effects and whether

these effects are likely to last. Whatever the outlook,

you and your partner may find it helps to discuss

your concerns.

For tips on coping, you may want to read the NCI

booklet Taking Time: Support for People With Cancer.

27
Taking Part in Cancer Research

Doctors all over the world are conducting many

types of clinical trials (research studies in which people

volunteer to take part). Clinical trials are designed to

find out whether new treatments are safe and effective. 

Even if the people in a trial do not benefit directly,

they may still make an important contribution by

helping doctors learn more about bladder cancer and

how to control it. Although clinical trials may pose

some risks, doctors do all they can to protect their

patients.

Doctors are studying new drugs and drug

combinations. If you’re interested in being part of a

clinical trial, talk with your doctor. You may want to

read the NCI booklet Taking Part in Cancer Treatment

Research Studies. It describes how treatment studies

are carried out and explains their possible benefits and

risks.

NCI’s Web site includes a section on clinical trials at

http://www.cancer.gov/clinicaltrials. It has general

information about clinical trials as well as detailed

information about specific ongoing studies of bladder

cancer. NCI’s Cancer Information Service at

1–800–4–CANCER (1–800–422–6237) and at

LiveHelp at http://www.cancer.gov/livehelp can

answer questions and provide information about

clinical trials.

28
Dictionary 

Definitions of thousands of terms are on NCI’s Web

site in NCI’s Dictionary of Cancer Terms. You can

access it at http://www.cancer.gov/dictionary.

Abdomen (AB-doh-men): The area of the body that

contains the pancreas, stomach, intestines, liver,

gallbladder, and other organs.

Arsenic: A poisonous chemical used to kill weeds and

pests. Also used in cancer therapy.

Bacteria (bak-TEER-ee-uh): A large group of singlecell microorganisms. Some cause infections and

disease in animals and humans. The singular of

bacteria is bacterium.

BCG solution (suh-LOO-shun): A form of biological

therapy for superficial (not invasive) bladder cancer.

The solution is made from a weakened form of the

bacterium Mycobacterium bovis (bacillus CalmetteGuérin) that does not cause disease but stimulates the

body’s immune system. 

Benign (beh-NINE): Not cancerous. Benign tumors

may grow larger but do not spread to other parts of the

body. Also called nonmalignant.

Biological therapy (BY-oh-LAH-jih-kul THAYR-uhpee): Treatment to boost or restore the ability of the

immune system to fight cancer, infections, and other

diseases. Also called immunotherapy. 

Biopsy (BY-op-see): The removal of cells or tissues for

examination by a pathologist. The pathologist may

study the tissue under a microscope or perform other

tests on the cells or tissue. 

Blood vessel: A tube through which the blood

circulates in the body. Blood vessels include a network

of arteries, arterioles, capillaries, venules, and veins.

29
Cancer (KAN-ser): A term for diseases in which

abnormal cells divide without control and can invade

nearby tissues. Cancer cells can also spread to other

parts of the body through the blood and lymph

systems. 

Carcinoma in situ (KAR-sih-NOH-muh in SY-too): A

group of abnormal cells that remain in the place where

they first formed. They have not spread. These

abnormal cells may become cancer and spread into

nearby normal tissue. Also called stage 0 disease.

Catheter (KA-theh-ter): A flexible tube used to deliver

fluids into or withdraw fluids from the body.

Cell (sel): The individual unit that makes up the tissues

of the body. All living things are made up of one or

more cells.

Chemotherapy (KEE-moh-THAYR-uh-pee):

Treatment with drugs that kill cancer cells.

Clinical trial (KLIH-nih-kul TRY-ul): A type of

research study that tests how well new medical

approaches work in people. These studies test new

methods of screening, prevention, diagnosis, or

treatment of a disease. Also called clinical study.

Contrast material: A dye or other substance that helps

show abnormal areas inside the body. It is given by

injection into a vein, by enema, or by mouth. Contrast

material may be used with x-rays, CT scans, MRI, or

other imaging tests.

CT scan: A series of detailed pictures of areas inside

the body taken from different angles. The pictures are

created by a computer linked to an x-ray machine. Also

called CAT scan, computed tomography scan,

computerized axial tomography scan, and

computerized tomography.

