In the early stages of bladder cancer, you may not notice any signs or symptoms of the disease. The most common symptom of bladder cancer is blood in the urine. Other symptoms include changes in urination such as increased frequency, urgency, burning, or difficulty urinating. Symptoms may not appear until the bladder tumour has become large enough or has grown far enough into the bladder wall. Because the symptoms can mimic other conditions, including urinary tract infections (UTIs), bladder cancer is often diagnosed later than it should be. Diagnosis typically involves a urine test, a cystoscopy to directly examine the bladder, and, if a tumour is found, a surgical procedure called a TURBT to remove it and confirm the stage and grade of the cancer. The earlier bladder cancer is detected, the better.
Bladder Cancer Symptoms and Diagnosis
What is the Most Common Symptom of Bladder Cancer?
Blood in the Urine
The most common symptom of bladder cancer is painless blood in the urine, called hematuria, seen in approximately 85% of patients with the disease. The bleeding comes directly from the cancer tumour. The amount of blood may be very small and only detected with urine tests or under a microscope, called microscopic hematuria. In other cases, the blood is visible, called gross hematuria. It often turns the toilet water red or pink or you may see spots of blood in the water after urinating. The colour may vary from pale yellow-red to bright or rusty red. Blood may always be in the urine, or it may come and go, but even if it disappears temporarily, it should never be ignored. This symptom is never normal and should always be evaluated by a health care provider.
Other Common Symptoms of Bladder Cancer
- The need to urinate often (called urinary frequency)
- An intense need to urinate (called urinary urgency)
- Trouble urinating
- A weak urine stream or the feeling that the bladder is not fully empty
- A burning sensation or pain during urination
- Back, pelvic or groin pain
Symptoms of Metastatic Bladder Cancer
Metastatic bladder cancer occurs when bladder cancer spreads beyond the bladder to other parts of the body, such as the lymph nodes, bones, lungs, or liver. In addition to urinary symptoms, metastatic bladder cancer symptoms may include:
- Weight loss and loss of appetite
- Fatigue, weakness, and general discomfort
- Swelling in the feet
- Bone pain
- Swollen lymph nodes
- Shortness of breath or coughing
The symptoms of metastatic bladder cancer vary depending on where the cancer has spread.
When to See a Health Care Provider
It is important to note that you may not have all these signs and symptoms. Also, some of the symptoms listed above may be signs of other conditions. The symptoms are also dependent on which part of body the cancer has spread to. You should consult your health care provider if you notice blood in your urine, experience persistent urinary symptoms, or are concerned about any possible signs or symptoms of bladder cancer. Early diagnosis can improve treatment options and outcomes.
SEE RED?
SEE YOUR DOCTOR.
Because the disease may have progressed unnoticed, it is critical to see a doctor once you begin to experience symptoms. Since many symptoms are similar to other medical conditions, bladder cancer is often misdiagnosed as, for example, a urinary tract infection. Ask your doctor for a referral to a urologist to rule out bladder cancer.
How Do Doctors Detect Bladder Cancer?
The earlier bladder cancer is diagnosed, the better the outcome. Early detection can improve treatment options and may increase the likelihood of successful treatment. Since there is currently no screening test for bladder cancer, most people are diagnosed after they show symptoms, such as blood in the urine. Because symptoms of bladder cancer can be a sign of other conditions, there can be a delay in diagnosing bladder cancer.
If bladder cancer is suspected, your health care provider may recommend one or more tests to determine whether cancer is present and whether it has spread beyond the bladder. Here are some of the diagnostic tests and procedures used to detect bladder cancer. Please note, since individual cases and facilities are different, not all these tests may be required or available in your area.
Urinary Screening
Since blood in the urine is the most common sign of bladder cancer, doctors will use urinalysis—or a urine test—to check a sample of your urine under a microscope to determine if blood is present. In addition, a specialized physician called a cytopathologist, may do a urine cytology scan by examining a sample of urine to see if there are any tumour cells in the urine. Urine cytology is particularly useful for detecting high-grade bladder cancers and is often ordered alongside urinalysis as part of the initial workup.
