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4 Warning Signs That Could Mean Bladder Cancer

These symptoms often have other causes but should never be ignored

spinner image African American woman on a bed grabbing her flank in pain due to bladder cancer

Igor Vershinsky/Getty Images

The most common cancers in men in the United States are prostate, lung and colorectal cancers. But number four?

Many people are surprised to hear that it’s bladder cancer, says Bernard Bochner, a urologic surgeon at Memorial Sloan Kettering Cancer Center in New York City. “And it’s important in women as well,” he says. 

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According to the American Cancer Society, about 61,700 U.S. men and 19,480 women will be diagnosed with bladder cancer this year; 12,120 men and 4,980 women will die from it. Like lung cancer, bladder cancer is strongly linked to smoking, thought to cause about half of cases. Age is another major risk factor: Most cases happen after age 55 and the average age of diagnosis is 73, according to the American Cancer Society.

When caught in its earliest form, bladder cancer is highly treatable, with 96 percent of patients surviving five years, according to the National Cancer Institute. The survival rate for all stages combined is 77 percent.

Because there’s no recommended screening test for bladder cancer, catching it early means responding to warning signs and symptoms. Yet many people who show up in doctors’ offices with possible bladder cancer “have never heard of it,” says Yair Lotan, a professor of urology at University of Texas Southwestern Medical Center in Dallas.

Here are four possible warning signs you should never ignore:

1. Invisible blood in your urine

The urine sample you leave as part of a routine checkup or other medical visit is often checked for microscopic amounts of blood during a lab test called urinalysis. If even a few red blood cells are found, you should always find out the cause, Lotan says. Though there’s usually another explanation, these traces of blood can be the first signs of bladder cancer, he says.

Other possible causes include urinary tract infections, kidney or bladder stones and prostate problems. Women with blood in their urine often are assumed to have urinary tract infections, but that diagnosis should always be confirmed with a culture, a test that finds any bacteria growing in the urine, Bochner says. The assumption that women are unlikely to have bladder cancer is one reason women are diagnosed later and fare worse with the disease than men do, says Eugene Pietzak, also a urologic surgeon at Memorial Sloan Kettering.

2. Visible blood in your urine

The first sign of bladder cancer may be blood you see in your urine stream or in the toilet bowl. Usually, it’s pink or red and isn’t accompanied by any pain, Bochner says. “Most people otherwise feel perfectly fine … [so] people will sometimes think, Well, I may have strained myself or I did something that caused that,” he adds.

Often the blood doesn’t show up again for days or weeks. In the meantime, Bochner says, many people think “it must not be that important, because it went away.” Even visible blood usually has an explanation other than cancer, but you should always find out what that explanation is, Lotan says. Bochner’s advice: Call your doctor the first time you think you see blood.


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3. Problems with urination

While less common than blood in the urine, changes in urination patterns also can be early signs of bladder cancer. Those changes can include having to pee more often, waking up multiple times to pee at night, feeling like you have to pee even when you don’t or having a weak urine stream. If some of those symptoms sound familiar to many older people, it’s because they are common signs of other problems that become more frequent with age.

“Just because things are common doesn’t mean they are normal,” Lotan says. Such changes rarely signal cancer. The most common causes include infections, overactive bladder and, in men, prostate enlargement.

4. Pain

Most people with early bladder cancer feel no pain. But sometimes, the cancer can cause painful urination or flank pain, between the abdomen and lower back on one side. Painful urination is more likely to be due to an infection, and flank pain can have many different causes, from infection to arthritis to gallbladder disease. But such symptoms should always be checked out.

Some people with bladder cancer don’t notice symptoms until their cancer is more advanced. Advanced cancer can cause symptoms such as weight loss, loss of appetite, swollen feet and bone pain, according to the American Cancer Society.

What happens next?

If your symptoms don’t have other good explanations, your primary doctor may send you to a urologist, a doctor who specializes in urinary tract problems. You should expect your doctors to ask not only about your symptoms, but also about your medical and personal history. The workup you get may depend partly on how high your bladder cancer risk is, Lotan says.

Older adults and current or former smokers are at much higher risk than younger people or never-smokers. People exposed to certain cancer-causing chemicals in their work also have a heightened risk, the American Cancer Society says. They include people who have worked in the making of dyes, rubber, leather, textiles and paint. Hairdressers, who are exposed to dyes, and truck drivers, exposed to diesel fumes, also have a higher-than-usual risk.

(If you are wondering how cigarette smoke and other toxins cause bladder cancer, the answer, Bochner says, is exposure plus time: Your body concentrates toxins in urine, which then sits in your bladder long enough to cause harm.)

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To find or rule out bladder cancer, you may get several tests, including a CT scan, MRI scan or ultrasound and urine tests to look for abnormal cells that could be cancerous.

A more definitive test is a procedure called a cystoscopy, in which a doctor looks inside the bladder using a thin lighted tube passed through the urethra. If you have cancer, it’s often visible as a cauliflower-like growth or a flat red patch, Lotan says. The next step would be a biopsy and removal of the visible tumor, which is then examined in a lab. With that information, you and your medical team can start planning your treatment.

Treatment for bladder cancer

Options depend on how far the cancer has advanced. According to the American Cancer Society, about half of bladder cancers are found before they spread beyond the inner lining of the bladder. These are called in situ or noninvasive cancers. Another third have spread to deeper layers, but not beyond the bladder. In most remaining cases, the cancer has reached nearby tissues or lymph nodes, but not more distant sites.

Some people with early bladder cancer need just a few weeks of a chemotherapy drug, put directly into the bladder right after diagnosis — and studies suggest some patients may need just one dose, Pietzak says. Others will get more chemotherapy or treatments with a germ related to tuberculosis, called Bacillus Calmette-Guérin (BGC). BCG is put directly into the bladder and can stimulate the immune system to attack cancer cells. Radiation is also a possibility.

People with cancer that has invaded the bladder’s muscle wall may need to have all or part of their bladder removed. When that’s done, doctors have several ways to create an internal pouch to hold urine and allow drainage, Pietzak says. Or patients may get an external urine bag. The internal options are more likely to be offered at major medical centers, he says.

Newer, targeted drugs that work differently than traditional chemotherapy also show great promise for bladder cancer, Bochner says.​​

Preventing bladder cancer

Many cases of bladder cancer can be prevented.  To lower your risk:

  • Don’t smoke. If you do smoke, make a plan to quit. For free help, call federal Centers for Disease Control and Prevention at 800-QUIT-NOW (800-784-8669) or the American Cancer Society at 800-227-2345.
  • Limit workplace exposures. If you work around dyes, diesel fumes or other potentially hazardous substances, follow all safety rules.
  • Drink plenty of fluids. Research suggests it may protect your bladder.
  • Eat plenty of fruits and vegetables. Some, but not all, studies show they lower bladder cancer risks.

Source: American Cancer Society

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