Bladder cancer is the most common type of urinary tract cancer. It is estimated that 550,000 new cases are diagnosed each year worldwide.
Like many cancers, the earlier this cancer is detected and treated, the better the prognosis, so it’s important to recognize symptoms early.
The most common early symptom is blood in the urine (blood that can be detected by eye or microscope). Less commonly, symptoms of bladder irritation, such as burning, frequency, or urgency, may occur.
This article will look at early and advanced symptoms of bladder cancer, as well as important differences in how the disease affects both sexes, and when you should see your healthcare provider.
Early symptoms of bladder cancer
In the early stages of bladder cancer, most people have no symptoms. When early symptoms do appear, they can have many other potential causes that are more likely than bladder cancer. Early symptoms include:
blood in the urine (hematuria)
blood in the urine (hematuria) is the most common Early symptoms of bladder cancer. This blood in the urine occurs as a result of bleeding from a tumor, which is usually on the surface of the bladder and in direct contact with the urine. This can be:
- Macroscopic (macro-hematuria): Most often pink or orange. Unless a person is not urinating regularly, a brownish appearance that suggests old blood is uncommon. An estimated 20% of people with this condition are found to have bladder cancer.
- Visible only under the microscope (microscopic hematuria): This is defined as three or more red blood cells in each high-power field in at least two of three samples taken at different times under the microscope. Only 0.4% to 6.5% of people with this symptom will develop bladder cancer.
Hematuria may be visible or microscopic, or both. It may be continuous or it may come and go. It is usually painless but may be associated with discomfort.
Other causes of blood in the urine
Blood in the urine (hematuria) is common. Asymptomatic microscopic hematuria occurs in 1% to 18% of the population at any one time, but only 1.3% of patients with this symptom have bladder cancer. Other causes of hematuria include:
- Certain foods (such as beets, rhubarb, berries, aloe vera, and fava beans)
- some medicines (including pyridine (phenazopyridine), rifadine (rifampicin), certain blood thinners, laxatives. and chemotherapy drugs
- bladder and/or kidney infection
- Long-distance running (called “March hematuria”)
- kidney stones
- Polycystic kidney disease (causing fluid-filled sacs in the kidneys)
- Other bladder or kidney tumors (cancerous and benign)
- Women’s menstruation (period bleeding)
- benign prostatic hypertrophy in men (enlarged prostate)
Causes and diagnosis of hematuria or blood
Bladder irritability/abnormal urination
The manifestations of other symptoms can be subtle and vary from person to person, so it is important to compare with your normal condition. Symptoms of irritable bladder or abnormal urination may include:
- Painful urination (difficulty urinating): usually described as pain, burning, or just a problem
- Frequency: urinating more frequently than usual
- Urgency: The need to quickly run to the bathroom to pee
- Nocturia: The need to get up and urinate at night, which is especially common in men with an enlarged prostate.
- Urinary hesitancy (weak or slow flow): may feel like the flow of urine is slow (like a faucet that is turned on low), or in some cases, having to strain to urinate
- Difficulty urinating: may include problems starting to urinate, continuing to urinate after starting to urinate, or stopping urinating when needed
- Feeling of incomplete emptying: The feeling of needing to urinate after urinating
- Incontinence: involuntary urination
- Low back pain: usually occurs on only one side of the body
Other causes of bladder irritation
Symptoms that describe urination problems are more likely not to be bladder cancer and include:
- Urinary Tract Infection (UTI)
- Interstitial cystitis (recurrent pelvic pain caused by inflammation)
- Sexually Transmitted Diseases (STIs, such as herpes)
- ovarian cyst
- enlarged prostate
- Neurogenic bladder (lack of bladder control due to nerve damage to the bladder)
- polycystic kidney disease
- Endometriosis (a condition in which endometrial tissue grows outside the uterus)
- Pelvic inflammatory disease (infection of one of the reproductive organs)
- skin conditions, such as psoriasis or atrophic vaginitis (vaginal dryness due to menopause)
- Epididymitis (inflammation of the coiled tube at the back of the testicle)
Late symptoms of bladder cancer
Other symptoms are less common or may appear later in bladder cancer. Some of these symptoms may be due to bladder cancer spreading to other parts of the body, including:
- inability to urinate (complete obstruction)
- blood clots in the urine
- Pain in one side of the lower back or abdomen
- Perineal pain (pain between the penis and rectum or between the vagina and rectum)
- abdominal or pelvic mass
- swollen lymph nodes in the groin
- swelling of the feet or legs
- fatigue (cancer fatigue)
- loss of appetite
- Unintentional weight loss
- minimally traumatic bone pain or fracture (due to bone metastases)
- Nausea and vomiting, jaundice (yellowish skin), abdominal pain and itching (due to liver metastases)
- shortness of breath or chronic cough (due to lung metastases)
Bladder cancer in men and women
Bladder cancer is 3 to 4 times more common in people assigned male at birth than in those assigned female at birth.