Cystoscopy
A cystoscopy is the main procedure used to diagnose bladder cancer and determine if cancer tumours are present in the bladder. The urologist uses a thin, hollow tube telescope with a lens, called a cystoscope. The procedure involves inserting the cystoscope through the urethra, the tube which drains urine from the bladder. Once it is slowly moved into the bladder, the urologist can closely examine the bladder and the bladder lining for tumours.
White Light and Blue Light Cystoscopy
The cystoscope shines a light inside the bladder to aid in visibility. There are two types of procedures to illuminate irregularities within the bladder: the traditional cystoscopy uses white light and the other a combination of white and fluorescence or blue light.
In some facilities a blue light cystoscopy may be used if technology called Cysview* is available. A solution containing an “agent” is inserted into the bladder about an hour before the cystoscopy. The agent essentially “marks” the tumour, which can be seen using a blue light. The urologist first views the bladder with a white light and then switches to blue light.
If a doctor spots something unusual during the cystoscopy, a biopsy may be done to confirm the diagnosis. This involves removing a small piece of tumour growth for further examination and testing. If a tumour or other abnormality is identified, the physician will likely schedule you for a transurethral resection of the bladder tumour, or TURBT.
The procedure can be done in a doctor’s office or hospital setting, while you are asleep under anesthesia or while you are awake with moderate sedation and pain management. Follow your physician’s instructions on whether you should fast before the procedure.
*Currently the use of blue light versus the traditional white light is being studied in a clinical trial to determine if there is a greater likelihood of detection with one light over another. Also, not all hospitals have Cysview technology, and availability can vary depending on factors such as the hospital’s budget, location, and patient demand for such services. [2024]
Scans
Medical imaging helps doctors determine whether bladder cancer has spread beyond the bladder and assists with staging the disease.
CT Urogram
Depending on the facility and disease status, “Computed Tomography” (CT or CAT) radiological scan may be used. The CT Urogram examines the upper urinary tract (kidneys and ureters) in detail to look for possible reasons for blood in the urine or to detect other symptoms and conditions. A “contrast dye” is injected intravenously (by IV) to better see the internal structures being examined. A CT Urogram will help identify signs of spread to lymph nodes or other organs like the liver.
Magnetic Resonance Imaging (MRI)
Another option for imaging is “Magnetic Resonance Imaging” (MRI) of the abdomen and pelvis or MR Urogram. This test is also effective in detecting tumours in the kidneys and ureters, as well as indications of cancer spread. It may be employed as an alternative to radiation, especially in patients with contrast dye allergies or those with borderline kidney function.
PET Scan
Ongoing research suggests that, in specific situations, “Positron emission tomography” (PET or PET-CT) scan may possibly be better than a CT scan or MRI alone at helping to find bladder cancer that has spread. Not all hospitals have MRI or PET machines, and availability can vary depending on factors such as the hospital’s budget, location, and patient demand for such services.
Ultrasound
An ultrasound uses sound waves to create a picture of the internal organs and is the least invasive way to evaluate the kidneys or ureters. It does not require radiation and avoids contrast. Ultrasounds can miss small kidney stones and tumours and will not detect tumours in the ureter unless they are causing a blockage leading to hydronephrosis, a condition where one or both kidneys become stretched and swollen as the result of a build-up of urine inside them.
Transurethral Resection of Bladder Tumour (TURBT)
The urethra is a tube that lets urine leave your bladder and your body. A surgical procedure through the urethra, called a TURBT, is done in a hospital setting under general or local anesthesia. During the TURBT, the doctor will remove tumours and samples of the bladder muscle near the tumours. The material removed is sent to a lab for analysis under a microscope. The result of the analysis is used to help determine the stage and grade of the bladder cancer.
Exam Under Anesthesia (EUA)
Another procedure often done during the TURBT is called EUA (exam under anesthesia). During this examination, the urologist feels the bladder and surrounding tissues to determine whether any masses can be detected, providing additional information about the extent of the cancer.