Bladder Cancer


They actually listened to what I wanted from the surgery; they were able to give me options that other hospitals were not able to give me." Christine Crews, bladder cancer survivor

If you have been recently diagnosed with bladder cancer, talk to the experts at City of Hope. Our bladder cancer team is an integrated group of experts who will focus on providing you optimal care from the moment of diagnosis to active treatment to recovery and survivorship.

After consulting with you about your concerns and desired goals, we will design a personalized treatment plan to give you the best possible outcome.

Request a Consultation

If you have been diagnosed with bladder cancer or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673 (HOPE). Please visit Making Your First Appointment for more information. 

Highlights of our bladder cancer program include:

  • Our leadership and experience in bladder surgery, being one of the largest centers offering robotic cystectomies with novel urinary diversion options, such as Indiana pouches and neobladders.
  • Our surgeons’ expertise in minimally invasive operations
  • A “coordinated care pathway” that integrates experts from multiple specialties to focus on individual cases through the entire continuum of care and rehabilitation — expediting recovery, improving outcomes and enhancing the patient experience
  • A wide portfolio of drugs that can fight cancer better with fewer side effects
  • Ongoing research and clinical trials of promising new therapies, including immunity-based and stem cell therapies
  • Long-term survivorship and follow-up program focused on minimizing recurrence risk and improving quality of life




City of Hope has been named a best hospital for urology and cancer by U.S. News & World Report, and a National Cancer Institute comprehensive cancer center, the highest designation that recognizes our commitment to cancer treatment, research and education.

As a founding member of the National Comprehensive Cancer Network, our doctors also help develop and improve evidence-based bladder cancer treatment guidelines for patients throughout the country.




What is bladder cancer?

Bladder cancer is a disease in which cells in the urinary bladder start growing abnormally and uncontrollably.

About 90 percent of bladder cancers are transitional cell carcinomas (also known as urothelial carcinomas), which begins in the cells that line the inside of the bladder.

Rarer bladder cancers include squamous cell carcinomas (originating from flat-shaped cells), adenocarcinomas (from mucus-secreting gland cells), small cell carcinoma (from nerve-like neuroendocrine cells) and sarcomas (from the bladder’s muscle cells).

What increases your risk of bladder cancer?

Factors that can elevate risk of bladder cancer include:

  • Smoking: Smoking causes approximately half of all bladder cancer cases and smokers are three times more likely to get bladder cancer compared to nonsmokers.
  • Age: Approximately 90 percent of cases are diagnosed in people older than 55.
  • Gender: Bladder cancer is more common in men.
  • Chronic bladder infections or irritations, including prolonged use of urinary catheters
  • Workplace chemical exposures: Chemicals called aromatic amines, which are used in the dye industry, can cause bladder cancer. As such, people work in printing, painting, textiles and hairdressing industries may have a higher bladder cancer risk.
  • Prior treatment with radiation therapy in the pelvic area or with chemotherapy
  • Inherited genetic mutations, such as Lynch syndrome (also known as hereditary nonpolyposis colorectal cancer, or HNPCC), Cowden disease and retinoblastoma

What are the signs and symptoms of bladder cancer?

Most common bladder cancer symptoms are linked with urination changes, including:

  • Blood in the urine
  • Pain or burning sensation during urination
  • Weak urine flow
  • Urgency to urinate, even with bladder is not full
  • Increased urination frequency

Bladder cancer may also cause more generalized symptoms, such as:

  • Pain in the lower back or pelvic area
  • Fatigue
  • Swelling in the feet
  • Loss of appetite and unexplained weight loss

Although these symptoms can be caused by other conditions, you should check with a doctor – preferably a urologist – so they can make a definitive diagnosis.


Sources: National Cancer Institute and American Cancer Society

How is bladder cancer detected?

Once you notice symptoms, or as part of a routine examination, your doctor may use the following tests to look for bladder cancer:

  • Physical exam
  • Internal exam: The doctor inserts gloved, lubricated fingers into the vagina or rectum to feel for lumps in the bladder.
  • Urine lab test: A sample of your urine is taken and examined for cancerous or precancerous cells or biomarkers indicating bladder cancer.
  • Biopsy: Surgical removal of suspicious tissues for further examination
  • Cystoscopy: A thin, flexible tube (cystoscope) equipped with a lens and light source is inserted into the urethra and guided into the bladder. The bladder is then filled with fluid and examined for abnormalities. If suspicious tissues are seen, it may be biopsied for further examination. Localized, spinal or general anesthesia may be administered prior to this procedure.
    • Fluorescence cystoscopy: Also known as blue light cystoscopy, this enhanced form of cystoscopy uses a light-activated drug. The drug is taken up by cancer cells and glows when a blue light is shone upon it, allowing for easier detection of cancerous areas.

