Bladder cancer

Bladder cancer can occur in men and women. However, in the UK, there are more men with bladder cancer than women. It is also a disease that affects the older person.

Article by Ian Peate

First published: Last updated:
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Key Points
  • In the UK there are approximately 10,300 new bladder cancer cases annually, with a higher incidence in men than in females.
  • Bladder cancer begins when the cells that make up the urinary bladder start to grow out of control.
  • As more cancer cells develop, they can form a tumour and with time, spread to other parts of the body.
  • The key risk factors are tobacco smoking and exposure to certain chemicals in working and general environments.
  • Ongoing research aims to identify and reduce risk factors, as well as to understand the impact that genetics may have on bladder cancer risk.

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There are three main types of bladder cancer (Kaufman et al, 2009). The type of bladder cancer depends on how the tumour's cells appear under the microscope. 

  1. Urothelial carcinoma (or UCC) accounts for about 90% of all bladder cancers. This type begins in the urothelial cells located in the urinary tract. Urothelial carcinoma also called transitional cell carcinoma or TCC.
  2. Squamous cell carcinoma develops in the bladder lining in response to irritation and inflammation, as time passes these cells can become cancerous. Squamous cell carcinoma accounts for around 4% of all bladder cancers.
  3. Adenocarcinoma accounts for about 2% of all bladder cancers developing from glandular cells. 

Other, less common types of bladder cancer, includes sarcoma and small cell anaplastic cancer. Sarcoma begins in the fat or muscle layers of the bladder. Small cell anaplastic cancer, a rare type of bladder cancer, is likely to spread to other parts of the

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Risk factors

There are several risk factors for bladder cancer (Box 1). The main risk factor is increasing age. However, smoking and exposure to some industrial chemicals also increase the risk (National Institute for Health and Care Excellence, NICE, 2015a). The risk of developing bladder cancer is 2-6 times greater in smokers compared to non-smokers (Freedman et al, 2011). 

Box 1. Bladder cancer risk factors 

  • Age
  • Smoking
  • Chemicals in the work place
  • Treatment for other cancers (e.g. pelvic radiation)
  • Some medical conditions (e.g. diabetes, spinal cord injury, Crohn's disease)
  • Infection (e.g. cystitis, gonorrhoea)
  • Bladder calculi (NICE, 2011; Cancer Research UK. 2018a)

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Bladder cancer may present as a number of signs and symptoms (Box 2). It is frequently identified on the basis of painless haematuria. Gross haematuria refers to enough blood present in the urine that can be seen. It is also possible that there are small amounts of blood in the urine that cannot be seen, this is termed microscopic haematuria and can only be found with a urine test.

Bladder cancer often presents for the first time as an emergency admission and this late presentation is commonly associated with a poor prognosis. Advanced disease may cause the person to present with voiding symptoms. 

Box 2. Signs and symptoms of bladder cancer 

  • Frequency of micturition
  • Urgency
  • Dysuria
  • Nocturia
  • Weight loss
  • Back pain
  • Lower abdominal pain
  • Bone pain
  • Malaise (Domino et al, 2014; Tobias and Hochhauser, 2015)

It should be noted that the symptoms may be caused by other conditions that may

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A physical examination (this may include an internal vaginal or rectal examination) should be undertaken. In early stage bladder cancer, the physical examination may be normal, in advanced disease there may be abdominal or pelvic masses. A detailed patient history should also be obtained.

When a physical examination and history have been gathered, this provides the opportunity for further tests and investigations to be considered so as to make a diagnosis or to make a differential diagnosis (for example, urinary tract infection). NICE (2015b) recommends evidence based approaches that are used to make a diagnosis of bladder cancer.

A urine specimen is obtained to ascertain if the symptoms could be a urinary tract infection (urinalysis). If there is bladder cancer then the patient's urine could contain cancer cells, this is called urine cytology. The urine specimen is examined under a microscope for the presence of cancer or pre-cancer cells. Different

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There are several factors that will determine the type of treatment, for example, the size of the cancer and if it has metastasised, the type of bladder cancer, the grade and the person's general health. 


This treatment mode is undertaken for most bladder cancers. The type of surgery undertaken depends on the stage of the cancer. Transurethral resection of bladder tumour (TURBT) removes the tumour in the bladder through the urethra—usually the first-line treatment for early bladder cancer.

Cystectomy, when bladder cancer is invasive, all or part of the bladder may need to be removed (cystectomy). Generally, chemotherapy is given before cystectomy is performed.

  • Partial cystectomy: If the cancer has invaded the muscle layer of the bladder wall, but is not very large and is in one place only, occasionally it can be removed, along with part of the bladder wall, without taking out the whole bladder

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I would like to thank Mrs Frances Cohen for her help and support. 



Near to the front


The point or area at which something divides into two branches or parts


Also known as stones

Contrast medium 

A special kind of dye injected into a vein or given as a liquid to swallow


Removal of the bladder


Inflammation of the urinary bladder


Situated away from the centre of the body


To glow


The presence of blood in the urine


Situated or occurring within the bladder


The serous membrane that lies in the cavity of the abdomen and covering the abdominal organs


Near to the back


Next to or nearest to the point of attachment or origin, located toward the centre of the body

Bellmunt J, Orsola A, Leow JJ et al. Bladder cancer: ESMO practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 Suppl 3:iii40–48.

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