Facts About Bladder Cancer

Confirming a Bladder Cancer Diagnosis

Our experts begin by checking details about your disease, including the type, extent and grade of the cancer, so we can provide the right treatment for you. A biopsy shows if you have cancer. It will also give details about the type of cancer you have. Most bladder cancers are a type called urothelial cancer. But there are many rare histologic types, called variants. Some examples are squamous cell carcinoma, adenocarcinoma, micropapillary, sarcomatoid, nested, plasmacytoid and neuroendocrine variants. 

The extent of the cancer — how far it has spread — matters, too. Your care team needs to know if your cancer sits on or in the first lining of your bladder (non-muscle invasive), if it goes into the bladder muscle wall (muscle-invasive) or if it has spread to distant parts of your body (metastatic).

We also compare the cancer cells to normal cells to tell the cancer grade. The grade helps your physicians predict how your bladder cancer will behave (how aggressive it is).

At Fred Hutch, we have a great deal of experience with all forms of bladder cancer. We have pathologists and radiologists who specialize in diagnosing these cancers. They will give your treating physicians the details needed to tailor your care to you.

We often take another look at the test results and imaging that patients have had elsewhere. This allows us to update your exact diagnosis and disease stage in important ways that can affect your treatment choices.

Staging Bladder Cancer

Staging means finding out how far cancer has spread in your bladder or other parts of your body. Knowing the stage of your cancer helps your doctors predict which therapies to use to treat your disease.

Stages of Bladder Cancer

Doctors use Roman numerals 0 (zero), I (one), II (two), III (three) and IV (four) to name the stages of bladder cancer. Stage 0 is the least advanced, and stage IV is the most advanced. All stages can be treated. 

  • Stage 0: Cancer is only on the inner lining of the bladder.
  • Stage I: Cancer has grown through the inner lining of the bladder to the layer below. It has not gone into the bladder muscle or other parts of the body.
  • Stage II: Cancer has spread to the muscle wall of the bladder but not further.
  • Stage III: Cancer has spread through the bladder muscle to other tissue. It may be in the fatty layer around the bladder, the prostate, the uterus or vagina or nearby lymph nodes.
  • Stage IV: Cancer has spread further outside the bladder. It may be in the pelvic or abdominal wall, lymph nodes outside the pelvis or other parts of the body.

Staging Tests

Doctors use these methods to help diagnose bladder cancer and also tell if the cancer has spread.

  • Microscopic urinalysis — testing your urine to help rule out infections and check for blood, sugar, bacteria or proteins that should not be there.
  • Urine cytology — testing your urine to help find cancer cells. This is often done along with fluorescent in-situ hybridization (FISH) or protein tests. 
  • Physical exam — this includes an exam of your abdomen, back and rectum to feel for bumps that may be tumors. If you have a vagina, the exam also includes the vagina.
  • Cystoscopy/ureteroscopy — putting a thin camera through your urethra to check your bladder and maybe your ureters. The doctor may also take a tissue sample (biopsy) to help tell the type and stage of the cancer.
  • Transurethral resection of a bladder tumor (TUR or TURBT) — taking out the tumor and samples from other parts of your bladder. This is done through your urethra. A pathologist can then check the type of cancer and how deep it is in the tissue.
  • Molecular profiling — checking the make-up of your cancer. This allows doctors to choose the most effective treatments and find clinical trials that may be right for you.
  • Imaging tests — such as magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, X-rays, ultrasounds and bone scans. These tests help your doctors tell if cancer has spread beyond your bladder.
  • Blue-light cystoscopy with hexaminolevulinate HCl — makes bladder tumors glow bright pink in blue light. The glow helps your provider see and remove the cancer. 

Types of Treatment for Bladder Cancer

All types and stages of bladder cancer and other urinary tract cancers are treatable. The key is to get care from experts who know the complex factors that go into choosing the right treatments for you at the right time — like the doctors at Fred Hutchinson Cancer Center.

Bladder Cancer Second Opinions

If you have been diagnosed with bladder cancer or another urothelial cancer, we recommend getting a second opinion before choosing where you will be treated. 

