Signs and Symptoms of Bladder Cancer

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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 the disease.

bladder cancer symptoms
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Frequent Symptoms

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.

Blood in the Urine

Blood in the urine, or hematuria, in bladder cancer is usually painless, visible, and comes and goes. In fact, blood can be present and then disappear only to reappear days or weeks later.

In bladder cancer, blood is typically present throughout the urination process. This is a subtle clue that something may be wrong, but not a hard and fast rule.

However, 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 visible blood in the urine have bladder cancer and about 2 percent of people with microscopic blood in the urine have bladder cancer.

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.

Regardless, it is important to see your doctor and/or 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 (bladder, prostate, or kidney). Again, early detection is vital.

Irritation When Urinating

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

  • 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 (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.

Obstruction 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 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)

Rare Symptoms

If your bladder cancer has spread to other parts of your body—referred to as metastasis—you may have symptoms of advanced disease. These include generalized symptoms like:

  • Unusual fatigue
  • Loss of appetite
  • Weakness
  • 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 (the area between the vagina/penis and the anus) may also occur with bladder cancer that has reached nearby tissues.

And, depending on where the bladder cancer has spread, you may develop symptoms specific to that area. For instance:

  • Bladder cancer that has spread to the lungs may cause someone to cough, have trouble breathing, or even cough up blood.
  • Bladder cancer that has spread to the kidneys 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.
  • Abdominal pain may occur if the cancer has spread to the liver or lymph nodes in the stomach.

Complications

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

For example, during an abdominal exam, 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. Also, an abnormal feeling prostate gland may occur if the bladder cancer has spread to the prostate.

When to See a Doctor

In most instances, the physical exam 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 irritation when urinating that bring a person to the doctor.

After discussing such symptoms with your physician, he/she will use a screening test to identify cancer before it causes any real 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. This could include someone who has had a prolonged chemical exposure or someone with certain birth defects of the bladder.

It is also important to remember that screening is different from surveillance. Surveillance means that a person has already been diagnosed with bladder cancer and is now being monitored.

As of now, the decision to screen for bladder cancer is 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. However, research on bladder cancer screening and detection is evolving.

Causes and Risk Factors of Bladder Cancer
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