[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Bladder cancer [Conditions](https://durgical.com/en/conditions/) · [Pelvis](https://durgical.com/en/anatomy/region/pelvis/) # Bladder cancer Bladder cancer is a cancer of the bladder lining that usually shows as painless blood in the urine; it affects both sexes but is more common in men. Updated 2026-10-30 ## Structures involved Tap one to see what it is and open it in 3D. - [Urinary bladder](https://durgical.com/en/anatomy/urinary-bladder/) - [Trigone of bladder](https://durgical.com/en/anatomy/trigone-of-bladder/) - [Ureters](https://durgical.com/en/anatomy/ureter/) - [Urethra (female)](https://durgical.com/en/anatomy/female-urethra/) - [Obturator nodes](https://durgical.com/en/anatomy/obturator-nodes/) - [External iliac nodes](https://durgical.com/en/anatomy/external-iliac-nodes/) - [Internal iliac arteries](https://durgical.com/en/anatomy/internal-iliac-artery/) ## Microorganisms that cause it - [Schistosoma mansoni / S. haematobium / S. japonicum](https://durgical.com/en/microbiology/schistosoma-mansoni-s-haematobium-s-japonicum/) ## In histology - [Simple, stratified, pseudostratified and transitional epithelium](https://durgical.com/en/histology/simple-stratified-pseudostratified-and-transitional-epithelium/) - [Ureter, bladder and urethra: urothelium](https://durgical.com/en/histology/ureter-bladder-and-urethra-urothelium/) ## In embryology - [Urachal anomalies: patent urachus, cyst and sinus](https://durgical.com/en/embryology/urachal-anomalies-patent-urachus-cyst-and-sinus/) ## In the clinical exam - [Urinary symptoms: dysuria, frequency, oliguria and hematuria](https://durgical.com/en/clinical-exam/urinary-symptoms-dysuria-frequency-oliguria-and-hematuria/) ## Why it happens - [Dysplasia and carcinoma in situ](https://durgical.com/en/general-pathology/dysplasia-and-carcinoma-in-situ/) - [Chemical carcinogens: initiation, promotion and the table to know](https://durgical.com/en/general-pathology/chemical-carcinogens-initiation-promotion-and-the-table-to-know/) - [Tobacco: how smoking injures tissue](https://durgical.com/en/general-pathology/tobacco-how-smoking-injures-tissue/) - [Cytology: the Pap test, fine-needle aspiration and body fluids](https://durgical.com/en/general-pathology/cytology-the-pap-test-fine-needle-aspiration-and-body-fluids/) - [Metaplasia](https://durgical.com/en/general-pathology/metaplasia/) - [Air pollution and occupational exposures](https://durgical.com/en/general-pathology/air-pollution-and-occupational-exposures/) ## What it is A malignant tumour of the bladder lining, most often urothelial carcinoma, that typically presents with painless visible blood in the urine. It affects both sexes, although it is several times more common in men. ## Who gets it Mainly a disease of older adults and smokers, more frequent in men; women are often diagnosed later because haematuria is first blamed on infection. Smoking-attributable bladder cancer caused an estimated 1,742 deaths in Latin America and the Caribbean in 2023. Schistosomiasis-linked squamous carcinoma belongs to endemic areas outside the Americas. ## Causes - Tobacco smoking, the main known cause - Occupational aromatic amines and other chemicals (dye, rubber, leather, paint and metal industries) - Chronic bladder irritation: long-term catheters, stones, recurrent infection (squamous type) - Schistosoma haematobium infection in endemic regions (squamous type) - Previous pelvic radiotherapy or alkylating chemotherapy - Arsenic in drinking water ## Risk factors - Smoking, current or past - Age over about 55 - Male sex - Occupational chemical exposure - Previous pelvic radiation or cyclophosphamide treatment - Chronic catheterization or bladder inflammation - Family history ## Pathophysiology Carcinogens excreted in urine stay in contact with the urothelium and cause genetic damage. Most tumours grow as papillary lesions confined to the lining (non-muscle-invasive) and tend to recur; a smaller group, including carcinoma in situ, is high grade and can invade the detrusor muscle and spread to pelvic lymph nodes and distant organs. ## Classification - Histology: urothelial (transitional cell) carcinoma in most cases; squamous cell carcinoma; adenocarcinoma - Non-muscle-invasive: Ta (papillary), Tis (carcinoma in situ), T1 (into lamina propria) - Muscle-invasive: T2 and above - Low grade or high grade - TNM staging for nodes and metastases ## Symptoms and signs - Painless visible haematuria, often intermittent - Microscopic haematuria found on testing - Irritative symptoms: frequency, urgency, dysuria, especially with carcinoma in situ - Advanced disease: pelvic or flank pain, leg swelling, weight loss, bone pain ## Red flags - Any visible haematuria in an adult, even once, without a confirmed cause - Haematuria persisting after treated urinary infection - Clot retention - Flank pain with hydronephrosis - Weight loss, bone pain or anaemia ## Diagnosis **Clinical** History of haematuria, smoking and occupational exposure; examination including pelvic or rectal palpation; bimanual examination under anaesthesia at resection. **Tests** Urinalysis and culture to exclude infection; urine cytology; [kidney](https://durgical.com/en/anatomy/kidney/) function and blood count. Cystoscopy is the key test; transurethral resection of the tumour (TURBT) gives the histology, grade and depth. **Imaging** CT urography to assess the upper urinary tract; CT or MRI of the [abdomen](https://durgical.com/en/anatomy/region/abdomen/) and [pelvis](https://durgical.com/en/anatomy/region/pelvis/) and [chest](https://durgical.com/en/anatomy/region/chest/) imaging to stage muscle-invasive disease. ## Differential diagnosis - Urinary tract infection (haemorrhagic cystitis) - Kidney or bladder stones - Renal cell carcinoma or upper tract urothelial carcinoma - [Prostate](https://durgical.com/en/anatomy/prostate/) disease in men; gynaecological bleeding mistaken for haematuria in women - Radiation or drug-induced cystitis - Glomerular disease ## Goal of treatment Remove the tumour, reduce recurrence and progression in non-invasive disease, and cure or control muscle-invasive disease while preserving quality of life. ## Treatment **Surgical** Transurethral resection of bladder tumour (TURBT) for diagnosis and treatment, with repeat resection in selected high-risk tumours. **Procedure** Intravesical therapy after resection: a single instillation of chemotherapy for low-risk tumours, and courses of intravesical BCG immunotherapy for intermediate and high-risk disease. **Surgical** Radical cystectomy with pelvic lymph node dissection and urinary diversion (ileal conduit or neobladder) for muscle-invasive or BCG-unresponsive high-risk disease; in women it usually includes removal of the uterus and anterior [vagina](https://durgical.com/en/anatomy/vagina/). **Medical** Platinum-based neoadjuvant chemotherapy before cystectomy; systemic chemotherapy, immune checkpoint inhibitors or antibody–drug conjugates for advanced disease. **Procedure** Bladder-preserving trimodal therapy (maximal resection plus chemoradiotherapy) in selected patients. **Follow-up** Regular surveillance cystoscopy and urine cytology, as recurrence is common; imaging of the upper tract. **Lifestyle** Stopping smoking, which lowers the risk of recurrence. ## Drugs for this condition - [Cisplatin](https://durgical.com/en/pharmacology/cisplatin/) - [Doxorubicin](https://durgical.com/en/pharmacology/doxorubicin/) - [Mitomycin](https://durgical.com/en/pharmacology/mitomycin/) ## Complications - Recurrence and progression to invasive disease - Clot retention and anaemia - Ureteric obstruction and kidney failure - Metastases to lymph nodes, bone, lung and [liver](https://durgical.com/en/anatomy/liver/) - Treatment effects: BCG cystitis, stoma and diversion problems, sexual dysfunction ## Prognosis Non-muscle-invasive tumours have good survival but recur often and need long follow-up. Prognosis worsens with muscle invasion, nodal spread and metastases. ## Prevention - Not smoking, or stopping - Occupational protection from carcinogenic chemicals - Prompt evaluation of haematuria ## Test yourself Think of the answer, then tap the question to see it. ## What is the classic presentation of bladder cancer? Painless visible (gross) haematuria in an older adult, often a smoker. ## What is the most important risk factor for bladder cancer? Tobacco smoking; occupational aromatic amines are next. ## Which histological type is most common in bladder cancer? Urothelial (transitional cell) carcinoma; squamous cell carcinoma is linked to schistosomiasis and chronic irritation. ## What procedure both diagnoses and stages a bladder tumour? Transurethral resection of the bladder tumour (TURBT), which must include detrusor muscle to judge invasion. ## Which intravesical treatment reduces recurrence in high-risk non-muscle-invasive bladder cancer? Intravesical BCG immunotherapy after resection. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/bladder-cancer/) ## Related conditions - [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/) - [Kidney stones (urolithiasis)](https://durgical.com/en/conditions/kidney-stones/) - [Prostate cancer](https://durgical.com/en/conditions/prostate-cancer/) Educational information, not medical advice. For any symptom, see a health professional. Sources: [Bladder Cancer](https://www.ncbi.nlm.nih.gov/books/NBK536923/) (StatPearls (NCBI Bookshelf), 2024); [The burden of bladder cancer and kidney cancer attributable to smoking in Latin America and the Caribbean from 1990 to 2023 and projections to 2050](https://europepmc.org/article/PMC/PMC13576406) (Tobacco induced diseases, 2026) · adapted, [CC BY 4.0](https://creativecommons.org/licenses/by/4.0/). 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