Bladder Cancer Symptoms

Bladder Cancer Symptoms

This article describes typical symptoms that occur with bladder disease and emphasize those that may point to the presence of a bladder cancer. There are many diseases that can occur in the bladder and most are not cancer. Many bladder symptoms are not very specific in that they occur in both cancer and non-cancer conditions of the bladder. Fortunately, most bladder cancers cause some type of symptom or sign that gives clues to their presence. This gives the opportunity for early diagnosis and early treatment. The basic assumption with most cancers is that if they are caught early enough then they can likely be cured or minimized in some way. Therefore, being alert to possible red flag symptoms may facilitate an early diagnosis with bladder cancer.

Bladder cancer is the fourth most common cancer in the United States and occurs more commonly in men.  It is among the top ten most common causes of death from cancer in men.  Bladder cancer tends to occur in older persons with over 80% being found in people > 60 years old.  Bladder cancer is found more commonly in people of European descent.  These factors are important because if a 68 year old Caucasian male smoker develops the painless passage of bloody urine and some difficulty in emptying the bladder, this scenario would be very concerning for bladder cancer because he has so many risk factors.  Cigarette smoking is a common risk factor and greatly increases the risk of getting bladder cancer.

There are multiple risk factors for bladder cancer including also including:

  • Cigarette Smoking (most common risk factor)
  • Certain types of chemotherapy (e.g. cyclophosphamide)
  • Arsenic in well water
  • Many bouts of bladder stones
  • Multiple bladder infections over many years
  • Infection of the bladder with schistosomiasis
  • Certain occupational exposures to dyes such as aromatic amines

There are more than 20 different types of bladder tumors but the most common type of bladder cancer is transitional cell urothelial cancer. Not all growths of the bladder are cancer. Cancer is generally defined by invasion of cell layers and growth elsewhere. Some growths of cells do not invade and look like normal cells, just growing in an unusual way. These polyps can also cause bleeding and when large enough can block the flow of urine also.

The list of possible symptoms of bladder cancer is not as extensive as other cancers. Tumors of the bladder basically can do two things: they bleed into urine and can block the flow of urine. Either of these or some combination of these can be present. Bladder cancer has the potential to spread outside of the bladder and these can cause a whole separate set of problems.

  • Hematuria: Hematuria is also known as blood in the urine. Blood in the urine can occur in several forms. The blood may be microscopic and not appear bloody at all (i.e. microscopic hematuria). The urine may appear a little bloody or be bright red with blood. Both of these would be called gross hematuria. The most common and consistent sign of bladder cancer is painless hematuria. The absence of pain is important because there are many possible causes of hematuria and many of them involve some type of infection and not cancer. Generally bladder infections are associated with pain. This is why hematuria with or without pain in the bladder is so important to distinguish. Possible causes of hematuria include:
    • Infections: many possible types. Infections of the kidneys ureters, prostate or bladder can all cause some blood to appear in the urine.
    • Stones forming or found in the kidney, ureters, or bladder
    • Enlargement or inflammation of the prostate gland
    • Tumors, cancers or polyps of the bladder. (cancers of the kidney will also cause this)
    • There are at least 20 other possible causes but these are the most common ones.

Blood in the urine, especially when painless does not mean it is cancer but it must be evaluated.

  • Blockage: The other broad category of symptoms has to do with some type urinary obstructive symptom. This can involve either difficulty with starting urination, frequent urination, a feeling of incomplete bladder emptying, or having to strain very hard to urinate. There are many possible causes of these types of blockage problems and common causes include bladder infections and enlargement of the prostate gland in men. Bladder tumors can also cause these types of blockage symptoms as well. Obviously the combination of blockage symptoms and blood in the urine would be very concerning.

One of the commonest ways to evaluate the bladder is to look at it from the outside with an ultrasound probe and from the inside with a camera that is passed through the urethra. Cystoscopy (passing a camera into the bladder through the urethra) allows direct viewing of the bladder surface where 90% of bladder cancers grow.

 

 

REFERENCES:

  1. www.cancer.gov/cancertopics/pdq/treatment/bladder/Patient/page1
  2. www.nlm.nih.gov/medlineplus/bladdercancer.html
  3. Diagnosis and treatment of bladder cancer. Sharma S, Ksheersagar P, Sharma P. Am Fam Physician. 2009 Oct 1;80(7):717-23. Review. PMID:19817342
  4. Townsend Jr, CM;Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18th ed. Chapter 77. New York,NY: Saunders.
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.