After Surviving Bladder Cancer, British Artist Tracey Emin, 62, Shares What It’s Like Living With a Urostomy Bag After Bladder Removal and Why She Wishes She’d Never Smoked

“I wish I had what I have now and my youth,” she told TIME, reflecting on the clarity and appreciation she gained after treatment.

She described to BBC News how close she came to believing her life was ending when the gravity of her diagnosis took hold.

“When you’ve had cancer to the level that I had… and then suddenly everything turns around, it’s like being born again, and life starts again,” Emin said.

She added that after years of feeling angry or nihilistic, surviving cancer “was such a game-changer… I just thought, I want to live.”

Although the exact subtype of her cancer hasn’t been publicly confirmed, Emin has said it was aggressive — likely in the later stages. As Dr. Matthew Mossanen of Brigham and Women’s Hospital explains, tumor stage is one of the strongest predictors of outcome.

Bladder Cancer By Stage

• Stage 0 is bladder cancer in the earliest form of the disease. The tumor is found only on the inner lining of the bladder and has not invaded deeper layers.
• Stage 1 means the tumor has grown beyond the lining and into the connective tissue layer beneath it, but it has not reached the bladder muscle.
• Stage 2 means the tumor has invaded the muscle layer of the bladder wall. This is often referred to as muscle-invasive bladder cancer, and it represents an important turning point in treatment decisions.
• Stage 3 means the cancer has grown through the bladder wall into surrounding tissues. In men, this may involve the prostate or seminal vesicles. In women, it may involve the uterus, ovaries, or vaginal wall.
• Stage 4 is considered advanced or metastatic disease. The cancer might spread to nearby lymph nodes or pelvic/abdominal structures or to distant organs such as the lungs, liver, or bones.

WATCH: Staging Muscle-Invasive Bladder Cancer: Understanding The Process

“One of the most important predictors of a patient’s outcome, how long they’ll live, and how well they’ll do is their tumor stage,” Dr. Mossanen told SurvivorNet.

Emin underwent major surgery to remove her bladder and now lives with a urostomy bag, a permanent urinary diversion.

“Surgery for bladder cancer is highly curative, but it’s associated with substantial impact on quality of life, and that impact is permanent,” Dr. Arjun Balar, Director of Genitourinary Medical Oncology at NYU Langone Health’s Perlmutter Cancer Center, told SurvivorNet.

 

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After bladder removal, surgeons must create a new way for the body to store and pass urine — often through a urostomy, neobladder, or continent pouch.

“After we remove the bladder, of course, the bladder is a storage organ, and you have to figure out how you’re going to store the urine and how you’re going to get the urine out of the body,”  Dr. Piyush Agarwal, Professor of Surgery and Director of the Bladder Cancer Program at the University of Chicago, told SurvivorNet.

For some people diagnosed with bladder cancer, treatment may involve removing the bladder entirely in a procedure called radical cystectomy. Surgeons have developed several ways to safely redirect urine so the body can continue to function normally.

WATCH: Muscle-Invasive Bladder Cancer Removal Considerations

These procedures are known collectively as urinary diversions. Although they represent a major change, many patients go on to live full, active lives after surgery. There are generally three major urinary diversion options after a radical cystectomy:

• Urostomy (ileal conduit)
• Neobladder
• Continent cutaneous pouch

Each approach works differently and comes with its own advantages and challenges.

 

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Adjusting to life without a bladder has been challenging for the famous artist.

“Living without a bladder is really hard. Having a stoma is hard… I get infections all the time… Everything has to be planned around where the loos are, who you’re sitting with,” she told The New York Times. Despite the difficulties, Emin carries a sense of renewed pride and renewed purpose.

As she put it, surviving such a severe illness made life feel new again. “It’s like being born again, and life starts again, and all these really amazing things happen.”

Bladder Cancer In Women

Although bladder cancer is diagnosed more often in men, thousands of women are affected every year. For many women, early symptoms can seem mild or mimic common issues like urinary tract infections, which means their cancer is sometimes detected later — making awareness especially critical.

“There is a large body of data showing that although women are diagnosed less frequently with bladder cancer, they tend to have worse outcomes,” Dr. Mosannen said. He explains further that symptoms such as blood in the urine, urinary frequency, urgency, or pain are often mistaken for a UTI, delaying the correct diagnosis.

WATCH: Bladder Cancer In Women Is Less Common & Often Diagnosed Later

For women, bladder cancer surgery is more extensive than simply removing the bladder. A radical cystectomy typically involves removing:

• The bladder
• Nearby lymph nodes
• The uterus
• The fallopian tubes and ovaries (in many cases)
• Part of the vaginal wall closest to the bladder

Since these organs sit so closely together, treating the cancer often requires removing or altering surrounding reproductive structures.

“For patients considering surgery, we talk a lot about the magnitude of the operation,” Dr. Mosannen says.

“Cystectomy is a major surgery with a long recovery and potential complications, so it’s essential that the patient and surgeon are aligned on the plan and how they want to manage the tumor.”

What to Expect from Bladder Cancer Surgery

While patient preference is central to treatment planning, doctors also evaluate several clinical factors that may determine whether surgery or bladder-preserving therapy is more appropriate.

