Bladder cancer

Bladder cancer is a malignant tumor that develops in the lining of the bladder. Some bladder cancers are only superficial, others penetrate to deeper layers of the bladder wall, possibly spreading beyond the organ.

At a glance

  • Bladder cancer is the most common cancer of the urinary tract.  
  • Men are about three times as likely to be affected as women.
  • In about 7 out of 10 of those affected, the tumor is confined to the lining of the bladder. This cancer is called non-muscle-invasive bladder cancer.
  • In the remaining patients, the cancer has spread into the muscle layer. This is called muscle-invasive bladder cancer.
  • The main risk factor for bladder cancer is active and passive smoking. This means that the main preventive measure is to abstain from nicotine.
  • Non-muscle-invasive bladder cancer has a better chance of recovery than muscle-invasive bladder cancer.  

Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.

Bladder cancer: older man lying on his back on a hospital bed being pushed through a hospital corridor. Four men in white coats are standing around the man.

What is bladder cancer?

Bladder cancer is a malignant (cancerous) tumor of the lining of the bladder called the urothelium.

  • If the cancer cells are superficial, this is non-muscle-invasive bladder cancer. 
  • Tumors where the cancer cells spread to the muscle layer are called muscle-invasive bladder cancers.  

When they’re first diagnosed, most bladder cancers have not yet spread to the muscle layer. 

Eine Illustration mit der Überschrift "Eindringtiefe eines Harnblasenkarzinoms". Darunter steht: "Nicht muskelinvasiver Blasenkrebs: Schleimhaut und Submukosa" und "muskelinvasiver Blasenkrebs: Muskelwand und Fettgewebe."

Ist der Krebsbefall der Harnblase oberflächlich, spricht man von einem nicht-muskelinvasiven Karzinom. Sind tiefere Schichten betroffen, handelt es sich um ein muskelinvasives Karzinom.

What are the symptoms of bladder cancer?

Bladder cancer is difficult to detect. But the following signs are typical: 

  • blood in the urine, usually not painful, sometimes with a reddish or brown discoloration of the urine
  • symptoms when urinating, for example frequent urge to urinate with only small amounts of urine each time  

In the early stages, some patients have no symptoms, or only very general ones. Men may think the symptoms are prostate problems and women may think they have a bladder infection.

If unusual symptoms persist for a long time, the person affected is advised to go and see a doctor. General Practitioners can already narrow down what is causing the symptoms and, if necessary, initiate further diagnostic steps with specialists.

Bladder cancer: what are the risk factors?


The main risk factor for bladder cancer is active and passive smoking. If a smoker gives up smoking, the risk of them getting bladder cancer is reduced.

Chemical substances

But some chemical substances can also increase the risk of getting bladder cancer. Bladder cancer is recognized as an occupational disease for workers in occupational groups who are exposed to carcinogenic substances in their work. This affects painters and decorators, for example.


Bladder cancer is more common in people who have chronic inflammatory diseases.  

Further information about the causes of and risk factors for bladder cancer can be found on the German Cancer Research Center’s Cancer Information Service website (in German).

Is screening for bladder cancer offered in Germany?

There is currently no statutory cancer screening program for bladder cancer in Germany. Examining the urine for hidden blood may be appropriate for people with an increased risk of bladder cancer, for example heavy smokers.

There are commercial tests offered as an additional service. They are known as individual health services (“Individuelle Gesundheits-Leistung” – IGeL). But experts do not recommend these tests to screen for bladder cancer as their benefit has not been adequately clarified in studies. 

How is bladder cancer diagnosed?

If they suspect someone might have bladder cancer, doctors perform the following tests: 

  • consultation (medical history) – one important thing for doctors to know is if the patient smokes 
  • physical examination
  • blood test
  • ultrasound (sonography)

Additional measures may be carried out to confirm the findings: 

  • Urine test to look for blood and cancer cells
  • Examination of the bladder (cystoscopy): with the patient under local anesthetic, the doctor passes a thin tube through the urethra of the person affected and into their bladder. A small camera on the end transmits images of the inside of the bladder onto a screen. Doctors can use this to identify changes in the bladder lining and take tissue samples (biopsy) from areas of suspicion. The tissue samples are then examined under the microscope in the laboratory.  
  • Transurethral resection of the bladder (TUR-B): if a rigid cystoscopy is carried out, the suspicious tissue is completely removed with an electrical wire loop, if possible, with the patient under general or local anesthetic. Additional tissue samples may be taken and are also examined under the microscope in the laboratory. 
Eine Illustration zeigt einen männlichen Unterleib bei einer transurethralen Resektion (TUR). Dargestellt sind Schwellkörper im Penis in Relation zum Resektoskop, ein Rohr mit einer Elektroschlinge, die Harnblase, Prostata und ein zu entfernender Tumor.