If cancer is found, additional tests are performed to determine the type and stage of disease. These diagnostic tests include:

  • Intravenous pyelogram (IVP): Also called intravenous urogram (IVU), this procedure first injects a special dye into the vein. The dye then coats the interior lining of the urinary tract and an X-ray is taken to see if there are any tumors in the bladder, kidneys or ureters.
  • Retrograde pyelogram: For patients who cannot tolerate an IVP, this test injects the dye using a urinary catheter.
  • Computed tomography (CT or CAT) scan: This test involves taking a series of X-ray images at different angles to form a computer-generated image, which determines tumor size, location and number. CT scans may also be used to guide a biopsy.
  • Ultrasound: High energy sound waves are used to create images of the bladder, and it may be also be used to guide a biopsy.
  • Magnetic resonance imaging (MRI) urogram: This procedure images the bladder, ureters and kidneys using a powerful magnet, radio waves and a computer. A biopsy may be taken at the same time if the images show any abnormalities.
  • Lymph node biopsy: Removal and examination of lymph nodes in the pelvic region to see if the cancer has spread
  • Bone scan: A procedure using a small amount of radioactive material to determine if bladder cancer cells have spread to the bones
  • Genomic testing: The cancerous tissue is tested to see if it exhibits certain genetic mutations, which can be used to determine better treatments.

Based on the results of these tests, the bladder cancer is then staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs. Bladder cancer is also evaluated by “grades” based on how much it resembles normal bladder cells and how aggressive it grows.

What are the current screening guidelines for bladder cancer?

There are currently no screening guidelines for bladder cancer, since no screenings have been shown to lower risk of dying from bladder cancer for people of average risk. However, your physician may recommend screening if you are at a high risk of developing bladder cancer, due to:

  • Specific genetic mutations
  • Birth defects
  • Workplace chemical exposure

Bladder Cancer Treatment Options

With bladder cancer, the majority of patients that I see can be cured; the challenge is to get patients the same quality of life that they had before surgery.”  Kevin Chan, M.D., head of reconstructive urology at City of Hope

Your bladder cancer is every bit as unique as you are, and that is why treatment at City of Hope is focused around you and your loved ones.

This means our physicians will personally consult with you about your disease, treatment options and desired outcomes. Afterward, our multidisciplinary team of specialists will work together to discuss, design and deliver an individual treatment plan to best meet those goals.

The innovative treatments we use to treat bladder cancer include surgery, drug therapy and radiation therapy.


Surgery is a common treatment option for most bladder cancer patients, particularly those with early-stage, localized cancer.

Depending on size, stage, grade and location of the tumor, surgeries performed include:

  • Transurethral resection (TUR) with fulguration: This procedure uses a thin, flexible tube (cystoscope) that is inserted into the urethra and guided into the bladder. After cancerous tissue is identified, tools inserted through the tube can surgically remove it or burn it off using an electric current.
  • Partial cystectomy: Also known as segmental cystectomy, this surgery removes part of the bladder and may be done for patients with low-grade tumors confined to one area of the bladder. Because only part of the bladder is removed, the patient may urinate normally after recovery.
  • Radical cystectomy: Surgery removing the entire bladder, along with nearby lymph nodes and tissues. In men, the prostate and seminal vesicles are removed. In women, the ovaries, fallopian tubes, uterus, cervix and a small portion of the vagina are removed. Because the entire bladder is removed, the surgeon will also need to perform a reconstructive procedure to divert urine flow.

Depending on the disease, patient’s health, desired outcomes and quality-of-life goals, the surgeon may opt for one of several urinary diversion procedures following a radical cystectomy.   Urinary diversions can be done intracorporeally or extracorporeally. The most common ones include:

  • Ileal Conduit: The ureters (tubes that drain urine from the kidneys) are connected to a small segment of the ileum (small intestine). The end of the ileum conduit is brought out into the skin through an abdominal opening called a stoma. The stoma is covered by an external bag which collects urine as it drains from the conduit.
  • Indiana Pouch: This procedure creates an internal reservoir using the ileum and colon (large intestine), with a small part of the ileum brought to the skin as a stoma. The ureters empty into this pouch and the patient will regularly empty the pouch by passing a small, thin catheter through the stoma and into the pouch.
  • Neobladder: Some patients may be eligible for a neobladder procedure, which creates a pouch from the small intestine that is connected directly to the urethra. While this procedure allows patients to pass urine through the urethra, it may take a while to regain urinary control and patients may have to self-catheterize to drain urine from the neobladder.

City of Hope is a nationwide leader in bladder cancer surgery, specializing in minimally invasive robotic procedures with advanced urinary diversion techniques. Our team has done over 500 robotic cystectomies over the past decade.

City of Hope also has an extensive recovery and follow-up program for postcystectomy patients, aimed at helping them:

  • Regain urinary control
  • Minimize risk of complications
  • Address emotional, social and lifestyle issues related to the cancer or treatments

Specialists in this program include nurses, rehabilitation therapists, occupational therapists, clinical social workers, psychologists, psychiatrists, dieticians and other supportive care medicine experts.