30
Cyclophosphamide (SY-kloh-FOS-fuh-mide): A drug

that is used to treat many types of cancer and is being

studied in the treatment of other types of cancer. Also

called CTX and Cytoxan.

Cystoscope (SIS-toh-SKOPE): A thin, tube-like

instrument used to look inside the bladder and urethra.

A cystoscope has a light and a lens for viewing and

may have a tool to remove tissue.

Cystoscopy (sis-TOS-koh-pee): Examination of the

bladder and urethra using a cystoscope, inserted into

the urethra. 

Fibrous: Containing or resembling fibers.

General anesthesia (JEN-rul A-nes-THEE-zhuh): A

temporary loss of feeling and a complete loss of

awareness that feels like a very deep sleep. It is caused

by special drugs or other substances called anesthetics. 

Immune system (ih-MYOON SIS-tem): The complex

group of organs and cells that defends the body against

infections and other diseases.

Incision (in-SIH-zhun): A cut made in the body to

perform surgery.

Intestine (in-TES-tin): The long, tube-shaped organ in

the abdomen that completes the process of digestion.

The intestine has two parts, the small intestine and the

large intestine. Also called bowel.

Intravenous (IN-truh-VEE-nus): Into or within a vein.

Intravenous usually refers to a way of giving a drug or

other substance through a needle or tube inserted into a

vein. Also called IV.

IVP: A procedure in which x-ray images of the

kidneys, ureters, and bladder are taken at regular times

after a substance that shows up on x-rays is injected

into a blood vessel. The substance outlines the kidneys,

31
ureters, and bladder as it flows through the system and

collects in the urine. IVP is usually done to look for a

block in the flow of urine. Also called intravenous

pyelography (IN-truh-VEE-nus PY-eh-LAH-gruh-fee).

Kidney: One of a pair of organs in the abdomen.

Kidneys remove waste from the blood (as urine), make

a substance that stimulates red blood cell production,

and play a role in blood pressure regulation.

Large intestine (in-TES-tin): The long, tube-like organ

that is connected to the small intestine at one end and

the anus at the other.

Local anesthesia (LOH-kul A-nes-THEE-zhuh): A

temporary loss of feeling in one small area of the body

caused by special drugs or other substances called

anesthetics. The patient stays awake but has no feeling

in the area of the body treated with the anesthetic.

Lymph node (limf node): A rounded mass of

lymphatic tissue that is surrounded by a capsule of

connective tissue. Lymph nodes filter lymph

(lymphatic fluid), and they store lymphocytes (white

blood cells). They are located along lymphatic vessels.

Also called lymph gland.

Lymph vessel (limf): A thin tube that carries lymph

(lymphatic fluid) and white blood cells through the

lymphatic system. Also called lymphatic vessel.

Malignant (muh-LIG-nunt): Cancerous. Malignant

tumors can invade and destroy nearby tissue and

spread to other parts of the body.

Medical oncologist (MEH-dih-kul on-KAH-loh-jist):

A doctor who specializes in diagnosing and treating

cancer using chemotherapy, hormonal therapy,

biological therapy, and targeted therapy. A medical

oncologist often is the main health care provider for

someone who has cancer. A medical oncologist also

gives supportive care and may coordinate treatment

given by other specialists.

32
Metastatic (meh-tuh-STA-tik): Having to do with

metastasis, which is the spread of cancer from the

place where it started to other places in the body.

MRI: A procedure in which radio waves and a

powerful magnet linked to a computer are used to

create detailed pictures of areas inside the body. These

pictures can show the difference between normal and

diseased tissue. MRI makes better images of organs

and soft tissue than CT scans or other scanning

techniques. MRI is especially useful for imaging the

brain, the spine, the soft tissue of joints, and the inside

of bones. Also called magnetic resonance imaging.

Oncology nurse (on-KAH-loh-jee): A nurse who

specializes in treating and caring for people who have

cancer.

Organ: A part of the body that performs a specific

function. For example, the heart is an organ.

Partial cystectomy (PAR-shul sis-TEK-toh-mee):

Surgery to remove part of the bladder (the organ that

holds urine). Also called segmental cystectomy.

