Risk factors for childhood bladder cancer

Bladder cancer is caused by certain changes to the way bladder cells function, especially how they grow and divide into new cells. Learn more about how cancer develops at What Is Cancer?

The risk of bladder cancer is increased in children who have been treated for cancer with certain anticancer drugs, called alkylating agents, which include cyclophosphamide, ifosfamide, busulfan, and temozolomide. Survivors of heritable retinoblastoma also have an increased risk of developing bladder cancer. Not every child with these risk factors will develop bladder cancer. And it will develop in some children who don't have a known risk factor. Talk with your child’s doctor if you’re concerned about your child’s risk.

Symptoms of childhood bladder cancer

The symptoms of bladder cancer can vary from person to person. The most common symptom of bladder cancer is blood in the urine, called hematuria. It’s often slightly rusty to bright red in color. You may see blood in your child’s urine at one point, then not see it again for a while. Sometimes there are very small amounts of blood in the urine that can only be found by having a test done.

Other common symptoms of bladder cancer can include:

• frequent urination or feeling the need to urinate without being able to do so
• pain during urination
• abdominal or lower back pain

It’s important to check with your child’s doctor if your child has any of these symptoms. Keep in mind that urinary tract infections, kidney or bladder stones, or other problems related to the kidney could also be the cause, not cancer. Your child’s doctor will ask you when the symptoms started and how often your child has been having them. They’ll most likely ask for a urine sample as a first step in diagnosing what is causing these symptoms.

Tests to diagnose childhood bladder cancer

If your child has symptoms or lab test results that suggest bladder cancer, their doctor will need to find out if these are due to cancer or another problem. They may:

• ask about your child’s personal and family medical history to learn more about your child’s symptoms and possible risk factors for bladder cancer
• do a physical exam to check for signs of cancer
• ask for a sample of urine so it can be checked in the lab for blood, abnormal cells, or infection

Depending on your child’s symptoms and medical history and the results of their physical exam and urine lab tests, the doctor may recommend more tests to find out if your child has bladder cancer, and if so, its extent (stage). The results of tests and procedures done to diagnose bladder cancer are used to help make decisions about treatment.

The following tests and procedures may be used:

CT scan (CAT scan)

A CT scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body, such as the pelvis. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Learn more about Computed Tomography (CT) Scans and Cancer.

Computed tomography (CT) scan. The child lies on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of areas inside the body.

Ultrasound exam

An ultrasound exam uses high-energy sound waves (ultrasound) that bounce off internal tissues or organs, such as the pelvis, and make echoes. The echoes form a picture of body tissues called a sonogram.

Abdominal ultrasound. An ultrasound transducer connected to a computer is pressed against the skin of the abdomen. The transducer bounces sound waves off internal organs and tissues to make echoes that form a sonogram (computer picture).

Getting a second opinion

You may want to get a second opinion to confirm your child’s bladder cancer diagnosis and treatment plan. If you seek a second opinion, you will need to get medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans. They may agree with the first doctor, suggest changes to the treatment plan, or provide more information about your child’s tumor.

To learn more about choosing a doctor and getting a second opinion, see Finding Cancer Care. You can contact NCI’s Cancer Information Service via chat, email, or phone (both in English and Spanish) for help finding a doctor or hospital that can provide a second opinion. For questions you might want to ask at your child's appointments, see Questions to Ask Your Doctor about Cancer.

Prognosis of childhood bladder cancer

If your child has been diagnosed with bladder cancer, you likely have questions about how serious the cancer is and your child’s chances of survival. The likely outcome or course of a disease is called prognosis.

The prognosis can be affected by whether the cancer can be removed by surgery. In children, bladder cancer is usually low grade (not likely to spread) and the prognosis is usually excellent after surgery to remove the tumor.

Types of treatment for childhood bladder cancer

There are different types of treatment for children and adolescents with bladder cancer. You and your child’s cancer care team will work together to decide treatment. Many factors will be considered, such as your child’s overall health and whether the cancer is newly diagnosed or has come back.

A pediatric oncologist, a doctor who specializes in treating children with cancer, will oversee treatment for childhood bladder cancer. The pediatric oncologist works with other health care providers who are experts in treating children with cancer and who specialize in certain areas of medicine. Other specialists may include:

• pediatrician
• pediatric surgeon
• pediatric urologist
• pediatric nurse specialist
• rehabilitation specialist
• social worker
• psychologist
• fertility specialist

Your child’s treatment plan will include information about the cancer, the goals of treatment, treatment options, and the possible side effects. It will be helpful to talk with your child’s cancer care team before treatment begins about what to expect. For help every step of the way, see our downloadable booklet, Children with Cancer: A Guide for Parents.

Types of treatment your child might have include:

Treatment of childhood bladder cancer

Treatment of newly diagnosed bladder cancer in children is usually surgery:

• transurethral resection (TUR)
• surgery to remove the bladder (rare)

Learn more about these treatments in the Types of treatment section.

Sometimes bladder cancer can recur (come back) after treatment. If your child is diagnosed with recurrent bladder cancer, your child's doctor will work with you to plan treatment.

Side effects and late effects of cancer treatment

Learn more about Side Effects of Cancer Treatment.

Problems from cancer treatment that begin 6 months or later after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:

• physical problems
• changes in mood, feelings, thinking, learning, or memory
• second cancers (new types of cancer) or other conditions

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. Learn more about Late Effects of Treatment for Childhood Cancer.

Follow-up care

Some of the tests that were done to diagnose the cancer may be repeated to see how well the treatment worked.

If the bladder cancer recurs (comes back) after treatment, it will usually be within 3 years from diagnosis. Your child will receive tests from time to time after surgery to find out if their condition has changed or if the cancer has recurred. These tests are sometimes called follow-up tests or check-ups.

Coping and support

When a child has cancer, every member of the family needs support. Taking care of yourself during this difficult time is also important. Reach out to your child’s treatment team and to people in your family and community for support. To learn more, see Support for Families: Childhood Cancer.