Overview

The bladder is an expandable, hollow organ in the pelvis that stores urine (the body’s liquid waste) before it leaves the body during urination. The urinary tract is made up of the kidneys, ureters, bladder, and urethra and is lined with a layer of cells called the urothelium. This layer of cells is separated from the muscularis propria (bladder muscles) by the lamina propria (a thin, fibrous band).

Bladder cancer is a cancerous tumor that begins when cells in the bladder become abnormal and grow uncontrollably, forming a mass of tissue. It is described as either noninvasive or invasive. Noninvasive cancer does not spread through the lamina propria, and invasive cancer can spread through the lamina propria. Noninvasive cancer may also be called superficial cancer, although that term is being used less often because it may incorrectly imply that this type of cancer is not serious. Invasive cancer is subdivided as either cancer that only grows into the lamina propria or cancer that grows into the muscle layer.

There are three main types of bladder cancer, depending on the type of cell where the cancer begins:

Urothelial carcinoma. Urothelial carcinoma is a new term for this type of bladder cancer. It was previously called transitional cell carcinoma or TCC. Urothelial carcinoma accounts for about 90% of all bladder cancers and begins in the urothelium. A tumor of this type may be described further using one of the four subcategories explained below.

Noninvasive/superficial urothelial carcinoma. This subtype of urothelial carcinoma is limited to the urothelium and is noninvasive. It may spread into the lamina propria beneath the transitional cells. This is sometimes called invasive, though it is not the deeply invasive type that can spread to the muscle layer.

Deeply invasive urothelial carcinoma (often called invasive urothelial carcinoma). This subtype of urothelial carcinoma spreads to the bladder's muscularis propria and sometimes to the fatty layers or surrounding tissue outside the muscle.

Papillary urothelial carcinoma. Papillary is a word that describes a growth that is like a small polyp or flower-shaped cluster of cancer cells. A noninvasive papillary tumor grows into the hollow center of the bladder on a stalk. Invasive papillary urothelial carcinoma can spread into the muscle layer.

Flat urothelial carcinoma. Noninvasive flat urothelial carcinoma (also called carcinoma in situ, or CIS) grows in the layer of cells closest to the inside of the bladder and appears as flat lesions on the inside surface of the bladder. Invasive flat urothelial carcinoma may invade the deeper layers of the bladder, particularly the muscle layer.

Squamous cell carcinoma. This type accounts for about 4% of all bladder cancers and starts in squamous cells, which are thin, flat cells.

Adenocarcinoma. This type accounts for about 2% of all bladder cancers and begins in glandular cells.

All three major types of bladder cancer can metastasize (spread) beyond the bladder. If the tumor has spread into the surrounding organs (the uterus and vagina in women, the prostate in men, and/or nearby muscles), it is called locally advanced disease. The area outside of these organs where bladder cancer usually spreads is the lymph nodes in the pelvis. If it has spread into the liver, bones, lungs, or other parts of the body, these are distant metastases and the cancer may be called advanced disease.

There are other, less common types of cancer that arise in the bladder, including sarcoma (which begins in the muscle layers of the bladder) and small cell anaplastic cancer (a rare type of bladder cancer that is likely to spread to other parts of the body).

Statistics

In 2009, an estimated 70,980 adults (52,810 men and 18,170 women) will be diagnosed with bladder cancer in the United States. It is estimated that 14,330 deaths (10,180 men and 4,150 women) from this disease will occur this year. Among men, bladder cancer is the fourth most common cancer and the eighth most common cause of cancer death.

For people with noninvasive/superficial urothelial carcinoma, the five-year relative survival rate (the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) is 93%. Seventy-four percent (74%) of people are diagnosed with this stage. If the cancer has spread to the lymph nodes or nearby organs, the five-year survival rate is 45%. If the cancer has spread to distant parts of the body, the five-year relative survival rate is 6%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with bladder cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2009.

Find out more about basic cancer terms used in this section.