Bladder cancer is a disease of the urinary tract. The bladder is a hollow organ in the lower abdomen that stores urine, the waste that is produced when the kidneys filter the blood.
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.
Urothelial carcinoma: 8 insights about this common bladder cancer
Urothelial carcinoma is cancer that develops in the urothelial cells. These cells are located in the urothelium, which lines the inside of the urinary tract. Urothelial carcinoma can develop in the upper urinary tract (renal pelvis, ureter) or the lower urinary tract (bladder, urethra).
Most bladder cancers are urothelial carcinomas. We spoke with genitourinary medical oncologist Omar Alhalabi, M.D., to learn more about urothelial carcinoma of the bladder, including symptoms, treatment and prognosis.
What causes urothelial carcinoma?
While we don’t always know exactly what causes urothelial carcinoma, some factors can increase your chances of getting it.
Smoking or the use of tobacco products is one of the main risk factors. Cigarettes and other tobacco products contain carcinogens that get absorbed into the bloodstream and filtered by the kidneys. These harmful chemicals then collect in the urine, where they can cause cancer in the lining of the urinary tract.
Other risk factors include:
- Workplace exposure to certain chemicals, such as aromatic amines, which can be found in dyes, as well as oil refining, iron, steel, textile and rubber industries
- Chronic inflammation of the bladder, such as recurrent urinary tract infections or bladder catheters
- Exposure to other chemicals, such as arsenic in drinking water
- Prior chemotherapy, such as cyclophosphamide
- Prior radiation therapy, such as radiation to the prostate
- Genetic conditions, such as Lynch syndrome
Is urothelial carcinoma aggressive?
Muscle-invasive urothelial carcinoma can be aggressive. This is when the cancer has spread to the muscle walls of the bladder.
The cancer grade also determines if it’s aggressive. The grade is based on the characteristics of the cancer cell viewed under a microscope. The pathologist who reviews the biopsy sample will look at how abnormal the cell looks compared to a normal cell. If it’s a little bit abnormal and has some resemblance to normal cells, that’s considered low-grade. If the cell looks very abnormal to the point where it’s hard to tell if it looks like a normal cell at all, we consider it high-grade. High-grade urothelial carcinoma is a more aggressive form of cancer that tends to spread.
What are the symptoms of urothelial carcinoma?
The most common symptom is blood in the urine, also known as hematuria. It can be either something you can see with your eyes, or it might only show up during a urinalysis.
Other symptoms of urothelial carcinoma can include frequent urination and painful urination. These are also symptoms of urinary tract infections. We’ve seen many patients who were treated by their primary care doctor for recurring UTIs when they actually had early-stage bladder cancer.
Waking up frequently at night to urinate is another symptom of urothelial carcinoma. This symptom is almost always associated with one or more other symptoms.
How is urothelial carcinoma diagnosed?
Doctors may use the following tests and procedures to diagnose urothelial carcinoma:
Urine tests/urinalysis
This checks for blood and other substances in your urine.
Cystoscopy
A thin tube with a lens (cystoscope) is inserted through the urethra into the bladder, allowing the urologist to examine the area for abnormalities. This exam can be done in the clinic or in the operating room if a transurethral resection is needed.
Transurethral resection
A thin tool with a wire loop on the end (resectoscope) is placed through the urethra into the bladder to collect tissue samples to biopsy. This procedure may be done during a cystoscopy.
CT urogram
This is a CT scan of the urinary tract in which an iodine dye is injected into the vein so that doctors can check for disease.
MRI
This imaging scan may be used in patients who cannot get a CT urogram because they are allergic to iodine or have low kidney function.
What are the treatment options for urothelial carcinoma?
Urothelial carcinoma can be treated in many ways. At MD Anderson, you will meet with a medical oncologist, urologic surgeon and sometimes a radiation oncologist during your first appointment. This team will help come up with the best treatment plan for you.
Your treatment plan will depend on several factors, including the cancer grade and stage, the location of the tumor and your general health. Your treatment may include:
- Surgery
- Chemotherapy
- Immunotherapy
- Targeted therapy
- Intravesical therapy
- Radiation therapy
Intravesical therapy can be used to inject chemotherapy or immunotherapy like Bacillus Calmette–Guérin (BCG) directly into the bladder. This type of therapy is usually only effective when the disease is in its earliest stages and has not spread beyond the bladder wall or invaded the muscle.
