What Is Urothelial Bladder Cancer? (2023)

The urinary tract is made up of multiple organs that help the body filter waste products from the blood. The kidneys filter the blood and develop urine, which then moves through tubes called ureters into the bladder.

The bladder is a pouch that holds the urine until it is ready to leave the body.The urine then moves from the bladder into the urethra, which is an opening that allows the urine to pass out of the body.

The bladder is lined with a layer of cells called urothelial cells. Beneath these urothelial cells are deeper layers of the bladder, ending with the muscle layer.

When cancer cells develop in the bladder, they usually occur in this urothelial layer. About 90% of all bladder cancers start here. This layer is frequently exposed to the chemicals in the urine, which over time can be damaging to these cells.

Bladder cancer is most often diagnosed in older people, with an average age of 73 at diagnosis. Males are more likely to have bladder cancer than females. It is the fourth most common cancer in men.

This article will review the symptoms, causes, and treatment for urothelial bladder cancer.

What Is Urothelial Bladder Cancer? (1)

(Video) Bladder Cancer Urothelial Carcinoma


One of the first symptoms and the most common symptom is blood in the urine. This is called hematuria. There may be enough blood to be seen after urinating, or it may be in smaller amounts that can’t be seen easily. A urinalysis can detect microscopic amounts of blood. The blood may also occur on occasion and not be present every day.

Other symptoms of bladder cancer can include:

  • Urinating more frequently than normal
  • Burning or discomfort when urinating
  • Urinating often during the night
  • Having a weak urine stream
  • Feeling of being unable to pass urine
  • Pain in the lower back or abdomen


There is no single factor that causes bladder cancer to develop. Urothelial bladder cancer develops when the genetic material (DNA) inside of the urothelial cells lining the bladder becomes abnormal. These abnormal cells then divide and produce more abnormal cells. As more abnormal cells are made, the tumor develops.

Though there is not one specific cause for urothelial bladder cancer, there are several risk factors that may make bladder cancer more likely to occur. These risk factors include:

  • Smoking
  • Chemical exposures in the workplace, such as in the following occupations: painters, leatherworkers, and dye, rubber-tire, aluminum, steel, and iron industry workers
  • Previous treatment with the chemotherapy medications cyclophosphamide or ifosfamide
  • Use of the herb aristolochic acid (found in some herbal supplement used for arthritis and gout)
  • Arsenic exposure
  • Chronic bladder infections
  • Previous radiation treatment to the pelvis

It is also possible that someone can be born with a gene that makes them more likely to develop bladder cancer. Some of the genes that may increase the risk include PTEN and RB1.


When a bladder cancer diagnosis is suspected, many tests can be performed to help determine the cause of the symptoms and make the diagnosis.

History and Physical Exam

Obtaining a medical history can be very important. During this discussion, the patient will notify the doctors of any previous illnesses or medical conditions they have had and can learn about their risk factors for bladder cancer.

During a physical examination, the abdomen may be gently pressed on to see if any masses can be felt. For females, a pelvic exam may be done to evaluate the uterus and ovaries. For males, a digital rectal exam may be performed to evaluate the prostate.

(Video) Upper Tract Urothelial Cancer

Urine Tests

There are multiple lab tests that can be performed from a single urine sample. A urinalysis looks for the presence of blood in the urine. A urine culture checks for the growth of bacteria in the urine. A urine cytology determines if there are cancer cells in the urine.

Imaging Tests

A cystoscopy is one of the most frequently ordered imaging tests. During a cystoscopy, the doctor places a thin camera into the urethra (the outer opening where urine leaves the body) and up toward the bladder. This allows the doctor to inspect the bladder walls and see if any tumors or other abnormalities are present.

A cystoscopy is the best way to view the inside of the bladder, but other tests such as a CT (computed tomography) scan may be ordered to look at the areas around the bladder to see if any abnormal findings are present.


If a suspicious area is found during cystoscopy, a biopsy will be done. During a biopsy, a sample of the abnormal tissue is removed and evaluated in a lab to determine if cancer cells are present. The biopsy procedure is called a TURBT (transurethral resection of bladder tumor). A TURBT is performed much in the same way as a cystoscopy, but during a TURBT, a portion of the tumor along with the bladder wall is removed.