The researchers believe that the increased prevalence of bladder cancer among men assigned at birth may be due to differences in the way carcinogens (carcinogens) are metabolized before passing through the bladder, where they can cause cell damage. Or it may be that male sex hormones (androgens) promote bladder tumor formation, while female sex hormones (estrogens) suppress this progression.
In contrast, those assigned female at birth tend to be diagnosed in later (less curable) stages of the disease, respond poorly to treatment, and have higher cancer-specific mortality rates, so for those who are It is especially important for those assigned as women to be aware of early symptoms at birth and seek prompt evaluation.
A study looking at the prevalence of early cancer symptoms in men and women concluded that:
- Visible hematuria (blood in the urine) was present in 65% of men and 68% of women.
- Dysuria (painful urination) was present in 32% of men and 44% of women.
- 61% of men and 47% of women have a sense of urgency.
- Nocturia (need to urinate in the middle of the night) was present in 57% of men and 66% of women.
Painful urination due to bladder infection or friction (from tight underwear, intercourse, etc.) is often overlooked and may be less likely to be investigated, especially in women. One study found that 47 percent of women with bladder cancer received symptomatic treatment a year before diagnosis without any further evaluation. A lower proportion of women compared to men also saw a urologist (bladder specialist).
Bladder Cancer Causes and Risk Factors
There are few complications in the early stages of bladder cancer. These may include:
- Bleeding: This is rarely serious or life-threatening.
- Inability to urinate: If the tumor is large enough and in certain locations, it may prevent urine from flowing out of the bladder. Urgent treatment is needed to prevent kidney damage. That said, unless you have a neurological condition that limits bladder sensation, bladder distention is often very painful and will alert you to the problem.
When to see a healthcare provider
There are currently no guidelines or recommendations for screening for people at risk for bladder cancer, including those with significant risk factors. Clinical trials are underway to determine whether screening can detect bladder cancer early in certain populations.
You should consult your healthcare provider if:
- You may notice any blood in your urine even if you are not sure about blood in your urine, especially if it is persistent, worsening, or accompanied by other symptoms.
- You have any symptoms of abnormal urination, whether it’s pain or burning, frequent urination, urgency, incontinence, difficulty starting or stopping urination, or just feeling like something has changed.
- You have any other symptoms that don’t feel right.
The most common early symptom of bladder cancer is blood in the urine. Blood is either visible to the naked eye or only visible under a microscope. Other common symptoms include painful urination, increased frequency or urgency to urinate, the need to urinate in the middle of the night, and pain on one side of the lower back. Bladder cancer is very treatable if caught early, so be sure to see your healthcare provider for evaluation if you notice any of these symptoms.
Finding bladder cancer at its earliest stages greatly increases the chances of a cure. Since there are currently no screening tests, the best way to do this is to know your risk factors (such as being male, smoking, occupational exposure to certain chemicals, or having certain genetic conditions) and learn from your symptoms if you have blood in your urine or painful urination symptoms, ask your healthcare provider for help.
The most important symptoms are anything that seems atypical or unusual to you. Listen to your body. And make sure you have a health care provider who listens to you. However, you know yourself better than any healthcare provider. So if your concerns are not taken seriously, get a second opinion. Be your own health advocate.
Frequently Asked Questions
Do bladder cancer symptoms come on suddenly?
They may. Bladder cancer symptoms can appear suddenly or develop over time. The most common presentation is painless blood in the urine.
What are the common warning signs of bladder cancer?
By far the most common warning sign of bladder cancer is blood in the urine (hematuria). This can be visible when a person urinates or only detected under a microscope. Less commonly, people may experience bladder irritation symptoms such as painful urination, frequent urination, urgency, or the need to urinate more frequently at night (nocturia).
Can early detection of bladder cancer symptoms save a person’s life?
Yes. The earlier bladder cancer is detected, the better the effect of treating the tumor or prolonging life. More than 50% of cases are captured “in situ” (at the precancerous stage). The survival rate for these patients after five years was 96 percent. The overall five-year survival rate for all stages of bladder cancer is 77%.
Why are men more likely to get bladder cancer?
One theory is that men’s livers may be less efficient at breaking down carcinogens (carcinogens), which means these compounds are more damaging when they reach the bladder.
Another theory is that male sex hormones (androgens) promote bladder tumor formation, while female sex hormones (estrogen) slow or stop this progression.