Home › Topics › Bladder Cancer

Bladder Cancer

GMJ News knowledge hub · last reviewed August 2026 · Georgian Medical Journal

SummaryStatisticsGlossaryGMJ newsFAQDocumentsOrganizationsResearch

Bladder cancer — predominantly urothelial carcinoma of the urinary bladder — caused 573,278 new cases and 212,536 deaths in 2020, making it the 10th most common cancer globally and the most common urological cancer (IARC GLOBOCAN 2020). Cigarette smoking — causing approximately 50-65% of bladder cancers — is the most important risk factor globally, while Schistosoma haematobium causes a distinct squamous cell carcinoma subtype in Africa. Intravesical BCG immunotherapy is one of the oldest and most effective oncological immunotherapies, remaining standard of care for high-risk non-muscle-invasive bladder cancer. Pembrolizumab is now approved for BCG-unresponsive carcinoma in situ.

Key messages

573K cases — most common urological cancer
Bladder cancer caused 573,278 new cases and 212,536 deaths in 2020 — the 10th most common cancer and most common urological cancer globally, with significantly higher incidence in men (3-4:1 male predominance) (IARC GLOBOCAN 2020).
Smoking — 50-65% of cases
Cigarette smoking is the most important risk factor for bladder cancer globally — causing approximately 50-65% of cases through exposure of the urothelium to carcinogenic tobacco metabolites excreted in urine. Smoking cessation substantially reduces risk.
75% are non-muscle-invasive
75% of bladder cancers are non-muscle-invasive (NMIBC) at diagnosis — treatable with endoscopic resection (TURBT) ± intravesical BCG immunotherapy. 25% are muscle-invasive (MIBC) — requiring radical cystectomy or bladder-sparing trimodal therapy.
BCG — the oldest oncological immunotherapy
Intravesical BCG instillation after TURBT for high-risk NMIBC is one of the most impactful and cost-effective cancer immunotherapies ever developed — significantly reducing recurrence and progression. BCG shortage has been a global patient safety crisis.
Schistosomiasis causes SCC
In Africa, Schistosoma haematobium infection causes squamous cell carcinoma of the bladder — distinct from transitional cell carcinoma — occurring at a younger age and with worse prognosis. Up to 30% of bladder cancers in some African countries are attributable to schistosomiasis.
Immunotherapy for advanced bladder cancer
Checkpoint inhibitors (pembrolizumab, atezolizumab, avelumab) are approved for advanced/metastatic urothelial carcinoma — first-line in platinum-ineligible patients, and for maintenance after platinum response. Enfortumab vedotin + pembrolizumab is now the new first-line standard.

Key statistics

573K
new bladder cancer cases/year (2020)
IARC GLOBOCAN
213K
bladder cancer deaths/year (2020)
IARC GLOBOCAN
3-4:1
male to female incidence ratio
IARC
50-65%
of cases attributable to smoking
IARC
75%
are non-muscle-invasive at diagnosis
EAU/ASCO
30%
of bladder cancers in Africa from schistosomiasis (some settings)
IARC/WHO

Bladder cancer age-standardised incidence (per 100,000) by region — GLOBOCAN 2020

Source: IARC GLOBOCAN 2020. Southern Europe and Western Asia have highest rates.

Glossary of key terms

TURBT
EAU/AUATransurethral resection of bladder tumour — the standard initial treatment for NMIBC. Cystoscopy with resection of the tumour(s) through the urethra. Bimanual examination under anaesthesia assesses whether tumour has invaded the muscle wall (stage T2+). Followed by immediate single-dose intravesical chemotherapy (mitomycin C) to reduce implantation of tumour cells.
Intravesical BCG
EAU/WHOBCG (Bacillus Calmette-Guérin) instilled directly into the bladder through a catheter after TURBT — the standard treatment for high-risk NMIBC (high-grade, carcinoma in situ, large or multifocal tumours). Activates local immune response against cancer cells. One of the oldest and most effective cancer immunotherapies. WHO Essential Medicine.
NMIBC and MIBC
EAUNon-muscle-invasive bladder cancer (NMIBC — stages Ta, T1, carcinoma in situ): does not invade the detrusor muscle — manageable with endoscopic resection ± BCG; curable in most cases but high recurrence rate (50-70%). Muscle-invasive bladder cancer (MIBC — stage T2+): invades the detrusor — requires radical cystectomy or bladder-sparing trimodal therapy (TURBT + chemoradiation); much worse prognosis.
Radical cystectomy
EAUSurgical removal of the entire bladder — the standard of care for MIBC. Requires urinary diversion (ileal conduit, neobladder). Associated with significant morbidity. Neoadjuvant cisplatin-based chemotherapy (before cystectomy) improves survival by approximately 5-8% and is recommended for cisplatin-eligible MIBC patients.
Enfortumab vedotin + pembrolizumab
FDA 2024/EAUA combination of an antibody-drug conjugate (EV — targeting Nectin-4) and a checkpoint inhibitor (pembrolizumab) — approved as the new first-line standard for advanced/metastatic urothelial carcinoma (EV-302/KEYNOTE-A39 trial — significantly superior to platinum chemotherapy in OS and PFS). Represents a paradigm shift in advanced bladder cancer.
Haematuria workup
WHO/EAUHaematuria (blood in urine) — either macroscopic (visible) or microscopic — is the most common presenting symptom of bladder cancer (in approximately 85% of cases) and requires urgent investigation. Macroscopic haematuria in adults ≥35 should trigger cystoscopy ± upper urinary tract imaging. A single episode is sufficient to warrant investigation.

Latest GMJ coverage

Combination Immunotherapy Shows Promise in Bladder Cancer Surgery: New NEJM Evidence
12/07/2026
NHS England Expands Precision Radiotherapy Access to Reduce Prostate Cancer Treatment Sessions from 20 to 5
25/06/2026

Frequently asked questions 12 Q&A — structured for Google featured snippets and AI discovery

Knowledge hub: guidelines, conventions and reports

Organizations working in migration and health

Related health topics

CancerTobaccoSchistosomiasis (SCC)Kidney/urological diseaseProstate cancerOccupational cancer

About this hub. Produced by the GMJ News Editorial Team as a public-good service. Every statistic is linked to its primary source. Documents are preserved in the GMJ Repository with full attribution. Georgian Medical Journal · Contact the editorial team
GMJ BriefsView all →
●From Emergency Response to Durable Policy: Three Actionable Lessons from the 2026 Migrant Health Review2 hours ago●400 Million Cases of Atopic Dermatitis: Nature Reviews Confirms Massive Global Burden2 hours ago●Announcement: The 20 Amino Acids: The Chemical Alphabet of Life and What Every Patient Should Know2 hours ago●What Healthcare Providers Need to Know About Sandwich Generation Caregivers5 minutes ago●New Data: Unstable Connectivity Amplifies Loneliness More Than No Internet at All5 minutes ago●Announcement: Magnesium deficiency linked to multiple chronic diseases: what clinicians need to know5 minutes ago●Ultra-Processed Foods Account for Majority of Calories in Latin American Retail2 hours ago●What Clinicians Must Know: Screening and Managing Immigration-Related Family Separation Trauma2 hours ago●Announcement: Vitamin C May Reverse Skin Aging at the Genetic Level, New Research Suggests2 hours ago●Three Clinical Advances in the UK's Updated Influenza Vaccine Framework4 hours ago