Cancer Staging

Once a bladder cancer diagnosis is made, the oncologist (a medical doctor specializing in diagnosing and treating cancer) will determine the stage of the cancer. This can help determine what treatment is needed as well as the prognosis.

Stages include:

Stage 0: In this stage, cancer is present but is very small in size and has not grown into the deeper layers of the bladder or spread to any lymph nodes.

Stage 1: In this stage, cancer has grown a little deeper than the first layer of the bladder, but it has not grown into the muscle or to any lymph nodes.

(Video) Upper Tract Urothelial Carcinoma | Bladder Cancer Advocacy Network

Stage 2: The cancer has spread into deeper layers of the bladder but has not gone through the muscle layer or spread into any lymph nodes or other areas of the body.

Stage 3a: The cancer has spread through the muscle layer into the fat surrounding the bladder, or has spread into one lymph node in the pelvis. It could also have spread into nearby areas such as the prostate or uterus but hasn’t spread to distant areas in the body.

Stage 3b: The cancer has spread to more than one lymph node in the pelvis.

Stage 4: The cancer has grown through the bladder and into the abdominal wall or has spread to distant areas of the body, such as the bones or lungs.


Treatment for urothelial bladder cancer is dependent upon the stage of the cancer. Multiple treatments may be given in combination to best treat the cancer.

Intravesical Therapy

This treatment can be used in early stages of bladder cancer that have not spread deep into the bladder wall. During this type of treatment, the cancerous tissue is removed during a TURBT, and then chemotherapy or immunotherapy is administered directly into the bladder to treat the area. Sometimes this process is only required once, but it may need to be repeated if cancer returns.


Partial or full removal of the bladder may need to be done to treat the cancer. If full bladder removal is required, a patient will no longer be able to urinate normally, as there is no longer a pouch to hold the urine. A urostomy will be placed, which connects a small piece of intestine to an opening on the outside of the body called a stoma. This allows the urine to flow through to a bag attached to the outside of the body.


If bladder cancer has spread through the bladder muscle or into other areas of the body, chemotherapy may be needed. Chemotherapy is medication, usually given through an infusion or taken as a pill, that works by stopping cells from dividing, thereby destroying them.

(Video) Understanding Bladder Cancer


Immunotherapy infusions may be given when cancer has spread to other areas of the body. This medication works differently than chemotherapy. Immunotherapy helps your body’simmune system detect, attack, and destroy the cancer.

Radiation Therapy

During radiation therapy, high energy X-ray beams are directed at the area being treated. This type of treatment may be used to treat small areas of tumor, or to treat larger areas and try to prevent surgical removal of the bladder. If bladder cancer has spread to other areas of the body and are causing symptoms, such as pain, radiation therapy may be needed to improve those symptoms.


The prognosis of urothelial bladder cancer varies based on how advanced the cancer has grown, as well as the size of the tumor, and if it is a new tumor or has regrown.

The five-year survival rate—the percentage of people still alive at five years after diagnosis—for bladder cancer that has not gone into deeper layers is 96%.

If a tumor has invaded deeper layers but not the muscle wall, five-year survival is 69%. If it has spread into nearby lymph nodes or organs, the five-year survival rate is 37%. If bladder cancer has spread to distant areas of the body, five-year survival is 6%.


A bladder cancer diagnosis may cause stress and worry. Side effects from the cancer or the treatments may cause distressing changes to the body. Finding ways to cope with these changes—through support groups or with family and friends—may be helpful. Discussing expectations and concerns with your healthcare team may be helpful as well.

A Word From Verywell

If you’re experiencing symptoms, especially blood in the urine, or if you are concerned that you may have bladder cancer, don’t hesitate to reach out to your healthcare team to discuss your concerns.

It is very possible that the symptoms you’re having may be due to other reasons, such as a urinary tract infection. But if caught early, bladder cancer has a much better prognosis, so it's important to catch it and begin treatment as soon as possible. Be sure to discuss any concerns you have about your urinary health with your healthcare team.

