Bladder cancer

About bladder cancer

Bladder cancer develops in the lining of your bladder wall. It's caused by the uncontrolled growth of cells. In the UK, more than 10,000 people are diagnosed with bladder cancer each year.

Your bladder is a hollow, muscular, balloon-like organ that collects and stores urine. Urine is produced by your kidneys, which clean your blood by filtering out water and waste products. Urine passes from your kidneys through tubes (called the ureters) into your bladder and then outside your body (through the urethra).

Illustration showing the location of the bladder and surrounding structures

Types of bladder cancer

There are different types of bladder cancer, named after the type of cell the cancer first starts in and the stage of disease (how far it has spread). These are described below.

Cell type

  • Urothelial carcinoma (also known as transitional cell carcinoma, TCC). Nine out of 10 bladder cancers in the UK are of this type. The cancer develops in the top layer of cells that line your bladder wall. This usually happens in response to cancer-causing agents (carcinogens) passing out in your urine.
  • Squamous cell carcinoma (SCC). This type of bladder cancer is the most common worldwide. It develops in response to chronic irritation and sepsis (a severe infection of your whole body in which your bloodstream contains high levels of bacteria), mostly because of infections caused by parasites.
  • Adenocarcinoma. This is a very rare type of bladder cancer that develops in the mucus-producing cells that line your bladder wall.

Disease stage

  • Superficial (non-muscle invasive) bladder cancer. This is when the cancer is only in the bladder lining and hasn't spread into the deeper layers of your bladder wall. It usually appears as a small, mushroom-like growth on the lining of the bladder (called papillary cancer).
  • Invasive bladder cancer. This is when the cancer has spread into the muscle wall of your bladder. Depending on how far it has spread, invasive bladder cancer can be defined as T2, T3 or T4. For more information, see cancer staging and grading.

Symptoms of bladder cancer

The most common symptom of bladder cancer is having blood in your urine. Other symptoms may include having:

  • a burning feeling when you pass urine
  • a need to pass urine frequently and/or urgently
  • pain in your pelvis

If the bladder cancer is more advanced and has spread considerably, you may have additional symptoms such as bone pain.

These symptoms aren't always caused by bladder cancer, but if you have them see your GP.

Causes of bladder cancer

Doctors don't fully understand why bladder cancer develops. However, certain factors increase your risk of getting the disease. These are described below.

  • Smoking triples your risk of bladder cancer. Exposure to second-hand smoke during childhood may also increase your risk.
  • Exposure to certain industrial chemicals, for example those used in printing and textiles, gas and tar manufacturing, and iron and aluminium-processing industries.
  • A long-term infection with the parasitic disease schistosomiasis, which is also known as bilharzia.
  • A long-term or repeated bladder infection.
  • Having certain types of chemotherapy or radiotherapy treatment to your pelvic area.

Diagnosis of bladder cancer

Your GP will ask about your symptoms and examine you. He or she will also usually ask you to take a urine test. You may be referred to a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system).

You may have the following tests to confirm a diagnosis.

  • Cystoscopy. This procedure is used to look inside your bladder and urinary system. During the procedure, your surgeon may take a biopsy (small sample of tissue), which will be sent to a laboratory for testing to determine the cell type affected and whether it’s benign (not cancerous) or cancerous.
  • CT urogram. This involves taking a CT scan of your urinary tract before and after injection of a dye that shows up your urinary system.
  • Ultrasound, MRI or CT scan. These scans can help doctors check your urinary system to see if the cancer has spread.

Treatment of bladder cancer

Treatment depends on the position and size of the cancer in your bladder and how far it has spread. Your doctor will discuss your treatment options with you.


Transurethral resection of bladder tumour (TURBT)
TURBT is the main treatment option for early stage bladder cancer that hasn’t spread into your bladder wall. The procedure is carried out using cystoscopy and removes any unusual growths or tumours on your bladder wall. TURBT is usually followed by bladder treatment with mitomycin C or Bacille Calmette-Guérin (BCG) to destroy any remaining cancer cells and reduce the chance of cancer coming back.

Bladder treatment with mitomycin C or Bacille Calmette-Guérin (BCG)
Mitomycin C is a chemotherapy medicine used to destroy cancer cells. BCG is an immunotherapy that contains a weak form of the bacterium Mycobacterium bovis that works by encouraging your immune system to attack cancer cells. Mitomycin C or BCG treatment is usually given after having a TURBT procedure, though sometimes it may be used alone to treat non-muscle invasive bladder cancer.


Removing your bladder and surrounding tissues is the main treatment for muscle-invasive bladder cancer. The operation is called a complete or radical cystectomy.

Before surgery, you may have chemotherapy to shrink the tumour. Then, after removing your bladder, your surgeon will create a new area for you to store urine. There are several ways to do this.

  • Bladder reconstruction (neobladder). A new bladder is made using part of your bowel. Your urine drains from your ureters into the new bladder. As you will have lost the nerves that tell you when your bladder is full, you will need to learn how to pass urine through your urethra by using muscle control.
  • Urostomy. Your ureters are connected to a small opening known as a stoma in your abdomen (tummy) using a short piece of your small bowel. A flat, watertight bag is placed over the stoma to collect your urine.
  • Continent urinary diversion. A section of your bowel is used to make a pouch inside your abdomen to collect urine. The pouch is connected to the outside of your body through a stoma, which is kept closed with a valve. You will need to empty the pouch four to five times a day by putting a thin, flexible tube (catheter) into the stoma.

For older people who can’t have surgery, radical radiotherapy may be a more suitable option.

Prevention of bladder cancer

If you smoke, stopping smoking can reduce your risk of developing bladder cancer.

Living with bladder cancer

After treatment for bladder cancer, you will have regular check-ups with your doctor. If you had a urostomy, a stoma nurse at hospital may be able to give you help and advice.

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There are support groups where you can meet people who may have similar experiences to you. Ask your doctor for advice.


Produced by Krysta Munford, Bupa Health Information Team, November 2012.

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