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What Is Bladder Cancer?

The bladder is the hollow muscular organ in the lower abdomen that stores urine. Most bladder cancers develop in the inner lining of the bladder. Over time, the cancer might grow outside the bladder and into nearby structures. When bladder cancer spreads (metastasizes), it tends to go to distant lymph nodes, bones, the lungs, or the liver.

According to the American Cancer Society, more than 83,700 new cases of bladder cancer are diagnosed in the U.S. each year, resulting in about 17,200 deaths.

In Colorado there are approximately 1,200 new cases of bladder cancer each year.

Bladder cancer is more common in men than women. For men, it is the fourth most common type of cancer.

Bladder Cancer Prognosis and Survival Rates

Bladder cancer prognosis depends on the type of cancer and the stage at which it is diagnosed.

About two-thirds of all bladder cancers are discovered while the cancer is still only in the inner layer of the bladder wall. This is called non-invasive bladder cancer. The five-year survival rate for these patients is 90%.

One-third of cases are diagnosed while the cancer is still confined to the bladder but has spread into deeper layers of the bladder muscle. This is called localized bladder cancer. The five-year survival rate for these patients is 70%. 

In rare cases, the cancer spreads beyond the bladder. The five-year survival rate for patients with regional bladder cancer, where the cancer has spread from the bladder to nearby structures or lymph nodes, is 36%.

Why Come to CU Cancer Center for Bladder Cancer 

As the only National Cancer Institute Designated Comprehensive Cancer Center in Colorado and one of only four in the Rocky Mountain region, the CU Cancer Center has doctors who provide top-notch, patient-centered bladder cancer care and researchers focused on diagnostic and treatment innovations.

There are multiple bladder cancer clinical trials being offered by CU Cancer Center members at any given time. These trials offer patients alternatives to traditional bladder cancer treatment and can result in remission or increased life spans.

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In addition, we offer a multidisciplinary care clinic for patients with bladder cancer. This includes reviews of tissue and pathology, imaging, and consultations with urologic oncologists, medical oncologists, and radiation oncologists.

Our clinical partnership with UCHealth has produced survival rates nearing the state average for all stages of urinary bladder cancer.
Urinary Bladder Cancer Graph

Number of Patients Diagnosed – UCHealth 379 – State of Colorado 1,165
Number of Patients Surviving – UCHealth 166 – State of Colorado 537
*n<30, 5 Year Survival – (Date of diagnosis 1/1/2010–12/31/2014)

Types of Bladder Cancer

Different types of bladder cells can become cancerous, and the type of cell affected determines the type of bladder cancer. They are categorized by looking at the cells under a microscope. Doctors use this information to understand the expected growth pattern and speed, as well as which treatments may work best.

Urothelial carcinoma is the most common form of bladder cancer, accounting for approximately 90% of all diagnoses. Urothelial cells line the inside of the bladder and are also found in the kidneys, the tubes (ureters) that connect the kidneys to the bladder, and the urethra. Because of this, urothelial carcinoma can also occur in those areas, but it is most common in the bladder. Urothelial carcinoma is sometimes called transitional cell carcinoma. Urothelial carcinoma can also have more aggressive cells like micropapillary, sarcomatoid, or plasmacytoid. 

Squamous cell carcinoma accounts for 1% to 2% of all bladder cancer in the U.S., though it is more common in parts of the world where a certain parasitic infection called schistosomiasis is a common cause of bladder infections. Seen with a microscope, squamous cells are thin, flat cells. Squamous cell carcinoma may occur after extended irritation of the bladder, such as infection or long-term use of a urinary catheter. This type of bladder cancer is usually invasive.

Adenocarcinoma makes up about 1% of bladder cancer diagnoses. It begins in the cells of the mucus-secreting glands in the bladder. Most adenocarcinomas are invasive.

Small cell carcinoma accounts for less than 1% of bladder cancers. This cancer forms in nerve-like cells called neuroendocrine cells and usually grows quickly.