Pathologist (puh-THAH-loh-jist): A doctor who

identifies diseases by studying cells and tissues under a

microscope.

Prostate (PROS-tayt): A gland in the male

reproductive system. The prostate surrounds the part of

the urethra (the tube that empties the bladder) just

below the bladder, and produces a fluid that forms part

of the semen.

Radiation oncologist (RAY-dee-AY-shun on-KAHloh-jist): A doctor who specializes in using radiation to

treat cancer.

Radiation therapy (RAY-dee-AY-shun THAYR-uhpee): The use of high-energy radiation from x-rays,

gamma rays, neutrons, protons, and other sources to

kill cancer cells and shrink tumors. 

33
Radical cystectomy (RA-dih-kul sis-TEK-toh-mee):

Surgery to remove all of the bladder (the organ that

holds urine) as well as nearby tissues and organs.

Registered dietitian (dy-eh-TIH-shun): A health

professional with special training in the use of diet and

nutrition to keep the body healthy. A registered

dietitian may help the medical team improve the

nutritional health of a patient.

Risk factor: Something that increases the chance of

developing a disease. Some examples of risk factors

for cancer are age, a family history of certain cancers,

use of tobacco products, being exposed to radiation or

certain chemicals, infection with certain viruses or

bacteria, and certain genetic changes.

Side effect: A problem that occurs when treatment

affects healthy tissues or organs. Some common side

effects of cancer treatment are fatigue, pain, nausea,

vomiting, decreased blood cell counts, hair loss, and

mouth sores.

Small intestine (in-TES-tin): The part of the digestive

tract that is located between the stomach and the large

intestine.

Spinal anesthesia (SPY-nul A-nes-THEE-zhuh): A

temporary loss of feeling in the abdomen and/or the

lower part of the body. Special drugs called anesthetics

are injected into the fluid in the lower part of the spinal

column to cause the loss of feeling. The patient stays

awake during the procedure. Also called SAB, spinal

block, and subarachnoid block.

Stoma (STOH-muh): A surgically created opening

from an area inside the body to the outside.

Supportive care: Care given to improve the quality of

life of patients who have a serious or life-threatening

disease. The goal of supportive care is to prevent or

treat as early as possible the symptoms of a disease,

34
side effects caused by treatment of a disease, and

psychological, social, and spiritual problems related to

a disease or its treatment. Also called comfort care,

palliative care, and symptom management.

Surgeon: A doctor who removes or repairs a part of

the body by operating on the patient.

Surgery (SER-juh-ree): A procedure to remove or

repair a part of the body or to find out whether disease

is present. An operation.

Tissue (TISH-oo): A group or layer of cells that work

together to perform a specific function.

Transitional cell (tran-ZIH-shuh-nul sel): A cell that

varies in shape depending on whether the tissue is

being stretched. They line hollow organs such as the

bladder.

Transitional cell cancer (tran-ZIH-shuh-nul sel KANser): Cancer that forms in transitional cells in the lining

of the bladder, ureter, or renal pelvis (the part of the

kidney that collects, holds, and drains urine). 

Transurethral resection (TRANZ-yoo-REE-thrul reeSEK-shun): Surgery using a special instrument inserted

through the urethra. Also called TUR.

Tumor (TOO-mer): An abnormal mass of tissue that

results when cells divide more than they should or do

not die when they should. Tumors may be benign (not

cancer), or malignant (cancer). Also called neoplasm.

Ultrasound (UL-truh-SOWND): A procedure in which

high-energy sound waves are bounced off internal

tissues or organs and make echoes. The echo patterns

are shown on the screen of an ultrasound machine,

forming a picture of body tissues called a sonogram.

Also called ultrasonography.

Ureter (YER-eh-ter): The tube that carries urine from

the kidney to the bladder.

35
Urethra (yoo-REE-thruh): The tube through which

urine leaves the body. It empties urine from the

bladder.

Urinary tract (YOOR-in-air-ee): The organs of the

body that produce and discharge urine. These include

the kidneys, ureters, bladder, and urethra.

Urine (YOOR-in): Fluid containing water and waste

products. Urine is made by the kidneys, stored in the

bladder, and leaves the body through the urethra.

Urologic oncologist (YOOR-uh-LAH-jik on-KAHloh-jist): A doctor who specializes in treating cancers

of the urinary system.