These include:

• Age and overall physical fitness
• Other medical conditions (co-morbidities)
• Prior radiation treatments to the pelvis

“There are patients who would be at very high risk for adverse surgical outcomes based on potentially factors such as their level of activity, their age, their other medical comorbidities,” Dr. Elizabeth Wulff of the University of Kansas Medical Center explained to SurvivorNet.

When bladder cancer is diagnosed, surgery may be recommended to remove the bladder and surrounding cancerous tissue to prevent the disease from spreading. Your treatment path will depend on several factors, including your overall health, the stage and grade of your cancer, and your personal preferences.

Understanding the Surgical Options

Bladder cancer surgery typically involves removing the bladder (a procedure called cystectomy) and nearby tissue. In many cases, a urinary diversion is also needed—this reroutes the flow of urine through a new pathway.

There are two main surgical approaches:

• Open Surgery
  • This traditional method involves a single, large incision from the belly button downward. The surgeon uses their hands to access and remove the bladder directly.
  • “Open surgery means making a cut on the skin and using our hands to do the operation,” explains Dr. Jay Shah, urologic oncology expert at Stanford Cancer Center.
• Robotic-Assisted Laparoscopic Surgery
  • A minimally invasive technique using several small incisions. The surgeon operates robotic instruments to perform the procedure with precision.
  • “Instead of one big cut, robotic surgery uses keyhole-size incisions and robotic tools,” says Dr. Shah.

Comparing Open vs. Robotic Surgery

Both approaches are effective for bladder cancer that hasn’t spread. The choice often depends on your surgeon’s expertise and your own preferences.

Open Surgery: Pros & Cons

Advantages:

• More surgeons are trained in this method
• Direct access to the bladder in emergencies

Considerations:

• More invasive, with longer recovery
• Higher risk of bleeding and infection

Robotic Surgery: Pros & Cons

Advantages:

• Less pain and blood loss
• Lower infection risk
• Shorter hospital stay and recovery
• Minimal scarring

Considerations:

• Not all surgeons are trained in robotic techniques
• May require travel to a specialized center
• Slightly higher risk of urinary tract infections

“What matters most is that your surgeon is experienced in the method they recommend,” Dr. Shah emphasizes. “You don’t want robotic surgery from someone who’s only trained in open techniques—or vice versa.”

Urinary Reconstruction & Diversion

If your bladder is removed, your surgeon will create a new way for urine to exit your body. This can be done using a portion of your intestine or an external collection system. These procedures are complex and often performed using open surgery.

Three common options include:

• Ileal Conduit: Urine flows through a stoma into an external bag, which is emptied throughout the day.
• Indiana Pouch (Cutaneous Continent Reservoir): A pouch made from intestine collects urine internally. A catheter is used to drain it through a stoma.
• Orthotopic Neobladder: A new bladder is constructed from intestine and connected to the urethra, allowing urine to exit the body naturally.
  Your surgeon will recommend the best option based on your anatomy, health status, and lifestyle.

Making the Right Decision for You

Robotic cystectomy offers benefits like reduced pain and faster recovery, but open surgery may be better suited for complex cases. Studies show that long-term outcomes are similar between the two methods.

The most important factor? Choosing a surgeon who is skilled in the approach they recommend—and who takes the time to understand your needs.

Understanding How Bladder Cancer Impacts Patients

Your bladder is a hollow, muscular, balloon-shaped organ that expands as it fills with urine, an essential component of your body’s urinary system.

Bladder cancer begins when the cells lining the inside of the bladder start growing uncontrollably and form tumors. “Smoking is a leading risk factor,” with smokers being three times more likely to develop the disease than non-smokers.

Common symptoms of bladder cancer may include:

• Frequent urination
• Pain or burning during urination
• Flank pain (discomfort in the sides of the lower back)
• A sudden, urgent need to urinate
• Blood in the urine, which may appear pink, red, or cola-colored

Risk Factors for Bladder Cancer

Smoking is one of the most dangerous contributors to bladder cancer. In fact, the National Institutes of Health reports that roughly half of all bladder cancer cases are caused by smoking.

Why? The toxic chemicals in nicotine and other compounds found in cigarettes remain in the bladder for extended periods before being flushed out through urine—giving them more time to damage bladder tissue.

WATCH: Understanding bladder cancer risk factors.

“The first and foremost thing for a healthy bladder is, don’t smoke,” advises Dr. Arjun Balar. “I think that’s an obvious suggestion for a number of reasons. But if we can eliminate cancer risks that are related to smoking, that’s probably the most important thing you can do.”

Tobacco smoke is a toxic mix—the Centers for Disease Control and Prevention (CDC) says that it contains over 7,000 chemicals, with at least 70 known to cause cancer. While most often linked to lung cancer, smoking is also a major driver of other cancers, including bladder cancer.

Cigarette smoking is responsible for 80–90% of lung cancer deaths, and smokers are 15 to 30 times more likely to develop or die from lung cancer than non-smokers. Even exposure to second-hand smoke significantly increases risk.

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