Bladder cancer is the tenth most common cancer worldwide. It is more likely to develop in men than women, though it is often picked up in women at a more advanced stage. It also is more prevalent in the elderly, though it can affect anyone at any age.
When urinary bladder cells begin growing out of control, bladder cancer develops. As more cancer cells begin developing, a tumour can form. With time, the cancer can start spreading to other areas of your body, causing various symptoms.
It's important to educate yourself on bladder cancer signs as early detection is vital when it comes to treatment. If you notice anything unusual, don’t wait for symptoms to worsen. Speak to your doctor as soon as possible.
The good news is that bladder cancer can often be found at an early stage when it is more likely to be treatable. Let's take a look at the symptoms of bladder cancer — early, advanced and recurrent — and the various tests available to detect it.
- Early Symptoms of Bladder Cancer
- Advanced Symptoms of Bladder Cancer
- Symptoms of Recurrent Bladder Cancer
- How Is Bladder Cancer Diagnosed
- Determining the Stage and Extent of Your Cancer
- Cxbladder, a Non-Invasive Genomic Urine Test for Bladder Cancer
The following are some of the early-stage bladder cancer symptoms you might experience:
1. Blood in the Urine
Blood in urine, often referred to as haematuria, is the most common symptom or sign of bladder cancer. With this symptom:
- You might have enough blood to change your urine colour to pink, orange or, less often, dark red.
- Your urine colour is sometimes normal, but a urine test (urinalysis), which the doctor performs during a general medical checkup or if you have other symptoms, can still detect small traces of blood.
- You may have blood one day and not the next, with your urine staying clear for weeks or maybe even months at a time.
Generally, the earlier stages of bladder cancer — when the cancer is small and confined to your bladder only — cause bleeding with either no pain or little pain.
It's important to note that blood in your urine doesn't necessarily indicate bladder cancer. The cause of blood may be due to another factor. In fact, many healthy individuals may have some unseen blood in their urine at some stage (microscopic haematuria). And, for most individuals, the cause isn't cancer.
In many situations, the cause is due to other things like benign (not cancerous) tumours, medications or foods, infection, bladder or kidney stones or another benign kidney disease. Still, you should have your doctor check it out.
If you're concerned about cancer, ask them about Cxbladder, a non-invasive genomic urine test that quickly and accurately detects or rules out bladder cancer.
2. Symptoms of Irritation or Changes in Bladder Habits
Bladder cancer can also cause urination changes like:
- Burning or pain during urination.
- Having to urinate more than usual.
- Having a weak urine stream or having trouble urinating.
- Feeling an immediate urge to go, despite your bladder not being full.
- Having to urinate several times during the night.
It's important to note, however, that symptoms like these are often caused by other conditions like bladder stones, a urinary tract infection (UTI) or an enlarged prostate in men. To find out what's really causing these symptoms, speak to your doctor for a diagnosis and treatment.
Bladder cancer is considered advanced when the tumour has grown and penetrated the bladder lining and surrounding layers of tissue and muscle. At this stage, the cancer may have spread to other parts of the body (metastasised). Symptoms of advanced bladder cancer include the following:
- Urination problems: Inability to urinate
- Pain in the lower back: Another indication the tumour has spread is pain, particularly in the area above your pubic bone or the flank area. Pain in your perineum (the area between the penis/vagina and the anus) might also occur if your bladder cancer has reached tissues nearby. Pain may only be on one side.
- Weight loss or loss of appetite: You lose weight without trying, or you've lost your appetite and aren't as hungry as usual.
- Feeling weak or fatigued: You may feel lethargic and extremely tired a lot of the time.
- Bone pain: If your cancer has spread to the bone, it can cause bone pain or a bone fracture.
- Swollen feet: Bladder cancer that has spread (metastasised) to your lymph nodes, for instance, could cause your feet to swell.
If the bladder cancer has spread to another part of your body, you could develop symptoms specific to that particular area. For example:
- Lungs: If your bladder cancer has spread to your lungs, it could cause you to have trouble breathing, cough or even cough up blood.
- Kidneys: If your cancer has spread to your kidneys, you could have problems with kidney function that can result in swelling of your feet and legs.
- Abdomen: If your cancer has spread to your stomach lymph nodes or liver, it could cause abdominal pain.
Once again, these symptoms could be due to something other than bladder cancer, so be sure to have your doctor check them out.