Urologist (yoo-RAH-loh-jist): A doctor who

specializes in diseases of the urinary organs in females

and the urinary and sex organs in males.

Uterus (YOO-ter-us): The small, hollow, pear-shaped

organ in a woman’s pelvis. This is the organ in which a

fetus develops. Also called womb.

Vagina (vuh-JY-nuh): The muscular canal extending

from the uterus to the exterior of the body. Also called

birth canal.

Wound, ostomy and continence nurse (woond OStoh-mee KAHN-tih-nents): A registered nurse who has

additional education and training in how to care for

people who have a wound, an ostomy (surgery to

create an opening in the abdomen for a new path for

urine or stool), or incontinence (inability to control

either the flow of urine from the bladder or the escape

of stool from the rectum). 

X-ray: A type of high-energy radiation. In low doses,

x-rays are used to diagnose diseases by making

pictures of the inside of the body. In high doses, x-rays

are used to treat cancer.

36
National Cancer Institute Publications

NCI provides publications about cancer, including

the booklets and fact sheets mentioned in this booklet.

Many are available in both English and Spanish. 

You may read these publications online and print

your own copy. Also, people in the United States and

its territories may order NCI publications: 

• By telephone: People in the United States and its

territories may order these and other NCI

publications by calling the NCI’s Cancer

Information Service at 1–800–4–CANCER

(1–800–422–6237). 

• On the Internet: Many NCI publications may be

viewed, downloaded, and ordered from

http://www.cancer.gov/publications. This Web site

also explains how people outside the United States

can mail or fax their requests for NCI booklets.

Cancer Treatment and Supportive Care

• How To Find a Doctor or Treatment Facility If You

Have Cancer (also in Spanish)

• Chemotherapy and You (also in Spanish)

• Radiation Therapy and You (also in Spanish)

• Pain Control (also in Spanish)

• Eating Hints (also in Spanish)

Coping with Cancer

• Taking Time: Support for People with Cancer

37
Life After Cancer Treatment

• Facing Forward: Life After Cancer Treatment (also

in Spanish)

• Follow-up Care After Cancer Treatment

• Facing Forward: Ways You Can Make a Difference

in Cancer

Advanced or Recurrent Cancer

• Coping With Advanced Cancer

• When Cancer Returns

Complementary Medicine

• Thinking about Complementary & Alternative

Medicine

Caregivers

• When Someone You Love Is Being Treated for

Cancer: Support for Caregivers

• When Someone You Love Has Advanced Cancer:

Support for Caregivers

• Facing Forward: When Someone You Love Has

Completed Cancer Treatment

• Caring for the Caregiver: Support for Cancer

Caregivers

Quitting Smoking

• Clearing the Air: Quit Smoking Today

Research Studies

• Taking Part in Cancer Treatment Research Studies

• Providing Your Tissue for Research: What You Need

To Know

• Donating Tissue for Cancer Research: Biospecimens

and Biorepositories

38
The National Cancer Institute 

The National Cancer Institute (NCI), part of the

National Institutes of Health, is the Federal

Government’s principal agency for cancer research

and training. NCI conducts and supports basic and

clinical research to find better ways to prevent,

diagnose, and treat cancer. The Institute also supports

education and training for cancer research and

treatment programs. In addition, NCI is responsible

for communicating its research findings to the

medical community and the public.

Copyright permission

You must have permission to use or reproduce the

artwork in this booklet for other purposes. The

artwork was created by private sector illustrators,

designers, and/or photographers, and they retain the

copyrights to artwork they develop under contract to

NCI. In many cases, artists will grant you permission,

but they may require a credit line and/or usage fees.

To inquire about permission to reproduce NCI

artwork, please write to: 

Office of Communications and Education

National Cancer Institute

6116 Executive Boulevard, Room 3066 

MSC 8323

Rockville, MD 20892–8323

You do not need our permission to reproduce or

translate NCI written text. The written text of this

NCI booklet is in the public domain, and it is not

subject to copyright restrictions. However, we would

appreciate a credit line and a copy of your translation

of this NCI booklet.
NIH Publication No.10-1559

Revised July 2010

Printed August 2010