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Bladder cancer isn’t a single disease — it comes in different types, each with its own characteristics. Understanding the type of bladder cancer you or a loved one has is essential for making informed decisions about treatment options and planning care.
In this article, we’ll walk you through the main types of bladder cancer and discuss common symptoms and treatments. We’ll start by explaining the difference between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), and we’ll also cover metastatic bladder cancer. Being aware of these distinctions can help you work with your doctor to choose the best treatment plan.
Located in the pelvic cavity, the bladder is the organ that stores urine. When cells in the bladder’s inner lining or muscle grow out of control, tumors can form, leading to bladder cancer. Bladder cancer is divided into two categories: non-muscle-invasive and muscle-invasive. These classifications are based on how deeply the cancer has grown into the bladder wall.
About 75 percent of bladder cancers are non-muscle-invasive. Sometimes, NMIBC is referred to as superficial bladder cancer. These cancers affect the inner lining of the bladder and haven’t spread to deeper muscle layers.
Non-muscle-invasive bladder cancers typically appear in two main forms: flat and papillary. Flat tumors are also called carcinoma in situ. They grow as thin lesions (solid, raised areas of damaged tissue) on the bladder lining. These tumors are often high-grade, meaning the cancer cells look more abnormal under a microscope and are more likely to spread if left untreated. They also tend to be more aggressive than papillary tumors.
Papillary tumors grow into the bladder cavity, forming fingerlike projections. These tumors are usually low-grade, meaning they are less aggressive and grow more slowly. Compared to flat tumors, papillary tumors are less likely to spread to other parts of the body. Doctors can usually spot papillary tumors more easily during a bladder exam with a special camera or scope.
NMIBC is usually treated with surgery first to remove the tumor. If surgery doesn’t fully get rid of the cancer, treatments such as chemotherapy and immunotherapy may be added. NMIBC is easier to treat than more advanced bladder cancer but often recurs (comes back).
MIBC is more serious than NMIBC because it grows into the muscle layer of the bladder wall and is more likely to spread to other parts of the body. About 25 percent of people with bladder cancer are diagnosed with MIBC.
Treatment for MIBC often involves multiple approaches. Surgery, which may include removing part or all of the bladder, is usually the primary treatment. Chemotherapy and radiation therapy are often used either before surgery to shrink the tumor or afterward to lower the risk of recurrence. Immunotherapy may also be part of the treatment plan.
The following are the four main types of bladder cancer, classified by the type of cells where the cancer begins and sometimes by how the cells look under a microscope.
Urothelial carcinoma (transitional cell carcinoma) is the most common type of bladder cancer, accounting for about 90 percent of cases in industrialized countries, including the United States. This type of cancer starts in the urothelial cells, which line the bladder. Symptoms of urothelial cancer include:
Treatment for urothelial cancer depends on whether muscle is involved. For NMIBC types, treatment often includes transurethral resection of the bladder tumor (TURBT). In this procedure, the tumor is removed through a cystoscope — a thin tube inserted through the urethra. Doctors may also use intravesical therapy, in which medication is delivered directly into the bladder to kill cancer cells.
Treating MIBC often includes a mix of surgery, chemotherapy, radiation therapy, and immunotherapy, depending on how advanced the cancer is. When choosing the best treatment plan, doctors also consider other factors, such as comorbidities (co-occurring conditions) and the person’s overall health.
Symptoms of bladder cancer, like blood in urine or pain when urinating, can be similar to those of less serious conditions, such as a urinary tract infection (UTI). If you develop these kinds of symptoms and they don’t go away, talk to your doctor immediately. Early diagnosis can make a big difference in treatment success.
Squamous cell carcinoma accounts for 3 percent to 5 percent of bladder cancers in the U.S. This type develops in the bladder’s thin, flat squamous cells, often because of ongoing irritation or inflammation. Chronic UTIs, bladder stones, or long-term catheter use can increase the risk.
Symptoms of squamous cell carcinoma are similar to urothelial cell carcinoma, with blood in the urine being the most common sign. Bladder pain or discomfort is also common.
Treatment for squamous cell carcinoma is similar to that of MIBC urothelial carcinoma and usually involves removing the bladder entirely (radical cystectomy). Reconstructive surgery may be done to create a new way for urine to leave the body. Radiation therapy may also be used after surgery to destroy remaining cancer cells or when surgery isn’t an option. In advanced cases, a combination of surgery, chemotherapy, radiation, and immunotherapy can be used to improve outcomes.
Adenocarcinomas are rare, making up about 1 percent to 2 percent of bladder cancers. This type develops in the bladder’s mucus-producing glandular cells. Similar to squamous cell carcinomas, adenocarcinomas are often linked to risk factors like chronic inflammation or irritation.
Symptoms of adenocarcinoma are similar to those of urothelial and squamous cell carcinoma and may include:
Early diagnosis is crucial because untreated adenocarcinoma tends to spread to nearby organs. Treatment usually involves radical cystectomy, possibly with lymph node removal, depending on how far the cancer has spread. In advanced stages, chemotherapy, radiation therapy, and immunotherapy may also be prescribed.
Small cell carcinoma is a rare but aggressive type of bladder cancer. It begins in neuroendocrine cells, which are part of the body’s hormone-regulating system. This type of cancer grows quickly and is more likely to spread to other parts of the body. Symptoms include:
Chemotherapy is typically the main treatment for small cell carcinoma because this type of cancer responds well to chemotherapy drugs. In some cases, a combination of surgery, chemotherapy, and radiation may be used to help control the cancer and prevent it from spreading. Immunotherapy might also be an option for some people.
Metastatic bladder cancer refers to cancer that has spread from the bladder to other parts of the body, such as the lymph nodes, lungs, liver, or bones. This isn’t a specific type of cancer but rather an advanced stage of the disease. Signs and symptoms of localized cancer (confined to the bladder) often occur with metastatic bladder cancer, too. Additional symptoms that may suggest the cancer has spread include:
Treatment for metastatic bladder cancer may include systemic chemotherapy, which targets cancer throughout the body. Immunotherapy drugs may also be given to boost the immune system’s ability to fight cancer. In advanced cases, treatment focuses on relieving symptoms and improving quality of life.
Bladder cancer can appear in many forms, and symptoms and treatment options vary depending on the type and stage. Recognizing symptoms early — such as blood in the urine, frequent urination, or pelvic pain — can lead to a faster cancer diagnosis and improved outcomes.
If you or a loved one is living with bladder cancer, working closely with your health care team to understand your specific type is key to finding the most effective treatment plan. Becoming informed about your condition is the first step toward taking control of your health.
MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.
Are you or a loved one living with bladder cancer? Which type was diagnosed? Share your thoughts in the comments below, or start a conversation by posting on your Activities page.
Alfredo Chua, M.D.
received his medical degree from the University of the Philippines Manila.
Learn more about him here.
Zoe Owrutsky, Ph.D.
earned her Bachelor of Science from the University of Pittsburgh in 2014 and her Ph.D. in neuroscience from the University of Colorado Anschutz Medical Campus in 2023.
Learn more about her here.
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