Fred Hutch has the region’s first Bladder Cancer Multispecialty Clinic. At this clinic, a team of physicians comes together to plan care for people with bladder or other urothelial cancers. During a single visit, you get a second opinion from an entire group of doctors. They include urologic oncologists, medical oncologists, radiation oncologists, pathologists and radiologists.

You can talk with cancer experts who understand your disease and treatment options in greater depth than the general oncologists in your local community. We will share information with your local physicians based on your wishes and be a resource for you and them.

Call us at 855.557.0555 to request an appointment for a second opinion.

How a Second Opinion Can Help

Getting a second opinion from specialists can help you:

  • Find out as much as possible about your exact diagnosis and cancer stage. These affect your treatment plan and prognosis.
  • Learn about the benefits of team-based care that is well coordinated.
  • Start with the best possible course of treatment for you. (It is not always easy or possible to change course.)
  • Think about advanced and recently approved treatment options that not all physicians may know about. These may include robot-assisted surgery to speed up your recovery, bladder reconstruction to help maintain your quality of life and faster access to many new treatments. 

If you were diagnosed through Fred Hutch, ask your care team about getting a second opinion. They will be happy to give you names of physicians we recommend.

Fred Hutch has researched and treated bladder cancer for decades.


There are many resources online for learning about your disease. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.

Whether you are newly diagnosed, going through treatment or know someone with cancer, our staff are available to tailor personalized resources and answer questions about support options in the community. 

Cancer Research Organizations

Our list of online resources provides accurate health information from reliable and reputable sources, like the National Cancer Institute (NCI), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN).

American Cancer Society

American Cancer Society (ACS): Overview of Bladder Cancer

If you have bladder cancer or a caregiver for someone who does, knowing what to expect can help you cope. Here you can find out all about bladder cancer, including risk factors, symptoms, how it's found and how it's treated.

American Society of Clinical Oncology

American Society of Clinical Oncology (ASCO): Guide to Bladder Cancer

This is Cancer.Net's Guide to Bladder Cancer. Here you can learn more about bladder cancer, treatment, the latest research and clinical trials.

American Society of Clinical Oncology

ASCO Answers: Bladder Cancer

ASCO Answers is a collection of oncologist-approved patient education materials developed by ASCO for people with cancer and their caregivers.


CancerCare: Bladder Cancer General information and Support

CancerCare provides free, professional support services for people affected by bladder cancer, as well as bladder cancer treatment information and additional resources, including financial and co-pay assistance.


CancerCare Treatment Update: Bladder Cancer

The CancerCare Connect® Booklet Series offers up-to-date, easy-to-read information on the latest treatments, managing side effects and coping with cancer.

National Comprehensive Cancer Network

National Comprehensive Cancer Network (NCCN) Guidelines for Patients: Bladder Cancer

This step-by-step guide to the latest advances in cancer care features questions to ask your physician, patient-friendly illustrations and glossaries of terms and acronyms.

National Cancer Institute

National Cancer Institute (NCI): Bladder Cancer-Patient Version

The NCI is the federal government's principal agency for cancer research and training. Here you can find more information about bladder cancer treatment, research and coping with cancer.

Cancer Support Organizations

Our list includes local and national organizations that are dedicated to improving the quality of life for patients and family members through providing emotional support, education and community.

Fred Hutchinson Cancer Center

2023 Updates in Bladder and Urinary Tract Cancers for Patients and their Loved Ones

This educational event recording provides the latest updates for bladder and urinary tract cancer patients and their loved ones.

American Bladder Cancer Society

American Bladder Cancer Society

This is an active online forum as well as other ways to connect with bladder cancer patients.

Bladder Cancer Advocacy Network

Bladder Cancer Advocacy Network (BCAN)

BCAN advocates for public awareness, increased funding for bladder cancer research and provides patients, caregivers and the medical community with educational resources and support services to navigate bladder cancer treatment and care.

Fred Hutchinson Cancer Center

Kidney and Bladder Cancer Support Group

The Fred Hutch Kidney and Bladder Support Group is open to all patients, survivors and their families. Meetings are held at the South Lake Union Clinic.