Bladder cancer

Monday 1 February, 2016

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On this page:  The bladder | What is bladder cancer? | What types are there? | How common is it? | What are the symptoms? | What are the risk factors? | Which health professionals will I see?

The bladder

The bladder is a muscular sac that stores urine. It is located in the pelvis and is part of the urinary system.

As well as the bladder, the urinary system includes two kidneys, two tubes called ureters leading into the bladder, and another tube called the urethra leading out of the bladder. In women, the urethra is a short tube that opens in front of the birth canal (vagina). In men, the tube is longer and passes through the prostate and down the penis.

The kidneys produce urine, which travels to the bladder through the ureters. The bladder is like a balloon and inflates as it fills. When it is time to go to the toilet, the bladder muscle contracts and urine is passed through the urethra and out of the body.

Layers of the bladder

There are four main layers of tissue in the bladder:

  • Urothelium - The innermost layer. It is lined with cells that stop urine being absorbed into the body. These cells are called urothelial cells.
  • Lamina propria - A layer of tissue and blood vessels surrounding the urothelium.
  • Muscularis propria - The thickest layer. It consists of muscle that contracts to empty the bladder.
  • Perivesical tissue - The outermost layer. It is made up mostly of fatty tissue that separates the bladder from nearby organs.
The urinary system

What is bladder cancer?

Bladder cancer begins when cells in the inner lining of the bladder become abnormal, which causes them to grow and divide out of control. The treatment for bladder cancer depends on how far the cancer has spread into the layers of the bladder:

Non-muscle-invasive tumours

The cancer cells are found only in the inner lining of the bladder (urothelium) or in the next layer of tissue (lamina propria) and haven’t grown into the deeper layers of the bladder wall. Most bladder cancers are non-muscle-invasive tumours. See treatment information.

Muscle-invasive tumours

The cancer has spread beyond the urothelium and lamina propria into the layer of muscle, or right through the bladder wall. See treatment information.

What types are there?

There are three main types of bladder cancer. They are named after the cell type in which the cancer first develops.

Urothelial carcinoma

About 80–90% of all bladder cancers start from the urothelial cells that line the bladder wall. This is sometimes called transitional cell carcinoma. Urothelial carcinoma can be papillary or flat (see below), and it can also occur in the ureters and kidneys (see surgery).

How urothelial carcinoma grows

The most common type of bladder cancer, urothelial carcinoma, is divided into two subgroups.

  1. Papillary urothelial carcinoma has slender, finger-like projections and grows towards the hollow centre of the bladder. Most urothelial carcinomas are papillary.
  2. Flat urothelial carcinoma, such as carcinoma in situ, grows flat on the bladder wall without developing any finger-like projections.


Urothelial Carcinoma


Squamous cell carcinoma

his type of cancer starts in the thin, flat cells in the lining of the bladder. It accounts for 1–2% of all bladder cancers1 and is more likely to be invasive.


This cancer develops from the mucus- producing cells of the bladder. It makes up about 1% of all cases2 and is likely to be invasive.

Rarer types of bladder cancer include sarcomas (starting in the muscle) and aggressive forms called small cell carcinoma, plasmacytoid carcinoma and micropapillary carcinoma.

How common is bladder cancer?

Each year, more than 2400 Australians are diagnosed with bladder cancer. Most people diagnosed with bladder cancer are 60 or older.

Men are three to four times more likely than women to be diagnosed with bladder cancer. Women have about a 1 in 430 chance of being diagnosed with bladder cancer before the age of 75. For men, the chance is about 1 in 110, making it one of the top 10 most common cancers in men.2

What are the symptoms

Sometimes bladder cancer doesn’t have many symptoms and is found when a urine test is done for another reason. However, often people with bladder cancer do experience symptoms. These can include:

Blood in the urine (haematuria)

This is the most common symptom of bladder cancer. It often occurs suddenly, but is usually not painful. There may only be a small amount of blood in the urine and it may look red or brown. For some people, the blood may come and go, or it may appear only once or twice.