Although seven of every 10 cases of bladder cancer are diagnosed at an early stage when the cancer is treatable, post-treatment recurrence is a particular risk, and the disease has a recurrence rate of about 70%19. Because of this, individuals who have had bladder cancer will require surveillance for years following treatment.
Recurrence happens when you have smaller areas of cancer cells that stay in your body undetected. These cells, over time, might increase in number and eventually cause symptoms or show up on test results. Your doctor, who knows your medical history, will discuss your risk of recurrence during follow-up care.
Symptoms of recurrent bladder cancer often resemble those of early or advanced cancer. Let your doctor know if you develop any new symptoms like frequent urination, blood in your urine, immediate need to urinate or pain while urinating. These symptoms could be signs of bladder cancer recurrence or signs of another health condition.
Knowing the symptoms and signs of bladder cancer, no matter if it's early, advanced or recurrent, is important and your first step to diagnosis and treatment.
Frequently, a doctor will diagnose bladder cancer after an individual tells them about blood in their urine. When there's enough blood in the urine to see it with the naked eye, it's called "gross haematuria." If you have small traces of blood in your urine you can't see, it's "microhaematuria." As mentioned previously, only a urine test can detect microscopic haematuria.
Procedures and tests your doctor may use to diagnose your bladder cancer include the following.
During cystoscopy, your doctor will insert a cystoscope (a narrow, small tube) through your urethra. This tool has a lens that allows them to see inside your bladder and urethra to examine their structures for signs of cancer.
2. Urine Cytology
The doctor analyses a sample of your urine under a microscope, checking for cancer cells.
3. Genomic Urine Test
This is a lab test that measures several biomarker genes in your urine to accurately assess the probability that you have cancer.
During a cystoscopy procedure, your doctor might pass a specific tool into your bladder through the scope to biopsy (collect a cell sample) for testing.
5. Imaging Tests
Imaging tests like retrograde pyelogram or computerised tomography (CT) allow your doctor to view and examine your urinary tract structures.
During a CT urogram, the doctor injects a contrast dye into your hand in a vein, and it eventually flows into your ureters, kidneys and bladder. They'll then take X-ray images during the procedure to obtain a detailed view of your urinary tract, helping them identify any areas with potential cancer.
During a retrograde pyelogram, the doctor uses an X-ray exam to obtain a detailed view of your upper urinary tract. They'll thread a catheter (a thin tube) into your bladder through your urethra to inject your ureters with contrast dye. This dye then begins flowing up to your kidneys as the doctor captures X-ray images.
Once your physician confirms you have cancer of the bladder, they might recommend additional testing to determine if the cancer has spread to other areas of your body, like your lymph nodes.
Testing might include:
- Magnetic resonance imaging (MRI)
- CT scan
- Chest X-ray
- Bone scan
The doctor will use the information from this testing to determine the stage of your cancer. The bladder cancer stages are indicated by a 0 to IV range of Roman numerals. The lowest cancer stages indicate it's confined to your bladder's inner layers and hasn't begun affecting your muscular bladder wall. Stage IV, the highest stage, indicates the cancer has begun spreading to distant organs and lymph nodes of your body.
The cancer stages system is continually evolving and becoming more complex with the improvement of cancer diagnosis and treatment. The stage of cancer you have will also determine which treatment will serve you best.
For more information on bladder cancer stages, please refer to the American Cancer Society website.
Cxbladder is a non-invasive genomic urine test that quickly and accurately detects or rules out bladder cancer. The test combines clinical risk factor markers with genetic information, measuring five biomarker genes to detect the presence or absence of bladder cancer.
When should you use Cxbladder?
- When you've seen blood in your urine
- If tests reveal you have blood in your urine
- When you're being monitored for recurrent bladder cancer
Cxbladder provides peace of mind and can make a meaningful difference to your care
- Cxbladder gives you certainty, resolving diagnostic ambiguity and improving overall detection accuracy.
- Most patients experiencing haematuria or who are being monitored for bladder cancer recurrence do not have cancer. Cxbladder enables the accurate rule out of patients who do not have bladder cancer, reducing the need for further invasive tests.
With performance proven in 12 peer-reviewed studies, Cxbladder is accessible to 65% of the New Zealand population via public healthcare and to the rest of New Zealand and Australia on request. In the US, Cxbladder is trusted by over 1,800 US urologists in over 40,000 patients.