Bei einer transurethralen Resektion (TUR) wird ein starres Rohr mit einer Elektroschlinge bis in die Harnblase vorgeschoben.

The following video explains how this surgical procedure is performed. How is a bladder tumor removed?

If the person has non-muscle-invasive bladder cancer with no risk factors, no further tests are carried out. If there are risk factors and/or the person has muscle-invasive cancer, the doctor assesses the spread of the bladder cancer with the following tests:

  • Imaging procedures are carried out if the person has non-muscle-invasive bladder cancer with risk factors. These include computed tomography (CT), possibly magnetic resonance imaging (MRI) and X-ray examinations of the lower urinary tract with a contrast agent. They provide information about the spread of the tumor.
  • If the person has muscle-invasive bladder cancer, experts recommend a CT scan of the chest area, stomach and pelvis with a contrast agent. An MRI can be carried out instead of a CT scan of the pelvis.
  • If bone metastases are suspected, experts recommend a bone scan (skeletal scintigraphy).
  • If brain metastases are suspected, a CT scan of the head is performed. 

Do you want to know how a cystoscopy works and what other diagnostic tests there are? You can find detailed descriptions of the diagnostic tests used on the German Cancer Research Center’s Cancer Information Service’s website (in German). 

How is bladder cancer treated?

The layers of the bladder wall affected by bladder cancer differ with non-muscle-invasive and muscle-invasive bladder cancer. This means that the treatments also differ. The other important thing to consider is how aggressive the tumor is and whether the bladder cancer has already spread. 

Non-muscle-invasive bladder cancer 

If the cancer is superficial, the doctor can often remove the tumor completely during therapeutic cystoscopy. This procedure involves the urologists passing an electrical wire loop through a rigid tube into the bladder and removing the tumor using an electric current, with the patient under general or local anesthetic. This procedure is called transurethral resection of the bladder (TURB).

With non-muscle-invasive bladder cancer there are often relapses. This is why experts recommend additional medication after the operation, which the doctor flushes into the bladder through a catheter. Possible options are chemotherapy or immunotherapy that only have a local effect and not on the entire body.

Since the muscle layer of the bladder is not affected by cancer, the bladder can be preserved for most patients. It is only if there is a particularly high risk of relapse that doctors recommend that the bladder is removed.

The aim of the treatment of non-muscle-invasive bladder cancer is to effect a complete cure.  

Muscle-invasive bladder cancer 

With muscle-invasive bladder cancer, the tumor has spread to the deeper bladder wall and possibly also the surrounding tissue.

Doctors usually remove the entire bladder. This operation is called radical cystectomy. This operation involves the surgeons removing the bladder and the neighboring lymph nodes. In women, the uterus, fallopian tubes, ovaries and parts of the vaginal wall are also removed and in men the prostate and seminal vesicle.

Patients who have muscle-invasive bladder may also receive chemotherapy before or after the surgery. Chemotherapy can reduce the risk of a relapse.

Sometimes the bladder can be preserved even with muscle-invasive bladder cancer. Doctors recommend a transurethral resection (TURB) for these patients. This involves the tumor being removed as completely as possible. The operation is followed by radiotherapy and chemotherapy. The aim of the treatment is to cure the cancer.

If the bladder has had to be removed, the surgeons perform a procedure to give those affected an artificial form of urinary diversion to pass urine. The patients can have a discussion with the doctor to decide what form is best for them.

There are two basic forms of artificial urinary diversion: 

  • dry (continent) urinary diversion and 
  • wet (non-continent) urinary diversion. 

With continent urinary diversion, the urine is stored in a newly created reservoir and drained away. Doctors most often use the neobladder. This involves them using a piece of the small or large intestine to form a reservoir where the urine collects, situated where the removed urinary bladder was.

