Bladder Cancer

Bladder cancer is cancer that begins in the bladder. The bladder is a hollow organ in the pelvis that stores urine before it leaves the body. The bladder wall is made of several layers. Most bladder cancers begin in a layer called the urothelium, which lines the inside of the ureter, bladder, urethra and parts of the kidneys. Cancer may also develop in other types of cells in the bladder.


Approximately 69,000 new cases of bladder cancer were diagnosed in the United States in 2011, and approximately 14,990 deaths were due to bladder cancer, according to the American Cancer Society. About half of all bladder cancers are diagnosed when they are still confined to the inner layers of the bladder. A diagnosis is almost always made before the cancer has spread to distant sites.


To understand bladder cancer, it can help to understand the anatomy of this region of the body. Urine is made by the kidneys and then transported to the bladder by tubes called ureters. In adults, the bladder can hold about two cups of urine, on average. During urination, fluid is pushed out of the bladder through the urethra. In women, the urethra is a fairly short tube; in men, the urethra is longer.


There Are Several Layers Of Cells In The Bladder:


Urothelium or Transitional Epithelium: This is the inner layer of tissue that lines the inside of the bladder, the ureter, the urethra and parts of the kidneys. Cells in this layer are called urothelial or transitional cells. As the bladder fills with urine, the transitional cells stretch to make space. When the bladder is emptied, the cells shrink.


Lamina Propria: A thin layer of connective tissue beneath the urothelium.


Muscularis Propria: A layer of muscle tissue underneath the lamina propria. This muscle helps squeeze urine out of the body when the bladder is emptied.


Outer Layer: Beneath these layers is fatty tissue that separates the bladder from other organs nearby. There are also blood vessels in this layer.


Transitional cell (urothelial) carcinoma (TCC) accounts for about 95 percent of bladder cancers. Cancer cells of this type look like the urothelial cells lining the inside of the bladder. There are two subtypes of TCC:


Papillary Carcinoma: This type of TCC grows out from the inner surface of the bladder toward the hollow center in fingerlike projections. Often, these tumors are called “noninvasive papillary cancers,” meaning they don’t grow into the deeper layers of the bladder wall. When papillary TCC is very low grade, it may be called “papillary neoplasm” of low-malignant potential, and typically has a very good outcome.


Flat Carcinomas: This type of TCC does not grow out of the urothelium toward the center of the bladder. Rather, flat carcinomas remain on the surface of the bladder wall. If a flat carcinoma is confined to the urothelium, it is called “noninvasive flat carcinoma” or “flat carcinoma in situ.”

Squamous cell carcinoma accounts for about 1 percent to 2 percent of bladder cancers diagnosed in the United States. Squamous cells look similar to the flat cells on the surface of the skin. Almost all squamous cell carcinomas of the bladder are invasive.


Adenocarcinoma of the bladder closely resembles the gland-forming cells seen in colon cancers, and accounts for about 1 percent of bladder cancers in the United States.

Small-cell carcinoma is extremely rare, accounting for fewer than 1 percent of all bladder cancers diagnosed in the United States. This type of bladder cancer begins in neuroendocrine cells, which are similar to nerves.


Sarcoma is another very rare type of bladder cancer that begins in the muscle layer of the bladder wall