Drug Therapy

Drug therapy may be given to patients to fight bladder cancer cells throughout the body by killing them or stopping their growth and spread. These drugs include:

  • Chemotherapy, which targets all rapidly-dividing cells, including bladder cancer cells
  • Immunotherapy, which stimulates the patient’s immune system to attack cancer cells

Drugs may also be prescribed to treat conditions related to bladder cancer or its treatments, such as low blood cell counts, nausea or pain.

In addition to oral and intravenous delivery, bladder cancer patients may also receive anti-cancer drugs intravesically. In intravesical therapy, a catheter is guided through the urethra and into the bladder, allowing for direct drug administration. By directly delivering and confining the drugs within the bladder, its effectiveness may be increased and side effects can be limited.

The drug or drug combination used depends on the type and stage of bladder cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.

City of Hope has a wide portfolio of cancer-fighting drugs available in its on-site pharmacy, allowing our medical oncologists to plan and prescribe a drug regimen that can best fight bladder cancer while minimizing side effects.

In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.


Radiation Therapy

Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may delivered externally using focused beams of energy, or internally by placing a radiation-emitting substance placed in or near the tumor site.

Depending on the cancer, the patient’s health and desired outcomes, radiation therapy may be offered on its own or in conjunction with surgery and drug therapy. This includes:

  • Postsurgical treatment for surgeries that did not remove the whole bladder
  • Primary treatment for early-stage bladder cancer patients who can’t have surgery
  • Initial treatment for advanced bladder cancer, along with cancer-fighting drugs

Radiation may also be used to relieve symptoms associated with bladder cancer.

City of Hope offers a wide variety of leading-edge radiation therapy options to treat bladder cancer. These include image-guided external radiation systems (such as TomoTherapy or TrueBeam) that combine detailed imaging and radiation delivery technologies, allowing our care team to “sculpt” radiation beams to the tumor site while avoiding nearby healthy tissue. This maximizes radiation’s cancer fighting ability while minimizing exposure to the bladder, rectum and other nearby organs.



City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat bladder cancer, coupled with our enduring belief in providing unparalleled compassionate care.

Urologic Oncologists

Kevin G. Chan, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Laura Crocitto, M.D., M.H.A.

Clinical Specialties

  • Urologic Oncology
  • Urology
Donald Hannoun, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Clayton S. Lau, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Jonathan N. Warner, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
  • Reconstructive Urology
Kristina Wittig, M.D.

Clinical Specialties

  • Urology and Urologic Oncology
Jonathan Lim Yamzon, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology
Bertram Yuh, M.D., M.S.H.C.P.M., M.I.S.M.

Clinical Specialties

  • Urologic Oncology
  • Urology
Ali Zhumkhawala, M.D.

Clinical Specialties

  • Urologic Oncology
  • Urology

Medical Oncologists

Sumanta Kumar Pal, M.D.

Clinical Specialties

  • Medical Oncology
Przemyslaw W. Twardowski, M.D.

Clinical Specialties

  • Medical Oncology

Radiation Oncologist

Sagus Sampath, M.D.

Clinical Specialties

  • Radiation Oncology

Bladder Cancer Research and Clinical Trials

At City of Hope, bladder cancer clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies with fewer side effects, novel surgical techniques, innovative radiation approaches and new prevention strategies.

These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.

Some of our current research projects include:

  • Surgical and reconstruction techniques that can improve clinical and quality-of-life outcomes
  • Enhancing urinary diversion follow-up protocols to expedite recovery and minimize complication risk
  • Studying a class of drugs called PD-1 inhibitors, which shuts down the cancer’s ability to evade the immune system, and their effectiveness against bladder cancers
  • Gene therapies that can overcome bladder cancer’s resistance mechanisms, making it more sensitive to other treatments
  • Using neural stem cells, which gravitate toward bladder cancer cells, to deliver gold nanorods to tumor sites; when an infrared light is shone on those rods, the gold particles heat up and destroy the surrounding cancer cells with intense heat
  • Evaluating targeted therapies that can selectively attack bladder cancer cells, increasing its effectiveness while reducing side effects
  • Looking into administering drugs prior to bladder cancer surgery, which may be able to shrink tumors enough to avoid a more invasive procedure
  • Molecular profiling that guide physicians toward better treatments or avoid unnecessary therapies
  • Studying the bladder tumor’s microenvironment to determine how likely it is to metastasize, and determining which patients would require more aggressive treatments



Living with bladder cancer

I can be normal and live a normal life,” Sheldon Querido, bladder cancer survivor

When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your bladder cancer treatment.

We can help with all of the following concerns, and more:

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites.

For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE).

Christine Crews Success Story Image
Christine, bladder cancer survivor

Just a little over a month after bladder cancer surgery, Christine was back at the gym teaching fitness classes and settling back into her presurgery life.


Help us turn innovative ideas in to powerful new treatments.