Over time, some patients with a neobladder are able to pass urine almost like they did with their healthy bladder. Others occasionally need a catheter that they insert into their bladder to divert the urine. 

Eine Illustration zeigt die Darstellung eines Oberkörpers. Hervorgehoben sind die Ersatzblase (Neoblase) und die Harnröhre. Daneben steht der Text: "Trockene" Harnableitung der Neoblase.

With a non-continent urinary diversion, the urine flows continuously through an opening in the abdominal wall. For the most common procedure, the conduit, the surgeons use a piece of the bowel. They stitch this to one opening with both ureters and to the other with the abdominal wall. The opening in the abdominal wall is called a stoma. This is where they attach a removable pouch known as a stoma bag which collects the urine.

Illustration with a diagram of a torso. The bladder is marked in color. The caption reads “Wet” urostomy. Ileal conduit. With an ileal conduit the urine flows through an opening in the abdominal wall.

Metastatic bladder cancer

Once the cancer has spread, a cure is no longer likely. With these patients, the aim is to:  

  • delay the progression of the disease for as long as possible.
  • maintain their quality of life as much as is possible and relieve their cancer-related symptoms. 

At this stage of the disease, the bladder is usually no longer removed. Systemic treatment affecting the entire body is intended to stop the disease from progressing further. The following medication is considered, depending on the situation: 

  • Chemotherapy uses medication (cytostatics) to stop cell growth or prevent cell division.
  • Immunotherapy uses medicines to stimulate some of the body’s own immune cells to fight the cancer cells directly.

The above-mentioned treatment options can have side effects.

How is cancer treated?

The video below explains how cancer can be treated.

This and other videos can also be found on YouTube

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Detailed information about how the treatments work, the side effects and coping with treatment complications with non-muscle-invasive bladder cancer and muscle-invasive bladder cancer can be found on the Cancer Information Service of the German Cancer Research Center’s website (in German).

After bladder cancer treatment: rehabilitation

Medical rehabilitation (rehab) after cancer treatment is intended to help patients recuperate. It also aims to help patients to deal with the effects of the disease and its treatment in the best possible way. This is why the rehab program is tailored to each person’s personal medical history and existing limitations. 
Urological rehab after bladder cancer treatment could include: 

  • how to deal with a replacement bladder 
  • how to deal with other forms of diversion, a stoma for example 
  • help with digestive problems and with diet 
  • how to deal with the effects of chemotherapy such as tiredness or nerve pain 

What’s next? Aftercare in bladder cancer

After the treatment, the doctors perform follow-up examinations, first at shorter intervals, then longer ones. They define the intervals between the examinations based on each affected person’s risk of relapse. 
Non-muscle-invasive bladder cancers have a high risk of relapse. Patients often relapse within five years of the treatment. This is why check-ups are very important. 
The doctors use the follow-up examinations to identify any complications of the treatment in good time. They can also detect a relapse early on and quickly start further treatment. The main follow-up examination is cystoscopy. The aftercare also includes urine and blood tests. 

What effect does bladder cancer have on everyday life?

The extent to which everyday life is altered after bladder cancer depends on how serious the cancer is and what treatments were required. 
If the bladder has been completely removed, the patient must expect problems with their sexual function and with passing urine.  
Patients with artificial urinary diversion can contact various specialist occupational groups dealing with the effects of bladder cancer. They include, for example, specially trained nurses known as stomal therapy nurses, nutritionists and social workers. Psychosocial support can make life with the disease easier.

What are the points of contact for bladder cancer?

Hospitals with a lot of experience in the treatment of patients with bladder cancer are called “Certified bladder cancer centers”.

You can find the addresses of the certified centers on the OncoMAP website.

A list of the Urological University Hospitals in Germany can be downloaded on the joint website of the German Society of Urology (Deutsche Gesellschaft für Urologie e.V.) and the urological professional association.

Do you have further questions about dealing with the condition in everyday life and additional support options? You can find information about this on the Cancer Information Service of the German Cancer Research Center website (in German).

If you have any questions about bladder cancer you can also make personal contact with the Cancer Information Service by dialing the freephone number 0800 - 420 30 40 or writing an email to

In cooperation with the Cancer Information Service of the German Cancer Research Center (Krebsinformationsdienst des Deutschen Krebsforschungszentrums).

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