(Video) Bladder Cancer - Overview (types, pathophysiology, diagnosis, treatment)


Is urothelial cancer same as bladder cancer? ›

Urothelial carcinoma, also known as transitional cell carcinoma (TCC), is by far the most common type of bladder cancer. In fact, if you have bladder cancer it's almost always a urothelial carcinoma. These cancers start in the urothelial cells that line the inside of the bladder.

Is urothelial cancer aggressive? ›

Muscle-invasive urothelial carcinomas are highly aggressive compared to cancers of the upper urinary tract, carrying a five-year disease-specific survival rate of <50% in pT2/pT3 disease, and this survival rate drops below 10% in pT4 cancer.

What is the life expectancy for urothelial carcinoma? ›

If the cancer extends through the bladder to the surrounding tissue or has spread to nearby lymph nodes or organs, the 5-year survival rate is 38%. If the cancer has spread to distant parts of the body, the 5-year survival rate is 6%. About 4% of people are diagnosed with this stage.

Is urothelial carcinoma life threatening? ›

These cancers can almost always be cured with treatment. During long-term follow-up care, more superficial cancers are often found in the bladder or in other parts of the urinary system. Although these new cancers do need to be treated, they rarely are deeply invasive or life threatening.

What causes urothelial bladder cancer? ›

Most cases of bladder cancer appear to be caused by exposure to harmful substances, which lead to abnormal changes in the bladder's cells over many years. Tobacco smoke is a common cause and it's estimated that more than 1 in 3 cases of bladder cancer are caused by smoking.

What is the most aggressive form of bladder cancer? ›

Muscle invasive bladder cancer is a serious and more advanced stage of bladder cancer. MIBC is when the cancer has grown far into the wall of the bladder (Stages T2 and beyond). For patients with MIBC, the overall prognosis (how the disease may progress) is dependent on stage and treatment.

What is the treatment for urothelial cancer? ›

Chemotherapy for the whole body (systemic chemotherapy), to increase the chance for a cure in a person having surgery to remove the bladder, or as a primary treatment when surgery isn't an option. Radiation therapy, to destroy cancer cells, often as a primary treatment when surgery isn't an option or isn't desired.

What is the first line treatment for urothelial cancer? ›

FIRST-LINE THERAPY A cisplatin-based combination chemotherapy regimen is the preferred initial therapy for patients with metastatic urothelial cancer of the bladder and urinary tract who are cisplatin candidates (algorithm 1).

Where is the first place bladder cancer spreads? ›

Where can bladder cancer spread to? Not all bladder cancers will spread. But If it does it's most likely to spread to the structures close to the bladder, such as the ureters, urethra, prostate, vagina, or into the pelvis.

Can high grade urothelial carcinoma be cured? ›

High-grade T1 (T1HG) bladder cancer (BCa) has a very high likelihood of disease recurrence and progression to muscle invasion. Radical cystectomy is considered the best chance at cure, albeit with a high risk of morbidity, and is overtreatment for some patients.

How does urothelial carcinoma spread? ›

Once bladder cancer has reached the lymph nodes, it can travel to distant parts of the body through the lymphatic system. Separately, it can also continue to grow into surrounding areas such as the abdominal wall (peritoneum).

What stage is high grade urothelial carcinoma? ›

Grade 3. The cancer cells look very abnormal. They are called high grade or poorly differentiated. They grow more quickly and are more likely to come back after treatment or spread into the deeper (muscle) layer of the bladder.

Is urothelial carcinoma slow growing? ›

Papillary urothelial carcinoma often has a slow growth rate compared to less common types of bladder cancer.

Is urothelial carcinoma painful? ›

When it's in its earliest stages, bladder cancer doesn't usually cause much pain. Some people have no pain whatsoever, while others may experience pain or burning when they urinate. Blood in the urine, either microscopic or visible to the naked eye, is commonly the first sign of bladder cancer.

Is urothelial carcinoma invasive? ›

The majority of high-grade papillary urothelial carcinomas become invasive (approximately 80%) and can spread to adjacent organs or give distant metastases (lung, liver, bone, brain, etc.).

