Bladder cancer begins when cells in the lining of the bladder (urothelium) become abnormal. This causes the cells to grow and divide out of control. As the cancer grows, it may start to spread into the deeper layers of the bladder wall. Some cancer cells can also break off and travel outside the bladder to other parts of the body.
The bladder is a hollow, muscular sac that stores urine (wee or pee). It is located in the pelvis and is part of the urinary system.
The urinary system also includes two kidneys, two tubes called ureters that lead from the kidneys into the bladder, and another tube called the urethra that leads out of the bladder. In males, the urethra is a long tube that passes through the prostate and down the penis. In females, the urethra is shorter and opens in front of the vagina (birth canal).
The kidneys produce urine, which travels to the bladder through the ureters. The bladder is like a balloon and expands as it fills with urine. When you are ready to empty your bladder, the bladder muscle contracts, and urine passes through the urethra and out of the body.
There are four main layers of tissue in the bladder:
- urothelium – the inner layer. It is lined with cells called urothelial cells that stop urine being absorbed into the body.
- 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 outer layer. It is mostly made up of fatty tissue, and separates the bladder from nearby organs.
How common is bladder cancer?
Each year, almost 3100 Australians are diagnosed with bladder cancer. Most people diagnosed with bladder cancer are 60 or older, but it can occur at any age. About 1 in every 110 men will be diagnosed with bladder cancer before age 75, making it one of the 10 most common cancers in men. For women, the chance is about 1 in 500.
Contact a cancer nurse
There are three main types of bladder cancer, which are named after the cells they start in:
- urothelial carcinoma (80–90% of all bladder cancers) – starts in the urothelial cells lining the bladder wall. It is also called transitional cell carcinoma.
- squamous cell carcinoma (1–2% of all bladder cancers) – starts in thin, flat squamous cells in the bladder lining. It is more likely to be invasive.
- adenocarcinoma (about 1% of all bladder cancers) – develops from the glandular cells in the bladder. It is likely to be invasive.
There are also rarer types of bladder cancer. These include sarcomas, which start in the muscle, and aggressive forms called small cell carcinoma, plasmacytoid carcinoma and micropapillary carcinoma.
Sometimes bladder cancer doesn’t have many symptoms and is found when a urine test is done for another reason. However, most people with bladder cancer do have some symptoms, which can include:
- Blood in the urine (haematuria) – this is the most common symptom of bladder cancer. It often happens suddenly, but is usually not painful. There may be only a small amount of blood in the urine, and it may look red or brown. The blood may come and go, or it may appear only once or twice. You should always see your doctor if you notice any blood in your urine.
- Changes in bladder habits – changes may include a burning feeling when passing urine (weeing or peeing), needing to pass urine more often or urgently, not being able to urinate when you feel the urge, and pain while urinating.
- Other symptoms – less commonly, people have pain in one side of their lower abdomen (belly) or back.
Not everyone with these symptoms has bladder cancer, but if you do have any or are concerned, see your doctor as soon as possible.
Research shows that people with certain risk factors are more likely to develop bladder cancer. These include:
- Smoking – cigarette smokers are up to three times more likely than non-smokers to develop bladder cancer.
- Older age – about 90% of people diagnosed with bladder cancer in Australia are over 60.
- Being male – men are around three times more likely than women to develop bladder cancer.
- Chemical exposure at work – chemicals called aromatic amines, benzene products and aniline dyes are linked to bladder cancer. These chemicals are used in rubber and plastics manufacturing, in the dye industry, and sometimes in the work of painters, machinists, printers, hairdressers, firefighters and truck drivers.
- Frequent infections – squamous cell carcinoma of the bladder has been linked to urinary tract infections (including parasite infections, although these are very rare in Australia) and untreated bladder stones.
- Long-term catheter use – using urinary catheters over a long period may be linked with squamous cell carcinoma.
- Previous cancer treatments – these include the chemotherapy drug cyclophosphamide and radiation therapy to the pelvic area.
- Diabetes treatment – the diabetes drug pioglitazone can increase the risk of bladder cancer.
- Personal or family history – having one or more close blood relatives diagnosed with bladder cancer, or having inherited a gene linked to bladder cancer, increases the risk of bladder cancer.
Learn more about preventing cancer
Your general practitioner (GP) will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist called a urologist. The specialist will arrange further tests. If bladder cancer is diagnosed, the urologist will consider treatment options.
Often the urologist will discuss your treatment options with other health professionals at what is known as a multidisciplinary team (MDT) meeting. During and after treatment, you will see a range of health professionals who specialise in different aspects of your care, including a continence nurse, stomal therapy nurse, dietician and exercise physiologist, among others.
Asking your doctor questions will help you make an informed choice. You may want to include some of the questions below in your own list.
- What type of bladder cancer do I have?
- Has the cancer spread? If so, where has it spread? How fast is it growing?
- Are the latest tests and treatments for this cancer available in this hospital?
- Will a multidisciplinary team be involved in my care?
- Are there clinical guidelines for this type of cancer?
- What treatment do you recommend? What is the aim of the treatment?
- If an operation is recommended, how many times have you performed it?
- Are there other treatment choices for me? If not, why not?
- If I don’t have the treatment, what should I expect?
- I’m thinking of getting a second opinion. Can you recommend anyone?
- How long will treatment take? Will I have to stay in hospital?
- Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
- How will we know if the treatment is working?
- Are there any clinical trials or research studies I could join?
- What are the risks and possible side effects of each treatment?
- If I need the bladder removed, what are my options for storing urine?
- Will I have a lot of pain? What will be done about this?
- Can I work, drive and do my normal activities while having treatment?
- Will the treatment affect my sex life and fertility?
- Should I change my diet or physical activity during or after treatment?
- Are there any complementary therapies that might help me?
- How often will I need check-ups after treatment?
- If the cancer returns, how will I know? What treatments could I have?
Understanding Bladder Cancer
Download our Understanding Bladder Cancer booklet to learn moreDownload now
Expert content reviewers:
Prof Dickon Hayne, Professor of Urology, UWA Medical School, The University of Western Australia, Chair of the Bladder, Urothelial and Penile Cancer Subcommittee, ANZUP Cancer Trials Group, and Head of Urology, South Metropolitan Health Service, WA; A/Prof Tom Shakespeare, Director, Radiation Oncology, Coffs Harbour, Port Macquarie and Lismore Public Hospitals, NSW; Helen Anderson, Genitourinary Cancer Nurse Navigator (CNS), Gold Coast University Hospital, QLD; BEAT Bladder Cancer Australia; Mark Jenkin, Consumer; Dr Ganessan Kichenadasse, Lead, SA Cancer Clinical Network, Commission of Excellence and Innovation in Health, and Medical Oncologist, Flinders Centre for Innovation in Cancer, SA; A/Prof James Lynam, Medical Oncology Staff Specialist, Calvary Mater Newcastle, NSW; Jack McDonald, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Tara Redemski, Senior Physiotherapist – Cancer and Blood Disorders, Gold Coast University Hospital, QLD; Prof Shomik Sengupta, Consultant Urologist, Eastern Health and Professor of Surgery, Eastern Health Clinical School, Monash University, VIC.
Page last updated:
The information on this webpage was adapted from Understanding Bladder Cancer - A guide for people with cancer, their families and friends (2022 edition). This webpage was last updated in February 2022.