Changes in bladder habits

A burning feeling when passing urine, needing to pass urine more often or urgently, not being able to urinate when you feel the urge, and pain while urinating can also be symptoms.

Other symptoms

Less commonly, people have pain in one side of their lower abdomen or back.

If you have any of these symptoms or are concerned, see your doctor as soon as possible.

Not everyone with these symptoms has bladder cancer. These changes might also indicate a bladder irritation or an infection. Blood in your urine can also be caused by kidney or bladder stones, and non-cancerous enlargement of the prostate in men.

Never ignore blood in your urine. Even if you’ve noticed blood in the urine only once, and it is painless, see your doctor.

What are the risk factors?

Research shows that people with certain risk factors are more likely to develop bladder cancer. These include:

  • smoking – cigarette smokers are up to six times more likely than non-smokers to develop bladder cancer
  • older age – most people with bladder cancer are over 60, and the risk increases with age
  • being male – men are three times more likely than women to develop bladder cancer
  • chemical exposure at work – chemicals called aromatic amines, benzene products and aniline dyes have been linked to bladder cancer; these chemicals are used in rubber and plastics manufacturing and in the dye industry and sometimes in the work of painters, machinists, printers, hairdressers and truck drivers
  • chronic infections – squamous cell carcinoma has been associated with urinary tract infections (including parasite infections, although these are very rare in Australia) and untreated bladder stones
  • long-term catheter use – long-term urinary catheter use may be linked with squamous cell carcinoma
  • previous cancer treatments – treatments that have been linked to bladder cancer include the chemotherapy drug cyclophosphamide and radiotherapy to the pelvic area (sometimes given for prostate cancer and gynaecological cancers)
  • diabetes treatment – diabetes medicines containing pioglitazone can increase the risk of bladder cancer
  • personal or family history – a small number of bladder cancers are associated with an inherited gene.

Which health professionals will I see?

Your GP will usually arrange the first tests. If these tests don’t rule out cancer, you’ll be referred to a urologist or to a local hospital that specialises in urology. The urologist will examine you and may do more tests. A range of health professionals will work as a multidisciplinary team (MDT) to treat you. 

The following health professionals may be in your MDT. Note that only some patients see a cancer care coordinator. If the bladder cancer is non-muscle-invasive, you are unlikely to need systemic chemotherapy or radiotherapy, so you probably won’t have to see a medical oncologist or radiation oncologist.

MDT health professionals
GP works in partnership with your specialists in providing ongoing care
urologist* specialises in diseases of the male and emale urinary systems and the male eproductive system; performs surgery
radiation oncologist* prescribes and coordinates the course of radiotherapy
medical oncologist* prescribes and coordinates the course of chemotherapy
cancer care coordinator or clinical nurse consultant (CNC) coordinates your care, liaises with other members of the MDT and supports your family throughout treatment
nurses administer drugs, including chemotherapy, and provide care, information and support throughout your treatment
stomal therapy nurse provides advice and support to patients with a stoma
continence nurse assesses and educates patients about bladder and bowel control
dietitian recommends an eating plan for you to follow while you are in treatment and recovery
social worker links you to support services and helps you with emotional or practical issues
clinical psychiatrist*, psychologist, counsellor provide emotional support and help manage any feelings of depression and anxiety
physiotherapist, occupational therapist assist with physical and practical problems, including restoring a range of movement after surgery

*Specialist doctor

Reviewed by: A/Prof Manish Patel, Urological Cancer Surgeon, Westmead Private and Macquarie University Hospitals and University of Sydney, NSW; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, Department of Health, WA; Leslie Leckie, Consumer; A/Prof Declan Murphy, Urologist, Chair of Uro-Oncology and Director of Robotic Surgery, Peter MacCallum Cancer Centre, VIC; Jan Priaulx, 13 11 20 Consultant, Cancer Council NSW.

1. JN Eble, G Sauter, JI Epstein, IA Sesterhenn (Eds.), World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs, IARC Press, Lyon, 2004.

2. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Bladder cancer, AIHW, Canberra, 2016. 

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