What is the first sign of bladder cancer?
Blood in the urine, also referred to as ‘hematuria’, is the most common symptom of bladder cancer and is usually the first symptom patients experience, given that early stage bladder cancer often causes bleeding without associated pain or other signs.
Visible blood in urine is also known as ‘gross hematuria’. Depending on the amount of blood present, your urine may look pink, red, or brownish in color. It is also important to realize blood may not always be present in the urine of individuals with bladder cancer—there may be relatively long periods of clear urine (weeks or sometimes months). Blood may also be present but at levels too low to visibly change the color of the urine, so requiring tests such a urinalysis or microscopy to detect. This is referred to as ‘microhematuria’.
Does having blood in my urine mean I have bladder cancer?
Not necessarily, and the likelihood is actually low. Most who experience hematuria do not have bladder cancer. In one study only about 10% of people with visible hematuria were diagnosed with bladder cancer.1 Other causes of hematuria can include bladder infection (i.e., urinary tract infections or UTIs), kidney infection, bladder or kidney stones, prostate enlargement, vigorous exercise, and physical kidney injury. Pigments in certain foods and medications can also discolor the urine (e.g., beets, berries, fava beans, food dyes, and certain medications).
That being said, approximately 4 in every 5 people with bladder cancer will experience hematuria,2 so it’s important you speak to a doctor and identify the cause of the bleeding as soon as possible.
Are there other early symptoms of bladder cancer?
Other early symptoms of bladder cancer that may be experienced are:
- Urinary irritation (for instance, pain or a burning sensation during urination)
- Changes in bladder habits (for instance, increased urination frequency and/or urgency, or difficulty passing urine)
If you’ve noticed any of these symptoms and are concerned about bladder cancer, speak to your doctor as soon as possible and ask them about Cxbladder, a non-invasive genomic urine test that quickly and accurately detects or rules out bladder cancer.
Learn more about Cxbladder
What are the symptoms of advanced bladder cancer?
Bladder cancer that has grown in size or spread to other areas of the body may cause a variety of symptoms including:
- Inability to pass urine
- Lower back pain on one side of the body
- Pain in the pelvic region
- Appetite/weight loss
- General weakness
- Swollen feet
- Bone pain
Again, just because you have these symptoms does not mean you have bladder cancer. You should, however, consult a doctor as soon as possible if you’re concerned as early detection will give you a broader, more effective range of treatment options, and improve the chance of success.
Symptoms of bladder cancer in men and women
Worldwide, bladder cancer is the tenth most common cancer3, with males 4 times more likely than females to be diagnosed with the disease during their lifetime.
In the United States, 81,400 new cases of bladder cancer and 17,980 attributed deaths were estimated to occur in 2020. In the United States, bladder cancer is also 4 times more common in males than females across all races and is most common in White men.4
Do the symptoms of bladder cancer differ in males and females?
In both males and females, blood in the urine is the most common symptom of bladder cancer and often the first sign that is noticed. However, while bladder cancer is more frequently diagnosed in men than in women, females often present with advanced tumors and their outcomes may be accordingly poorer.
A major reason for women presenting with more advanced bladder tumors is often the delay in receiving a diagnosis. This delay may occur because:
- Blood in the urine (or hematuria), the most common symptom of bladder cancer, may be discounted by women as being related to menstruation or post-menopausal bleeding.
- When blood in the urine and urinary irritation is reported to a doctor it may be initially misdiagnosed as a urinary tract infection (also referred to as UTIs), which has similar initial symptoms to bladder cancer (for example, hematuria and changes in urination habits).
- UTIs and bladder cancer can occur at the same time, in which case the UTI will be the logical first diagnosis.
- If a woman subsequently presents after treatment failure for a misdiagnosed UTI, further antibiotics may be prescribed rather than carrying out a complete urological evaluation.
Because of this confusion, a definitive diagnosis of bladder cancer may be delayed in some women. Of concern in these situations is the risk that bladder cancer becomes more advanced and may therefore be more difficult to treat.
How is bladder cancer diagnosed?
Several different diagnostic tests and procedures may be used to detect bladder cancer, often in combination. These tests are selected based on a patient’s symptoms and risk profile and may include:
- Testing of urine samples: (collected by urinating into a cup), including:
- Urinalysis: a quick test used to detect blood and other substances in urine.
- Urine cytology: urine is examined microscopically to see if cancer cells are present.
- Genomic urine tests: non-invasive molecular tests, such as Cxbladder, which measure gene expression (sometimes referred to as ‘tumor markers’) to quickly and accurately detect or rule out bladder cancer.
- Cystoscopy: A thin, flexible tube with a light and camera (a ‘cystoscope’) is inserted into the bladder through the urethra (the duct through which urine is excreted out of the body from the bladder). If an abnormal area is seen, a small sample of tissue (a ‘biopsy’) is usually collected for laboratory examination.
- Imaging: Several types of imaging test can be used to visualize the inside of the body, such as ultrasound, CT scan, MRI scan, and X-ray.
What to do if you suspect bladder cancer
If you have any signs or symptoms of bladder cancer, or if you believe factors put you at elevated risk, reach out to your doctor. Talking openly about your symptoms and asking to be tested for bladder cancer can put you at ease and ensure you get the medical support you need.
When you speak with your doctor, ask them about Cxbladder, an easy-to-use and non-invasive test that will help provide peace of mind. Cxbladder combines clinical risk factor markers with genetic information, measuring five biomarker genes to accurately detect the presence or absence of bladder cancer.
Learn more about Cxbladder Contact us for more information
Last Updated: 13 Mar 2021 08:00 pm
- Lotan Y, Choueiri T.K. Patient education: bladder cancer diagnosis and staging (Beyond the Basics). Available at: https://www.uptodate.com/contents/bladder-cancer-diagnosis-and-staging-beyond-the-basics?topicRef=870&source=see_link.
- Pashos C.L et al. Cancer Pract. 2002; 10:311-22.
- Richters A et al. World J Urol. 2020;38:1895-1904.
- Saginala K et al. Med Sci (Basel). 2020;8(1):15.
- National Cancer Institute Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Bladder Cancer. Available at https://seer.cancer.gov/statfacts/html/urinb.html.
- American Cancer Society. Bladder Cancer Signs and Symptoms.
- American Cancer Society. Survival Rates for Bladder Cancer.
- American Cancer Society. Tests for Bladder Cancer.
- Bladder Cancer Advocacy Network. Women & Bladder Cancer.
- Bladder Cancer Advocacy Network. Bladder Cancer Survival Differences for Women.
- Leslie S.W et al. Bladder Stones. [Updated 2020 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.
- Marks P et al. Transl Androl Urol. 2016;5:668-682.
- Mayo Clinic. Urine color.
- O’Leary MP. Patient education: Blood in the urine (hematuria in adults (Beyond the Basics).
- MSD Manual. Urine, Blood In
- University of Rochester Medical Center. Could persistent UTI-like symptoms be bladder cancer?
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