Sarcomas start in the muscle cells of the bladder and are very rare.

Bladder cancer tumors are also divided into two subtypes — papillary and flat — based on how they grow.

Papillary carcinomas grow in slender, finger-like projections from the inner surface of the bladder toward the hollow center, rather than into the deeper layers of the bladder wall. These are also called non-invasive papillary cancers.

Flat carcinomas do not grow toward the hollow part of the bladder. If a flat tumor is only in the inner layer of bladder cells, it is referred to as a non-invasive flat carcinoma or a flat carcinoma in situ.

If either a papillary or flat carcinoma grows into the deeper layers of the bladder, it is called an invasive urothelial carcinoma.

Risk Factors for Bladder Cancer

Bladder cancer has multiple risk factors. Risk factors are behaviors or conditions that increase a person’s likelihood of developing the cancer. 

Smoking: Smokers are three to seven times more likely to develop bladder cancer than non-smokers. This may be because smoking causes toxic chemicals to accumulate in the urine, damaging the lining of the bladder. About half of all bladder cancers are attributed to smoking.

Exposure to certain chemicals: Workers in industries that use certain types of chemicals may have a higher risk of bladder cancer. These include people involved in the production or use of rubber, leather, textiles, dye, and paint products, as well as printing companies. Other workers with an increased risk include machinists, hairdressers (because of heavy exposure to hair dyes), and truck drivers (because of exposure to diesel fumes).

Exposure to arsenic: Arsenic is a naturally occurring chemical element. When found in drinking water, arsenic is associated with an increased risk of bladder cancer. The chances of being exposed to arsenic depend on where you live and whether you get your water from a well or from a public water system that meets acceptable standards for arsenic content. Drinking water is not a major source of arsenic in the United States.

Exposure to radiation: Patients who have been treated with radiation to the pelvis area are more likely to develop bladder cancer.

History of bladder cancer: People who have already had bladder cancer have a greater risk of developing it again, either in the same spot as before or in another part of the urinary tract.

Chronic bladder infections: Patients with chronic or repeated urinary infections or kidney and bladder stones seem to have a higher risk of bladder cancer, as do those who require long-term use of a urinary catheter.

The parasitic infection schistosomiasis (also known as bilharziasis) is also a risk factor for squamous cell carcinoma. Schistosomiasis is rare in the United States but more common in parts of Africa, South America, Southeast Asia, and the Middle East.

Genetics: People with a family history of bladder cancer have an increased risk of getting it themselves. Although this is sometimes related to environmental and lifestyle factors, family members may also share changes in some genes (like GST and NAT) that make it difficult for their bodies to break down certain toxins. This can make them more susceptible to bladder cancer.

Other gene syndromes that may increase the risk for bladder cancer include a mutation of the retinoblastoma (RB1) gene; Cowden syndrome, which is caused by mutations in the PTEN gene; and Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, or HNPCC.

Bladder birth defects: Although extremely rare, about one-third of adenocarcinomas are related to a birth defect where part of the prenatal connection between the belly button and the bladder (called the urachus) remains after birth.

Another rare birth defect called exstrophy — in which the bladder and the abdominal wall in front of the bladder don’t close completely in utero and are fused together — greatly increases a person’s risk of developing bladder cancer.

Age: Bladder cancer can occur at any age, but the risk increases with time. About 90% of people diagnosed with bladder cancer are over 55, and the average age of people when they are diagnosed is 73.

Gender: Bladder cancer is the fourth most common type of cancer in men, but it is less common in women. Both the number of new bladder cancer cases and the number of bladder cancer-related deaths have decreased in women in recent years. For men, incidence rates have decreased, but death rates have remained the same.

Race and ethnicity: Caucasians are about twice as likely to be diagnosed with bladder cancer than Black or Hispanic people, though Black patients are slightly more likely to be diagnosed when the cancer is at an advanced stage.

Latest in Bladder Cancer from the CU Cancer Center

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Information reviewed by Janet Kukreja, MD, in May 2022.