Professor Rosalind Eeles, Consultant in Clinical Oncology and Oncogenetics at The Royal Marsden Private Care
The symptoms of bladder cancer are common in many other conditions, which is why you must see a medical professional to determine their likely cause.
What is bladder cancer?
Your bladder is a hollow muscular organ that holds your urine (pee).Bladder canceroccurs when the cells in the bladder grow uncontrollably. These abnormal, cancerous cells usually form a tumour in the bladder lining before spreading to other parts of the bladder.
We often diagnose this cancer early, as its first, most common symptom is quite noticeable: blood in the urine (haematuria). At an early stage, the cancer has not spread and is highly treatable. However, the cancer can come back – 75% of early-stage bladder cancers do – which is why follow-up testing is vital.
Symptoms
The first sign of bladder cancer is blood in the urine, which is painless for most people. In the early stages, this may be your only symptom, though some people don’t experience it. Other symptoms include changes in bladder habits, frequent urinary infections, and pelvic or back pain, which might be on one side.
Lower back pain on one side and pelvic pain are often signs the cancer has spread into the surrounding tissue.
Blood in the urine (haematuria)
Your doctor may use the terms macroscopic or visible haematuria, which simply means you can see it. If you need a urine test to find the blood, we call this microscopic haematuria, as there is a small amount of blood.
If you have visible haematuria, your urine may look pink, red, or brown/rusty. You may also notice streaks of blood in your urine.
However, bladder cancer is not the only cause of haematuria. Common causes include a urinary tract infection (UTI), kidney infection, kidney stones, and an enlarged prostate gland. Post-menopausal bleeding may also appear as blood in the urine.
Changes in bladder habits
If you have bladder cancer, you may find that your bladder habits change. It can cause the following symptoms:
- Urinating more often
- Feeling strong urges to urinate
- Incomplete emptying of the bladder
- Needing to go multiple times a night
- Burning sensation or pain when urinating
- Difficulty urinating or a weak urine stream
A more likely cause of these symptoms is a UTI, but it is important to get all your symptoms checked by a medical professional.
Advanced symptoms
As bladder cancer progresses, it spreads to other body parts. Your symptoms may differ depending on where the cancer has spread.
Advanced symptoms include:
- Unable to urinate
- Tiredness/fatigue
- Pain in your bones
- Feeling sick or unwell
- Swelling in the feet and legs
- Jaundice and lower abdominal pain
- Loss of appetite and unintentional weight loss
If cancer spreads to your lungs, you also may experience breathlessness or persistent coughing. Remember, experiencing these symptoms does not mean you have cancer. You will need diagnostic tests to determine the cause of your symptoms.
Diagnosis
We’ll begin by asking about your symptoms, family history, and lifestyle. By looking at your lifestyle, we can determine whether you’ve encountered potential causes of bladder cancer, such as smoking. During your initial consultation, we will also perform a physical examination. This allows us to feel for a lump.
Next, we may recommend a urine test to look for blood and cancer cells. We can also use a urine test to rule out or diagnose a UTI. A UTI diagnosis does not rule out cancer, but it may explain your symptoms if you do not have cancer. Your usual GP will likely have suggested a urine test already for this reason.
Further tests we may recommend include a cystoscopy to examine the inside of your bladder or a biopsy (small tissue sample) to look for cancer cells. We might also use imaging scans, such as CT, MRI or intravenous urogram.
If we find evidence of cancer, the next test would be a transurethral resection of a bladder tumour (TURBT). A TURBT allows us to take a biopsy of the tumour. We can also use it as a treatment method. You may have chemotherapy after this procedure.
After these tests, we can inform you of the stage, grade, and type of cancer - if we find evidence of cancer. From there, we can recommendthe most suitable treatment option.
Who is at risk?
While anyone could get bladder cancer, certain factors can mean your risk is higher. These include:
- Being over 55
- Arsenic exposure
- Previous radiotherapy
- Long-term bladder stones
- Male or designated male at birth
- Persistent UTIs or inflammations (cystitis)
- Exposure to certain chemicals, such as arylamines
Some genetic factors may also increase your risk. You might wish to speak to a genetic counsellor to help you identify your risk.Our Urology Unitleads nationally and internationally on genetic predisposition and targeted screening.Get in touchtoday to discover how we can help you.