What is the meaning of urothelial? ›

(yoo-roh-THEE-lee-um) The lining of the urinary tract, including the renal pelvis, ureters, bladder, and urethra.

What percentage of bladder cancer is urothelial? ›

Urothelial carcinoma (or UCC) accounts for about 90% of all bladder cancers. It also accounts for 10% to 15% of kidney cancers diagnosed in adults. It begins in the urothelial cells that line the urinary tract. Urothelial carcinoma used to be called transitional cell carcinoma or TCC.

Does bladder cancer spread quickly? ›

They tend to grow and spread slowly. High-grade bladder cancers look less like normal bladder cells. These cancers are more likely to grow and spread.

Can you live 10 years with bladder cancer? ›

Survival for all stages of bladder cancer

almost 55 out of every 100 (almost 55%) survive their cancer for 5 years or more after they are diagnosed. around 45 out of every 100 (around 45%) survive their cancer for 10 years or more after diagnosis.

Can you have bladder cancer for years and not know it? ›

Can bladder cancer go undetected for years? If symptoms such as blood in the urine and changes in urinary habits are ignored by an individual and/or repeatedly misdiagnosed, it's possible that bladder cancer may not be detected for months or, in some cases, even years.

Is bladder cancer worse than kidney cancer? ›

Kidney cancer has the highest mortality rate of the genitourinary cancers. There are management issues with the high recurrence rate of superficial bladder cancer while muscle invasive bladder cancer has a poor prognosis.

Where does urothelial cancer metastasize to? ›

Conclusion: Lymph nodes, lung, liver, bone, and peritoneum are the most common metastatic sites of upper urinary tract urothelial cancers.

How common is upper tract urothelial cancer? ›

UTUCs are relatively uncommon and account for only 5 percent to 10 percent of urinary tract cancers. These cancers develop primarily in people older than 70. Men are affected twice as frequently as women. Smoking: Smoking is one of the largest adjustable risk factors for developing UTUC.

Is urothelial cancer hereditary? ›

Inheritance. Bladder cancer is typically not inherited. It is usually associated with somatic mutations that occur in certain cells in the bladder during a person's lifetime. In rare families, the risk of bladder cancer is inherited.

What are the signs that bladder cancer is getting worse? ›

If bladder cancer reaches an advanced stage and begins to spread, symptoms can include: pelvic pain. bone pain. unintentional weight loss.
Symptoms of bladder cancer
  • a need to urinate on a more frequent basis.
  • sudden urges to urinate.
  • a burning sensation when passing urine.

What age do most people get bladder cancer? ›

Bladder cancer occurs mainly in older people. About 9 out of 10 people with this cancer are over the age of 55. The average age of people when they are diagnosed is 73.

Who typically gets bladder cancer? ›

People over the age of 55 are more at risk, as are men, more than women. Exposure to harmful chemicals, either at home or at work, previous cancer treatments, chronic bladder inflammation, or a family history of bladder cancer can also play a role.

What does urothelial carcinoma look like? ›

Papillary urothelial carcinoma tumors have a shape like a small mushroom. They attach with a tiny stem to the inner layer of the bladder, lower kidney, or ureter.

What is the most common risk factor contributing to the development of urothelial carcinoma? ›

Smoking is the most important risk factor for bladder cancer. People who smoke are at least 3 times as likely to get bladder cancer as people who don't.

How fast does high grade urothelial carcinoma grow? ›

T1Hg bladder cancer progresses to muscle-invasive or metastatic disease at a rate of 30% to 50% after 5 years.

What is the survival rate of stage 4 urothelial carcinoma? ›

For a person with stage 4 bladder cancer, the 5-year relative survival rate is around 5 percent . This means that the person is 5 percent as likely as someone without cancer to live for a minimum of 5 years after diagnosis.

What are the types of urothelial carcinoma? ›

Urothelial neoplasms of the urinary bladder may be subdivided into papillary (papillomas, low malignant potential and papillary carcinoma) and non-papillary (urothelial carcinoma in situ and invasive) categories.