When a patient has muscle-invasive bladder cancer, we may not be able to preserve the bladder. When that happens, the patient may have a cystectomy. This is a surgery to remove the entire bladder.
At MD Anderson, we customize treatment recommendations for every patient. For example, we may find it best to treat one patient with chemotherapy followed by a cystectomy; and for another patient, we may recommend radiation and chemotherapy with no surgery.
Does urothelial carcinoma have a high risk for recurrence?
Urothelial carcinoma has a relatively high risk for systemic recurrence, which is recurrence outside of the urinary tract, that increases with a higher disease stage.
The risk for systemic recurrence in stage 0 (carcinoma in situ) or stage I urothelial carcinoma of the bladder is relatively low. However, the risk becomes higher when the cancer doesn’t respond to intravesical BCG treatment. We usually estimate a 20% chance of cancer recurring outside of the bladder if you have early-stage disease.
Stage II urothelial carcinoma is muscle-invasive. Cancer at this stage has up to a 50% chance of relapse. Patients with stage II disease typically receive chemotherapy or other systemic therapies to reduce their chances of recurrence.
Stage III urothelial carcinoma occurs when cancer spreads to the fatty layers outside of the bladder or the lymph nodes. These patients have up to a 70% chance of relapse.
Stage IV cancer is typically not curable, but it is treatable. More than 90% of patients with stage IV urothelial carcinoma will always have the disease.
What is the survival rate for urothelial carcinoma?
The outlook for patients with urothelial carcinoma depends on many factors, including:
- whether the cancer is muscle-invasive,
- if the cancer comes back and
- the patient’s overall health
Your prognosis depends on how well the tumor responds to treatment, and it can change throughout the course of your treatment. It’s important to talk to your doctor about your prognosis. Keep in mind that any survival rates your doctor shares are estimates and not based on your specific case.
What research is being done to advance urothelial carcinoma treatment?
There have been many discoveries and advances in urothelial carcinoma treatment in the past several years. These include Food and Drug Administration (FDA) approvals for new immunotherapy drugs nivolumab and pembrolizumab, a targeted therapy pill called erdafitinib that can be used in about 20% of patients who have FGFR3 genetic mutations, and antibody drug conjugates, such as enfortumab vedotin and sacituzumab govetican. Most recently, the FDA approved combinations of these therapies to treat bladder cancer, such as chemotherapy with immunotherapy and antibody drug conjugates with immunotherapy.
Urothelial carcinoma is a tough disease, but the field is rapidly evolving. In the future, we hope to develop more targeted therapies as we discover more genetic mutations, such as MTAP loss, HER2 amplification and many others. We’re conducting clinical trials to develop new and better treatment options, and we’re excited about what’s to come.
Request an appointment at MD Anderson online or call 1-877-632-6789.
Why choose MD Anderson for your bladder cancer treatment?
When you come to MD Anderson's Genitourinary Cancer Center for bladder cancer care, you are the focus of a team of exceptional experts that customizes your treatment to ensure the best outcomes with the least impact on your body.
This team, which includes medical, surgical and radiation oncologists, as well as a specially trained support staff, works together closely to provide comprehensive, but personalized care every step of the way.
And, they target bladder cancer with the very latest leading-edge technology and techniques for diagnosis and treatment, many of which are available at only a few cancer centers in the nation. These include:
- Minimally invasive surgeries
- Advanced reconstruction techniques
- Innovative and personalized chemotherapy
- Immunotherapy, including BCG (Bacillus Calmette-Guérin)
- Chemoprevention
- Enhanced recovery pathways
Experience, expertise
MD Anderson surgeons are among the most experienced in the nation in bladder cancer procedures. This can make a crucial difference in your chances for successful treatment and recovery.
We offer early detection and chemoprevention for those at high risk of developing bladder cancer. We are particularly experienced in the management of high-risk, complex bladder cancer cases, especially those that have returned after treatment.
And, at MD Anderson you're surrounded by the strength of one of the nation's largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
Groundbreaking research
We are proud to be one of the few cancer centers in the nation to house a prestigious federally funded bladder cancer SPORE (Specialized Program of Research Excellence) program. As one of the world's largest cancer research centers, MD Anderson is leading the investigation into new methods of bladder cancer diagnosis and treatment, including by conducting clinical trials. Each patient benefits from the most advanced research, delivered as rapidly as possible.
There were so many things that were part of this miracle that I've experienced, but MD Anderson was definitely one of the biggest parts.
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