Signs and Symptoms of Bladder Cancer

Hematuria is the most common first sign of bladder cancer

Human bladder cancer
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The most common first sign of bladder cancer is blood in the urine, although a variety of other problems with urination may also serve as signals. Regardless, it's important to understand that the early signs and symptoms of bladder cancer are often intermittent and not severe.

While it is good to gain knowledge about the symptoms of bladder cancer, do not wait for them to worsen—see your doctor for a proper diagnosis.

Early detection is key to curing bladder cancer.

Blood in the Urine

Blood in the urine—or hematuria—in bladder cancer is usually painless, visible, and comes and goes. In fact, the blood can be present and then disappear, only to reappear days or weeks later. In bladder cancer, the blood is typically present throughout the urination process—a subtle clue, but not a hard and fast rule.

Sometimes blood in the urine is not visible to the naked eye. Rather, it is picked up microscopically, usually on a urine sample that was taken for another purpose in a doctor's office. According to American Family Physicianabout 20 percent of people with gross or visible blood in the urine have bladder cancer, while bladder cancer is present in about 2 percent of people with microscopic blood in the urine.

It is important to understand that having blood in your urine does not necessarily mean you have bladder cancer.

In fact, a decent percentage (about 9 to 18 percent) of healthy people have some blood in their urine, and for most, the cause is not cancer even if blood is found.

Regardless, it is important to see your doctor and/or a specialist (called a urologist) if you have blood in your urine. While it could be nothing, it could also be a sign of an infection, a stone, kidney disease, or a cancer of the urinary tract system (for example, the bladder, prostate, or kidney).

Early detection and treatment is key to surviving bladder cancer, so do not wait.

Irritative Symptoms When Urinating

One or more of these symptoms occur in about 30 percent of people with bladder cancer and include:

  • Burning, pain, or discomfort when you urinate
  • Having to urinate more frequently than usual, during the daytime and/or at night
  • Having an urge to urinate even when the bladder is not full
  • Losing urine involuntarily—this is called incontinence

Of course, these symptoms could be from other medical problems like a urinary tract infection or an enlarged prostate in men. Regardless, get it checked out, for both a proper diagnosis and treatment plan.

Obstructive Symptoms When Urinating

If you feel like something is blocking your urine flow, it is also important to see your doctor. Again, like irritative symptoms, this may be due to something else (like prostate enlargement), but get it evaluated for a proper diagnosis. In general, obstructive symptoms are less common than irritative symptoms in bladder cancer.

Examples of obstructive symptoms include:

  • Experiencing hesitancy when urinating, like having trouble getting the urine released or noticing a weak and/or intermittent stream of urine
  • Feeling like you cannot get all the urine out of your bladder
  • Straining to urinate
  • Flank pain (pain in the side or mid back area) may occur if the tumor is blocking a ureter—one of two tubes in the body that transports urine from the kidney to the bladder

Signs or Symptoms of Advanced Bladder Cancer

If your bladder cancer has spread to other parts of your body through a process called metastasis, you may have symptoms or signs of advanced disease. These included generalized symptoms like unusual fatigue, loss of appetite, weakness, and unintended weight loss.

Pain too can be an indication that the tumor has spread, especially pain in the flank area or the area above your pubic bone.

Pain in the perineum (which is the area between the vagina and the anus or the penis and the anus) may also occur in bladder cancer that has reached nearby tissues.

Depending on where bladder cancer has spread, you may develop symptoms or signs specific to that area. For instance, bladder cancer that has spread to the lung may cause someone to cough, have trouble breathing, or even cough up blood. Bladder cancer that has spread to the kidney may cause kidney functioning problems, which can lead to swelling in the legs or feet. Bone pain may develop if a person's cancer has spread to the bones, and abdominal pain may occur if it has spread to the liver or lymph nodes in the stomach.

Clues on a Physical Examination

Sometimes, a person has no symptoms of bladder cancer, but a doctor detects an abnormality on a routine physical examination or a physical examination that was performed for another medical purpose.

For example, during an abdominal examination, enlarged lymph nodes or an enlarged liver could be a sign of cancer (a number of cancers, in fact, not just bladder). In advanced cases of bladder cancer, a mass in the pelvis may be felt. An abnormal feeling prostate gland may also occur if the bladder cancer has spread to the prostate.

This all being said, in most instances, the physical examination of a person with bladder cancer is normal and is only going to be abnormal in advanced cases. Usually, it is symptoms like blood in the urine or irritating symptoms when urinating that bring a person to the doctor.

Can Your Doctor Check for Bladder Cancer If You Have No Symptoms?

A screening test is used to find cancer before it causes any signs or symptoms. A classic example of a screening test is a mammogram, which is used to detect breast cancer before a lump is felt.

You may be surprised to learn that there is currently no standard screening test for bladder cancer. That being said, a doctor may choose to screen a person who is at a very high risk of developing bladder cancer (for example, someone who has had a prolonged chemical exposure or someone with certain birth defects of the bladder).

As of now, this is a decision made on a case by case basis and is not very common. In other words, there are no standard guidelines for when or how to screen a person for bladder cancer. This may change, though, as research on bladder cancer screening and detection evolves.

It is also important to remember that screening is different from surveillance—the latter meaning that a person has been diagnosed with bladder cancer in the past and is now being monitored. Surveillance and screening tests for bladder cancer usually include:

  • a cystoscopy: a procedure in which a doctor inserts a thin, tube-like instrument with a light and camera on it into your bladder through your urethra, so any abnormalities can be visualized.
  • urine cytology: a urine test that allows a doctor to visualize any abnormal (cancerous) cells in the urine through a microscope.

Sources:

American Cancer Society. (May 2016). Signs and Symptoms of Bladder Cancer.

Hall MC et al. Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urol. 2007 Dec;178(6):2314-30.

Lotan, Y. (November 2016). Clinical presentation, diagnosis, and staging of bladder cancer. In: UpToDate, Lerner SP (Ed), UpToDate, Waltham, MA.

National Cancer Institute. (August 2016). Screening for Bladder and Other Urothelial Cancers.

Sharma S, Ksheersagar P, Sharma P. Diagnosis and treatment of bladder cancer. Am Fam Physician. 2009 Oct 1;80(7):717-23.

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