What is suspicious high grade urothelial carcinoma? ›

The diagnosis of “suspicious for high-grade urothelial carcinoma (SHGUC)” is meant to reflect the presence of urothelial cells with severe atypia that falls short for a diagnosis of high-grade urothelial carcinoma (HGUC) but beyond atypia that is associated with the “atypical urothelial cells” (AUC).

How is low grade urothelial carcinoma treated? ›

People with low-grade noninvasive bladder cancer (stage 0a) are treated with transurethral resection of bladder tumor (TURBT) first. Low-grade noninvasive bladder cancer rarely turns into aggressive, invasive, or metastatic disease, but patients are at risk for developing more low-grade cancers throughout their life.

Can low grade urothelial carcinoma be invasive? ›

Typically in invasive papillary urothelial carcinoma both the overlying papillary and the invasive components are high grade. We describe a series of patients with invasive low-grade papillary urothelial carcinoma (LPUC) in which both the noninvasive and invasive components are low grade.

What is the most common first symptom of a malignant tumor of the bladder? ›

For most people, the first symptom of bladder cancer is blood in the urine, also called hematuria. Sometimes the blood is visible, prompting the patient to visit a doctor.

What are the 3 types of bladder cancer? ›

The type of bladder cancer depends on how the tumor's cells look under the microscope.
The 3 main types of bladder cancer are:
  • Urothelial carcinoma. Urothelial carcinoma (or UCC) accounts for about 90% of all bladder cancers. ...
  • Squamous cell carcinoma. ...
  • Adenocarcinoma.

What are the 2 types of bladder cancer? ›

The most common type of bladder cancer is urothelial bladder cancer. This is also called transitional cell bladder cancer. There are some rarer types. These include squamous cell bladder cancer, adenocarcinoma, sarcoma and small cell bladder cancer.

Are there different kinds of bladder cancer? ›

Most bladder cancers — about 90 percent — begin in the cells on the surface of the bladder's inner lining. This type of cancer is called urothelial carcinoma (also called transitional cell carcinoma). Most urothelial carcinomas are a form of non-muscle invasive bladder cancer (NMIBC).

At what stage does bladder cancer spread? ›

Once cancerous cells have reached the lymphatic system, they can make their way to almost any part of the body. Bladder cancer that has spread outside the bladder into other areas is called metastatic bladder cancer, also known as stage 4 bladder cancer.

What is the best treatment for urothelial carcinoma? ›

FIRST-LINE THERAPY A cisplatin-based combination chemotherapy regimen is the preferred initial therapy for patients with metastatic urothelial cancer of the bladder and urinary tract who are cisplatin candidates (algorithm 1).

Is urothelial cancer slow growing? ›

The most common type of bladder cancer, urothelial carcinoma, is also the least invasive and slowest growing. Rare types of bladder cancer, such as small cell carcinoma, squamous cell carcinoma, and adenocarcinoma, typically grow much faster.

What is the latest treatment for bladder cancer? ›

New Bladder Cancer Treatments
  • Immunotherapy. Immunotherapy is treatment that helps the body's immune system fight cancer more effectively. ...
  • Targeted Therapy. ...
  • Combination Therapy. ...
  • Antibody Drug Conjugates. ...
  • Clinical Trials for Bladder Cancer.
Jun 22, 2022

Are most bladder cancers curable? ›

Can bladder cancer be cured? Bladder cancer is usually treatable when caught at an early stage but more challenging to address when found later. Recurrence also poses a risk, even with early-stage tumors, so regular surveillance is essential following treatment or surgery.


1. Bladder Cancer: The Basics | Johns Hopkins Greenberg Bladder Cancer Institute
(Johns Hopkins Medicine)
2. Non-urothelial cell bladder cancers - causes, symptoms, diagnosis, treatment, pathology
(Osmosis from Elsevier)
3. Understanding the basics of operating a Bladder Cancer | Dr.Abhay Kumar
(Narayana Health)
4. Urothelial Carcinoma
(NEJM Group)
5. Survival trends: urothelial vs. nonurothelial bladder cancer
6. Urothelial Cancer Clinical Study
(Mount Sinai Health System)
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