About bladder cancer

What is bladder cancer?

Bladder cancer begins when cells in the inner 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 (e.g. lymph nodes, lungs, bones or liver).

What are the main types?

There are 3 main types of bladder cancer. They are named after the cells they start in.

Urothelial carcinoma

• starts in the urothelial cells lining the bladder wall
• most common type (80–90% of all bladder cancers)
• also called transitional cell carcinoma or TCC
• includes 2 rare subtypes (plasmacytoid and micropapillary), which are more aggressive

Squamous cell carcinoma (SCC)

• starts in thin, flat squamous cells in the bladder lining
• accounts for 1–2% of all bladder cancers
• more likely to be invasive

Adenocarcinoma

• develops from the glandular cells in the bladder
• makes up about 1% of all bladder cancers
• usually invasive

There are also rarer types of bladder cancer, including an aggressive form called small cell carcinoma, and sarcomas, which start in the muscle.

Call Cancer Connect on 13 11 20 for more information on these types of cancer and their treatment.

How common is bladder cancer?

Each year, about 3350 Australians are diagnosed with bladder cancer. Most people diagnosed with bladder cancer are aged 60 or older, but it can occur at any age.

About 1 in every 67 males will be diagnosed with bladder cancer before age 85, making it 1 of the 10 most common cancers in males. For females, the risk is about 1 in 234 before age 85, although it is often diagnosed at an advanced stage.

The bladder

The bladder is a hollow, muscular sac that stores urine (wee or pee). It sits behind the pubic bone in the pelvis, and is part of the urinary system.

The urinary system also includes 2 kidneys, 2 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. A layer of muscle wraps around the urethra and works like a valve to keep the bladder closed and stop leaking of urine. When you are ready to empty your bladder, the bladder muscle tightens and the valves open, and urine passes through the urethra and out of the body.

Layers of the bladder wall

There are 4 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 – The layer of tissue and blood vessels that surrounds the urothelium.
• Muscularis propria – The thickest layer. It consists of muscle that tightens to empty the bladder.
• Perivesical tissue – The outer layer. Mostly made up of fatty tissue, it separates the bladder from nearby organs.

The urinary system

Which health professionals will I see?

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 (a urologist), who will arrange further tests.

If bladder cancer is diagnosed, the urologist will consider treatment options. They will often 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.

Health professionals you may see

• urologist/urological surgeon – diagnoses and treats diseases of the urinary systems, as well as disorders in the male reproductive system; performs surgery
• medical oncologist – treats cancer with drug therapies such as chemotherapy and immunotherapy
• radiation oncologist – treats cancer by prescribing and overseeing a course of radiation therapy
• cancer care coordinator – coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment; care may also be coordinated by a clinical
• nurse consultant (CNC) – nurse administers drugs and provides care, information and support throughout treatment
• urological nurse – provides specialist nursing care to people with diseases of the urinary system – they may conduct assessments, administer treatments and provide information and support
• continence nurse – assesses and educates people about bladder and bowel control
• stomal therapy nurse – provides information about surgery and can help you adjust to life with a stoma
• dietitian – helps with nutrition concerns and recommends changes to diet during treatment and recovery
• social worker – links you to support services and helps you with emotional, practical and financial issues
• physiotherapist – helps with restoring movement and mobility; a continence physiotherapist provides exercises to help strengthen pelvic floor muscles and improve bladder and bowel control
• exercise physiologist – prescribes exercise to help improve your overall health, fitness, strength and energy levels