Bladder Cancer

Urine passes from the kidneys into the bladder through tubes called ureters. Urine leaves the bladder through another tube called the urethra.

The bladder has an elastic and muscular wall that allows it to get larger and smaller as urine is stored or emptied.

Bladder cancer begins in the inside layer of the bladder and grows into the muscle walls. As it moves into the muscle, it requires more aggressive treatment.

Bladder cancer has a high rate of recurrence, estimated at 50% to 80%. Doctors believe this is because the conditions that can lead to bladder cancer impact the entire organ, not just a single spot.

Despite this high rate or recurrence, the disease is treatable, with more than 77% of patients surviving at least five years after diagnosis.

Bladder cancer types

Bladder cancer is classified based on the type of cells where it begins. The main types of bladder cancer are:

• Urothelial cell bladder cancer
• Squamous cell bladder cancer
• Adenocarcinoma of the bladder
• Urothelial cell carcinomas of the upper tract

Urothelial cell bladder cancer

About 90% of bladder cancers are urothelial cell carcinomas. These start in the urothelial cells, which line the inside of the bladder. This disease is also called transitional cell bladder cancer.

Squamous cell bladder cancer

This type of bladder cancer begins in squamous cells, which are thin, flat cells that may form in the bladder after long-term infection or irritation. These cancers occur less often than urothelial cell cancers.

Adenocarcinoma of the bladder

This disease develops in the inner lining of the bladder and tends to be aggressive.

Urothelial cell carcinomas of the upper tract

This technically is not a type of bladder cancer. Instead, it is a cancer of the inner lining of the kidneys or of a ureter, the tubes that carry urine from the kidneys to the bladder. Because it starts in the same type of cell as most bladder cancers, many of the treatments are the same, including chemotherapy, targeted therapy and immunotherapy options.

There are several other, rarer types of bladder cancer, including sarcomas, neuroendocrine tumors of the bladder and small cell carcinomas of the bladder.

Muscle-invasive vs. non-muscle invasive bladder cancer

Bladder cancer is also categorized based on whether and how much it has spread within and outside the bladder. A patient’s treatment options are often determined by this spread.

Non muscle-invasive bladder cancer: This is an early form of the disease. At this point, the cancer is located only on the inner lining of the bladder. It has not spread to the muscles surrounding the bladder. These bladder cancers can be treated in many different ways and typically do not require the bladder be removed.

Muscle-invasive bladder cancer: This type of cancer has spread into the muscles surrounding the bladder. It is more advanced and can require more complex treatments involving medical oncologists, radiation oncologists and urologists, but it is still treatable.

Metastatic bladder cancer: Metastatic bladder cancer has spread beyond the bladder and nearby lymph nodes to distant parts of the body. At this point, the disease is less often curable, but it can be managed.

In rare cases, bladder cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.

Bladder cancer risk factors

Anything that increases your chance of getting bladder cancer is a risk factor. These include:

Smoking tobacco: This is the greatest risk factor for bladder cancer that individuals can control. Smokers, including pipe and cigar smokers, are two- to three-times more likely than nonsmokers to get bladder cancer. Chemicals in tobacco smoke are absorbed into the blood, and then they pass through the kidneys and collect in the urine. These chemicals can damage the inside of the bladder and increase your chances of getting bladder cancer. 

Age: The chance of developing bladder cancer increases with age. It is uncommon in people under 40. Most diagnoses are in people age 65 or older.

Race: Bladder cancer occurs twice as often in Caucasians as it does in African Americans and Hispanics. Asians have the lowest rate of developing the disease.

Gender: Men are up to four times as likely as women to get bladder cancer.

Personal history of bladder cancer: Bladder cancer has a 50% to 80% chance of returning after treatment, either as a recurrence of the first cancer or as a second individual disease.

Exposure to chemicals: Historical studies have shown that people who work around certain chemicals are more likely to get bladder cancer. These include:

• People who work in the rubber, chemical and leather industries
• Hairdressers
• Machinists and metal workers
• Printers
• Painters
• Textile workers
• Truck drivers
• People who work at dry cleaning businesses

Parasitic infections: People infected with certain parasites, which are more common in tropical climates, have an increased risk of bladder cancer.

Treatment with cyclophosphamide or arsenic: These drugs, which are used in the treatment of cancer and other conditions, raise the risk of bladder cancer. Arsenic in drinking water may increase risk too. 

Chronic bladder problems: There is a direct link between chronic bladder infections and bladder cancer. Other sources of irritation, such as frequent catheterization and kidney stones may be risk factors, but no direct link has been established.

Organ transplantation: People who have an organ transplant take drugs to suppress the immune system. This can lead to more frequent bladder infections, which is a risk factor for bladder cancer.

Genetic conditions: People with hereditary nonpolyposis colon cancer (HNPCC, also called Lynch syndrome), have an increased risk of developing bladder cancer. View our hereditary cancer syndromes page for more information.

In rare cases, bladder cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Visit our genetic testing page to learn more.