Bladder cancer

Bladder cancer facts

Bladder cancers are highly curable if detected and treated early. Most begin in the cells of the inner lining of the bladder. They can spread to the bladder’s muscle wall and beyond. 

Seattle Cancer Care Alliance (SCCA) offers comprehensive treatment from a team of experts who specialize bladder, urothelial and other genitourinary cancers.

What is bladder cancer?

Bladder cancer begins in one of several types of cells in your bladder, the organ that stores urine. 
 
Cancer cells do not respond to regular cell growth, division and death signals like healthy cells do. They also don’t organize normally. Instead they grow into a tumor, which may invade surrounding layers of tissue and possibly spread to other organs.

Bladder cancer is divided into two main categories:

  • Nonmuscle invasive — which sits on or within the first lining of your bladder (lamina propria)
  • Muscle invasive — which extends through your bladder lining to the muscle wall of your bladder

When invasive bladder cancer spreads to other areas in your body, it is called metastatic bladder cancer. Locally metastatic means it has spread outside your bladder to nearby tissues rather than distant parts of your body.

Types

Most bladder cancers (90 to 95 percent) begin in the cells of the inner lining of the bladder. These cancers are called urothelial carcinomas or transitional cell carcinomas.

  • About 75 percent of transitional cell bladder cancers are nonmuscle invasive at the time of diagnosis. 
  • The remaining 25 percent invade the muscle, requiring more complicated treatment. 

Although it’s commonly referred to as bladder cancer, invasive urothelial or transitional cell cancer can be found not only in the bladder but also in related organs: 

  • Kidneys — which make urine (by removing waste and extra water from your blood) as well as substances to help control your blood pressure and make red blood cells
  • Ureters — which carry urine from your kidneys to your bladder
  • Urethra — which carries urine from your bladder out of your body

Other types of bladder cancer (nonurothelial) are rare, accounting for less than 10 percent of bladder cancers, and include:

  • Squamous cell carcinoma 
  • Adenocarcinoma 
  • Small-cell carcinoma
  • Micropapillary bladder cancer
  • Plasmacytoid bladder cancer
  • Other rare types

 

Symptoms

Bladder cancer symptoms are the same as symptoms of other problems, and they do not necessarily mean you have cancer. Talk to your doctor if you have any symptoms that concern you.

The most common bladder cancer symptom is blood (a rusty, red or pink hue) or blood clots (dark particles) in your urine. If you have this, see your doctor.

Other symptoms may include, but are not limited to:

  • Frequent urination 
  • Needing to urinate but not being able to
  • Pain during urination
  • Pain in your lower back on one side

By the time symptoms appear, cancer might have spread outside your bladder to another part of your body, and you may experience other symptoms too, depending on where the cancer is. Cancer that has moved to other organs like the liver or the lungs may cause pain, jaundice, coughing or shortness of breath.

If you have any suspicious symptoms, get a referral to a urologist for a work-up.

Diagnosing

If your doctor suspects that you may have bladder cancer, they may use several methods to help make a diagnosis and determine if the cancer has spread.

  • Microscopic urinalysis — testing your urine to help rule out infections and check for blood (hematuria), sugar, bacteria or proteins that shouldn’t be there
  • Urine cytology — testing your urine to help identify cancerous cells, often combined with fluorescent in-situ hybridization (FISH) or protein tests 
  • Physical exam — which will include an exam of your abdomen, back, rectum and, for women, vagina to feel for bumps that may be cancerous tumors
  • Cystoscopy/ureteroscopy — inserting a thin camera through your urethra to examine your bladder and possibly ureters and maybe take a tissue sample (biopsy) to help determine the type and stage of the cancer
  • Blue light cystoscopy with Cysview — makes bladder tumors glow bright pink in blue light. As a result, your provider can see them better and more accurately remove, identify and manage any cancer.
  • Transurethral resection of a bladder tumor (TUR or TURBT) — removing the tumor and taking samples from other parts of your bladder muscle through your urethra so a pathologist can determine the type of cancer and how deep it is in the muscle
  • Molecular profiling — analyzing the make-up of your cancer to select the most effective treatments and identify clinical trials of new therapies 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 to help determine whether cancer has spread beyond your bladder

 

What causes bladder cancer?

Researchers are still working to understand the causes of bladder cancer. We know that several factors may increase your risk.

  • Smoking — Smokers are two to four times as likely to develop bladder cancer as nonsmokers, making smoking the most significant risk factor. Smoking is estimated to be responsible for nearly half of bladder cancers in men and about one-third in women. 
  • Race — Whites are at highest risk. Bladder cancer is diagnosed twice as often in whites as in African-Americans. Hispanics have a lower risk than both groups. African-Americans tend to be diagnosed with a more advanced form of the disease and are more likely to die from it. 
  • Sex — Men are four times as likely to be diagnosed with bladder cancer as women are. Women are more commonly diagnosed with a more advanced form.
  • Chemicals — Certain industrial chemicals, dyes and other materials are linked with increased risk of bladder cancer.
  • Chronic bladder inflammation — A history of chronic inflammation (such as from recurring bladder infections or kidney or bladder stones) raises your risk.
  • Cyclophosphamide — If you have taken this medicine, used to treat some cancers or other conditions, you are at increased risk. 
  • Arsenic — This potential water contaminant raises bladder cancer risk.
  • Age — Nearly 90 percent of bladder cancers are found in people over 55. 
  • Genetics — Some people are genetically predisposed to be more sensitive to substances that cause cancer (carcinogens) and may develop cancer at higher rates. 
  • Family history — You are at greater risk if you have family members who have been diagnosed with bladder cancer. 

 

How common is bladder cancer?

Each year, about 65,000 men and 20,000 women in the U.S. are diagnosed with cancer in their bladder, ureter or other urinary organ. (This does not include kidney cancer.)