Bladder cancer is cancer that starts in the bladder. Superficial bladder cancer means it started in the lining of the bladder and hasn’t spread beyond it. Another name for it is non-muscle-invasive bladder cancer.

About 75 percent of new cases of bladder cancer are superficial, making it the most common type of bladder cancer.

Read on to learn more about the different types of superficial bladder cancer, how it’s diagnosed, and what you can expect of treatment.

The most obvious sign of bladder cancer is blood in your urine. Many other conditions can also cause blood in the urine.

In some cases, there may be such a small amount of blood that you don’t even notice it. In those cases, your doctor may discover the blood during a routine urine test. Other times, it’s enough blood that you can’t miss it. Blood in your urine can come and go for weeks or even months.

Here are some other symptoms of superficial bladder cancer:

  • frequent urination
  • feeling as though you need to urinate even when your bladder isn’t full
  • pain or burning sensation when you urinate
  • weak urination stream or difficulty urinating

It can be easy to mistake these symptoms for symptoms of urinary tract infection (UTI). UTIs can be diagnosed with a simple urine test. It’s always a good idea to see your doctor if you think you have a UTI so they can rule out other conditions.

There are 70,000 new cases of bladder cancer each year in the United States. The male-to-female incidence ratio is about 3 to 1. Your chances of developing bladder cancer increase with age.

The most common risk factor is smoking, which accounts for at least half of all new cases. Other risk factors include:

  • abuse of phenacetin, an analgesic
  • long-term use of cyclophosphamide (Cytoxan, Neosar), a chemotherapy drug and immune suppressant
  • chronic irritation due to a parasitic disease called schistosomiasis
  • chronic irritation from long-term catheterization
  • exposure to certain industrial chemicals used in the dye, rubber, electric, cable, paint, and textile industries

The road to diagnosis usually involves a number of tests, which may include:

  • Urine test (urine cytology): A pathologist will examine a sample of your urine under a microscope to look for cancer cells.
  • CT urogram: This is an imaging test that provides a detailed view of your urinary tract to check for signs of cancer. During the procedure, a contrast dye will be injected into a vein in your hand. X-ray images will be taken as the dye reaches your kidneys, ureters, and bladder.
  • Retrograde pyelogram: For this test, your doctor will insert a catheter through the urethra into your bladder. After contrast dye is injected, X-ray images can be taken.
  • Cystoscopy: In this procedure, the doctor inserts a narrow tube called a cystoscope through your urethra into your bladder. The tube has a lens so your doctor can examine the inside of your urethra and bladder for abnormalities.
  • Biopsy: Your doctor can take a tissue sample during a cystoscopy (transurethral resection of bladder tumor, or TURBT). The sample will then be sent to a pathologist for examination under a microscope.

If the biopsy confirms bladder cancer, other imaging tests may be used to determine if the cancer has spread. These may include:

If the cancer hasn’t spread outside the lining of the bladder, the diagnosis is superficial, or stage 0 bladder cancer.

Next, the tumor is assigned a grade. Low-grade, or well-differentiated tumors, are similar in appearance to normal cells. They tend to grow and spread slowly.

High-grade, or poorly differentiated tumors, bear little resemblance to normal cells. They are generally much more aggressive.

What are the different types of bladder cancer?

Bladder cancer is divided into two subtypes:

  • papillary carcinoma
  • flat carcinoma

The subtypes have to do with how the tumors grow.

Papillary carcinomas grow in thin, finger-like projections, usually toward the center of the bladder. This is called noninvasive papillary cancer. A slow-growing, noninvasive papillary cancer may be referred to as PUNLMP, or papillary urothelial neoplasm of low-malignant potential.

Flat carcinomas don’t grow toward the center of the bladder, but remain in the inner layer of bladder cells. This type is also called flat carcinoma in situ (CIS) or noninvasive flat carcinoma.

If either type grows deeper into the bladder, it’s called transitional cell carcinoma.

Over 90 percent of bladder cancers are transitional cell carcinomas, also known as urothelial carcinoma. These are cancers that start in urothelial cells that line the inside of your bladder. The same type of cells can be found in your urinary tract. That’s why your doctor will examine your urinary tract for tumors.

Less common types are:

  • squamous cell carcinoma
  • adenocarcinoma
  • small cell carcinoma
  • sarcoma

Superficial bladder cancer means that there is cancer inside the lining of the bladder, but it’s early stage cancer that hasn’t spread outside the lining.

The main treatment for superficial bladder cancer is TURBT or TUR (transurethral resection), which is used to remove the entire tumor. That may be all you need at this time.

The tumor grade will help determine if you need further treatment.

In some cases, you may need chemotherapy. This can involve a single dose, usually mitomycin, administered soon after surgery, or weekly chemo that begins a few weeks later.

Intravesical chemotherapy is administered directly into the bladder through a catheter. Because it’s not given intravenously and doesn’t go through your bloodstream, it spares the rest of your body from the harsh effects of chemotherapy.

If you have a high-grade tumor, your doctor may recommend intravesical bacille Calmette-Guerin (BCG), a type of immunotherapy given after surgery.

Superficial bladder cancer can recur, so you’ll need careful monitoring. Your doctor will probably recommend a cystoscopy every three to six months for several years.

Treatment and follow-up testing for superficial bladder cancer is generally successful.

If you have noninvasive papillary bladder cancer, your outlook is excellent. Although it may come back and require further treatment, these recurrences are rarely life-threatening.

Flat carcinomas are more likely to recur and become invasive.

Overall, the five-year survival rate for noninvasive bladder cancer is about 93 percent.