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Bladder and Urothelial Cancer

Bladder cancer is the broad term often used to represent a number of cancer types that can develop within the urinary tract system. The urinary system comprises the bladder, ureter, urethra and renal pelvis.

Bladder cancer is the fourth most common cancer in men, according to the American Cancer Society. The risk for developing bladder cancer increases with age. Other risk factors include smoking tobacco and a family history of bladder cancer. Symptoms of bladder cancer include blood in the urine, recurring urinary tract infections, frequent urination, and pelvic, groin or lower back pain. A specific genetic disorder called Lynch Syndrome can also predispose patients to cancer of the urinary tract.  

The layers of the bladder wall are complex, with each layer comprising a variety of cell types. After a tumor mass has been detected, pathologists – physicians trained to diagnose disease – analyze the types of bladder cells involved to identify bladder cancer sub-types as well as how advanced the cancer is. This identification, known as staging, confirms whether the cancer has grown beyond its original site into nearby muscles, lymph nodes or beyond. 

The two most important aspects that dictate both prognosis and treatment for bladder cancer are the stage and grade. Very simply put, “grade” refers to the biological aggressiveness of the cells. If the cells under a microscope appear close to normal and do not have the capability of escaping the bladder, we call this low-grade cancer. If the cells under a microscope appear abnormal in appearance and do have the ability to escape the bladder, we call this high-grade cancer.  

The term “stage” refers to the depth of invasion into the bladder wall. If the tumor is “flat” and confined within the cells lining the bladder — known as the mucosa or urothelium — it is considered stage Tis. A tumor that grows from the lining toward the center of the bladder is considered stage Ta. The first deep layer of the bladder is the “lamina propria,” the connective tissue under the urothelium that contains lymphatic and blood vessels. A tumor that invades this layer is considered stage T1. If the tumor extends into the next layer, the bladder muscle, it is a stage T2. Just outside the bladder is a layer of fat (adipose tissue). A tumor that extends into this layer is a stage T3. If the cancer extends to adjacent organs, such as the prostate, rectum or vagina, it is a stage T4 tumor.

At �ձ�avɫ��Ƭ, bladder cancer diagnosis and staging are completed by one of our specially trained genitourinary pathologists in partnership with our imaging (radiology) experts. These highly trained experts are dedicated to diagnosing and understanding the causes of cancers within the urinary and genital organs. Our next-generation mutation sequencing platforms and special magnetic resonance imaging (MRI) algorithms allow a non-invasive way for us to learn as much as possible about each patient’s individual tumor and its biology, and ensure a personalized treatment program. By analyzing the cancer and leveraging our multidisciplinary expertise and sophisticated technologies, we are able to make precise and informed treatment decisions.

Bladder Cancer Locations 

Bladder cancer is an umbrella category that encompasses cancers that originate in different places along the urinary tract. 

Ureter Cancer

Cancer of the ureter (also called ureteral cancer) is a type of bladder cancer that begins in the lining of the ureters (tubes) that connect your kidneys to your bladder. This type of cancer is relatively rare but is more common in older adults and others who have previously been treated for bladder cancer.

Urethral Cancer

Urethral cancer involves the tube that carries urine from the bladder to be excreted. Women are more likely to develop this rare form of cancer, which can spread throughout the reproductive system to other organs.

Renal Pelvis Cancer

The renal pelvis is the top part of the ureter, located inside the kidney, where urine is collected and held until it moves through the ureters to the bladder. Cancer in the renal pelvis is relatively rare, and care plans for this cancer type are developed jointly by our experts in bladder and kidney cancer treatment.  

Bladder Cancer Types

There are a variety of different bladder cancer sub-types, and the cellular makeup of a patient’s bladder cancer frequently plays an important role in treatment.

Urothelial or Transitional Cell Carcinomas

The vast majority of bladder cancers are transitional cell carcinomas, also called urothelial carcinomas. These cancers begin in the transitional (urothelial) cells that line the inside of the bladder, ureter, urethra and renal pelvis. When a transitional cell carcinoma occurs in the renal pelvis, it is called Upper Tract Urothelial Carcinoma (UTUC). 

Squamous Cell Carcinoma

Squamous cells can become cancerous as a result of chronic irritation or infection of the urinary system. While squamous cell carcinoma is rare compared to transitional cell carcinoma, it tends to be more invasive.

Bladder Adenocarcinoma

When gland-forming cells within the bladder become cancerous, they are called adenocarcinomas. Adenocarcinomas of the bladder are rare. This type of cancer is typically invasive.

Neuroendocrine or Small Cell Carcinoma

Bladder cancers that originate in the neuroendocrine (nerve-like) cells are called small cell carcinomas. Small cell carcinomas in the bladder, though rare, tend to grow quickly.

Bladder Sarcoma

Cancer that originates in the body’s soft-tissue cells is called sarcoma. A sarcoma of the bladder originates in the bladder’s muscle cells. Bladder sarcoma is relatively rare.

Plasmacytoid Bladder Cancer

Plasmacytoid cancer is an uncommon type of bladder cancer. It is more aggressive than other types and often tends to present at more advanced stages.

Rare Bladder Cancers

Our multidisciplinary team also has experience and expertise treating other rare bladder cancer sub-types. These include:

• Clear cell
• Inverted papilloma-like
• Lipoid cell
• Lymphoepithelioma-like
• Microcystic
• Micropapillary
• Nested
• Sarcomatoid

Bladder Cancer Invasiveness

In addition to identifying bladder cancer based on the location at which the cancer develops and the type of cells involved, our physicians also evaluate how advanced the bladder cancer is, or its level of invasiveness. All of these variables inform treatment decisions to ensure that our patients receive the best possible care for their unique diagnosis.

Non-invasive, Superficial or Non-Muscle-Invasive

In most cases (70 percent), bladder cancer starts in the bladder’s innermost lining, called the transitional epithelium or urothelium. It starts as a thin, superficial layer of transitional (urothelial) cells that have not invaded the bladder’s other layers or muscle.

Locally Advanced, Invasive or Muscle-Invasive

Over time, bladder cancer may grow through the bladder’s layers, then into the muscle. At this point, the cancer is considered locally advanced and invasive, meaning it has spread beyond where it began. 

Metastatic Cancer

In more advanced stages, the cancer may grow outside the bladder and into nearby organs and other tissues. The cancer may initially spread to lymph nodes located nearby the bladder. Eventually, bladder cancer can spread to more distant lymph nodes, other organs and bones.