When Should I Worry About...

5 Early Signs of Bladder Cancer To Not Ignore

Jan. 12, 2024 - Kim Rivera Huston-Weber

Bladder cancer is the eighth most common cancer in the U.S., according to the American Cancer Society. Men are four times as likely to develop the condition as women, although certain risk factors can increase the likelihood in individuals of either sex. And while bladder cancer symptoms can vary from person to person, you want to pay close attention if you experience certain changes, particularly blood in the urine.

What is bladder cancer?

Bladder cancer refers to any cancer that begins in the bladder, according to Dr. Raj Satkunasivam, a urologic oncologist with Houston Methodist. Although there are a few different specific types of bladder cancer, more than 90% are a type called urothelial cell carcinoma (UCC), which is a cancer of the cells that line the bladder, urethra, ureters, renal pelvis and some other organs.

Who is at risk for bladder cancer?

"There are several risk factors for bladder cancer, but the most common is cigarette smoking," Dr. Satkunasivam says. "Other risk factors include chronic inflammation of the bladder, occupational risks including exposure to certain types of dyes or solvents, and certain chemotherapies."

Another risk factor is simply getting older. Nine out of 10 people with bladder cancer are diagnosed after age 55, according to the American Cancer Society.

"Bladder cancer is more commonly seen in men and in older adults, generally those over the age of 60," Dr. Satkunasivam says. "But like any cancer, it can affect women and younger people as well. Unfortunately, sometimes diagnosis is delayed in those groups because it is less commonly seen."

What can complicate diagnosis is that some of the early symptoms can be associated with other conditions or the changes to our urinary habits as we age.

Changes in bathroom habits that could signal bladder cancer

"Bladder cancer can have many different symptoms depending on its stage," Dr. Satkunasivam says.

Bladder cancer in its early stages can share symptoms of other infections and conditions, whether it be urinary tract infections (UTIs), kidney stones or diabetes.

Dr. Satkunasivam advises people not to downplay or try to explain away persistent symptoms. It's better to be evaluated and catch bladder cancer early, he says, than have the condition progress to where it may become more difficult to treat. The five symptoms listed below are early signs of bladder cancer. Some of the symptoms can be related to getting older and other conditions, but when multiple symptoms are present and persistent, you should talk to your doctor.

"We recommend getting unusual or concerning symptoms evaluated as soon as possible," Dr. Satkunasivam says. "Hopefully, it will turn out to not be serious, but if it is bladder cancer — the earlier we know, the better."

1.Blood in the urine

"The most common symptom among all patients with bladder cancer is blood in the urine, either only seen under a microscope (microscopic hematuria) or seen with the naked eye (gross hematuria)," Dr. Satkunasivam says. "Developing either type of blood in the urine should lead to an evaluation by a urologist. However, blood in the urine can be due to other causes as well, such as infection, kidney stones, or an enlarged prostate."

UTIs are one of the most-common causes of hematuria. Women are more than three times as likely to experience UTIs as men, according to the U.S. Department of Health & Human Services' Office on Women's Health. This is because the urethra is shorter in women, making it easier for bacteria to get into the bladder. Additionally, women may assume that blood in their urine is due to monthly menstruation, a UTI or postmenopausal uterine bleeding.

According to Dr. Satkunasivam, seeing blood in your urine should always prompt you to talk to your doctor, even if it's painless. Tests can help rule out infections and other conditions and help get you to a urologist for care sooner if your symptoms persist.

2. Frequent urination

Staying hydrated is important to our overall health. And anyone who tries to increase their water intake knows that with increased hydration comes more trips to the bathroom. But if you find yourself running to the bathroom more than usual and your liquid intake hasn't changed, you'll want to be evaluated. Urinating frequently is another sign of a UTI but is also associated with other conditions such as overactive bladder, enlarged prostate, diabetes and certain types of cancer, including ovarian and bladder cancer.

3. Painful or burning urination (dysuria)

Feeling a burning sensation or pain when urinating can make anyone fear the bathroom. A burning or stinging sensation when urinating can be another symptom of a UTI, but it's also associated with diabetes, bladder infections, prostate conditions and certain sexually transmitted infections. In men, the pain may remain in the penis before or after urinating.

4. Changes to urgency and urine flow

Having changes to urine flow or feeling like you need to go constantly are both symptoms to check out with a doctor. If your once-strong urine flow now feels like a weak trickle or the flow is now stop-start-stop-start or you're heading to the bathroom often and can't go, it's time to seek care.

5. Going to the bathroom several times in the night (nocturia)

Waking up to urinate during the night may be seen as a common, yet annoying, side effect of aging for both men and women. For men, it may be attributed to prostate enlargement; for women, menopause can contribute to nocturia, in addition to other changes such as hot flashes. In both men and women, sleep apnea is one of the most common and underdiagnosed causes of nocturia.

No matter your age, if you go from sleeping soundly to suddenly getting up several times at night to go to the bathroom, you may want to talk to your doctor — especially if you're having any other symptoms.

Never ignore urinary symptoms

Let's face it: Many of us are taught from a young age that talking about our bathroom habits is somewhat taboo. But your bathroom habits can tell you many things about your health and shouldn't be ignored.

While many of the above symptoms can have less serious causes, getting them checked out can give you access to more treatments if it turns out to be bladder cancer.

"Bladder cancer, like many cancers, is treated very differently depending on how early it is found," Dr. Satkunasivam says. "Early bladder cancer can be managed with minor outpatient surgeries and office visits, whereas later stages of bladder cancer can involve much bigger surgeries and/or chemotherapy."

For non-invasive bladder cancer, the most common treatment is outpatient surgery where the tumors are scraped out from the inside of the bladder using a specialized camera (endoscope) through the urethra. This is sometimes followed up with several treatments where the bladder is filled with medication to help treat the cancer cells.

For more invasive bladder cancers, Dr. Satkunasivam says patients may need chemotherapy followed by either surgery to remove the bladder or radiation to the bladder. In the past five years, there have been many new medication treatments that have been approved for more invasive bladder cancer (such as immunotherapy).

"We are participating in several clinical trials that are working to find the best and safest new treatments for all our bladder cancer patients," Dr. Satkunasivam says.

Story was developed with assistance from Dr. Sameer Farooq, urologic oncology fellow.

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