Bladder Cancer Information, Facts and Types

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Bladder cancer is a common cancer that starts in the bladder lining and is usually detected when patients notice blood in the urine or urinary changes. Most bladder cancers are a type called urothelial cancer, but there are several less common histologic subtypes, called variants. Some examples are squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcomatoid.

In the United States, bladder cancer is the fifth most common cancer, with men being affected about four times more often than women. Globally, bladder cancer is the ninth most common type, with over 600,000 new cases diagnosed each year. Early diagnosis and treatment can improve outcomes for most patients.

The extent of the cancer — how far it has spread — matters, too. Your care team needs to know if your cancer sits on or in the first lining of your bladder (non-muscle invasive), if it goes into the bladder muscle wall (muscle-invasive) or if it has spread to distant parts of your body (metastatic).

When your Fred Hutch Cancer Center team designs your treatment plan, they will consider the type and stage of your cancer along with many other factors. The stage is an important part of choosing which treatments are right for you.

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Types of Bladder Cancer

Urothelial carcinoma, also known as transitional cell carcinoma (TCC), starts in the urothelial cells that line the inside of the bladder. This is the most common type of bladder cancer. Other types of cancer can start in the bladder, but these are all much less common than urothelial (transitional cell) cancer. At Fred Hutch, our bladder cancer care team treats all types of disease.

Urothelial Carcinoma (Transitional Cell Carcinoma)

If you’re told you have bladder cancer, it's very likely to be a urothelial carcinoma.

Urothelial cells also line the inside of other parts of the urinary tract, such as the part of the kidney that connects to the ureter (called the renal pelvis), the ureters and the urethra.

There are different subtypes of urothelial carcinoma. Most often the subtype doesn’t affect how the cancer is treated, although some subtypes might be more likely to have gene changes that could affect treatment options.

Urothelial Carcinoma with Divergent Differentiation

Sometimes urothelial cancers contain very small areas that look like other cancer types. This is known as divergent differentiation. For example, the cancer may contain areas of squamous or glandular differentiation. Most often, this doesn’t affect treatment.

Other Cancers that Start in the Bladder

Other types can start in the bladder, but these are all much less common than urothelial (transitional cell) cancer. These include squamous cell carcinoma (only 3% to 5% of cases), adenocarcinoma (only 1% to 2%), small cell carcinoma (less than 1%) and sarcoma (very rare).

Understanding Bladder Cancer

Stages

The treatment that your Fred Hutch care team will recommend for bladder cancer will be based in part on the stage of your cancer. The stage depends on: 

  • How deep the cancer has spread into the lining in or on your bladder (non-muscle invasive)
  • Whether it has spread into the bladder muscle wall (muscle-invasive) 
  • Whether it has spread to distant parts of your body (metastatic).

Bladder cancers are grouped into stages I (1) through IV (4), with stage I being the least advanced and stage IV being the most advanced.

Learn About Stages of Bladder Cancer

Symptoms

The symptoms of bladder cancer, like pain when urinating or blood in your urine, are not specific to this disease. Other conditions (that aren’t cancer at all) may cause the same symptoms. If you have any concerns about your bladder health, or your health in general, start by letting your primary care provider know. They can ask you questions, do an exam and order any tests needed to tell what’s happening in your body and why. 

Read About Bladder Cancer Symptoms

Prevention and Risk Factors

Bladder cancer risk is often genetic and bladder cancer can be diagnosed at any age, but the risk increases significantly as a person gets older, with a median age of diagnosis at 73 years. Risk factors for bladder cancer include:
  • A family history of bladder cancer
  • Genetic changes linked to bladder cancer, such as mutations in the HRAS, RB1, PTEN/MMAC1, NAT2 and GSTM1 genes
  • Lynch syndrome, a genetic condition that increases the risk of several types of cancer

It’s helpful to know about the many factors that might raise your risk for bladder cancer. Some are things you can’t control. But they may help your health care team decide how early you should start being screened and how often. Others are things you do have some control over, like tobacco use and exposure to environmental factors.

Learn About Prevention and Risk Factors

Screening and Diagnosis

A high percentage of bladder cancers can be cured if they are found early. Once cancer spreads outside the bladder, it is much harder to treat. That’s why it’s important to first bring up any concerning symptoms to your primary care provider.

Bladder cancer can sometimes also cause changes in urination, such as having to go more often than usual, pain or burning during urination or having to get up to use the bathroom many times during the night. Many conditions can also cause these symptoms, however, so it’s important to determine the cause.

Together, Fred Hutch and UW Medicine offer a full range of options to find and treat bladder cancer at its earliest stage.

Read About Screening Options

Bladder Cancer FAQ

Bladder cancer starts when cells in the bladder grow out of control. Normally, cells in the body grow and multiply to form new cells as the body needs them. When cells get old or damaged, they die and are replaced. Sometimes, this normal process breaks down. Abnormal or damaged cells grow and multiply when they shouldn’t, forming tumors. Some tumors are cancer, and others are benign (noncancerous).

Bladder cancer spreads by growing into, or invading, nearby tissues. If the cancer cells invade nearby lymph nodes or blood vessels, they can travel through the lymph or blood to distant parts in the body. Then they can form new tumors in these places. 

When physicians and scientists talk about cancer-specific survival rates, they typically mean the percentage of people expected to survive their cancer for at least five years after being diagnosed. (The rate doesn’t include the risk of dying during that time for some other reason.) Overall, the relative five-year survival rate for bladder cancer in the U.S. can vary significantly depending on the stage, extent and other features of the cancer, as well as the general health of the individual and their other medical conditions.

This rate comes from looking at a large group of people. The chance of surviving cancer at least five years can vary greatly from one person to another. Your Fred Hutch care team can explain how statistics like survival rates might apply to you.