Nine signs of bladder cancer

Every year, more than 10,000 people in the UK are diagnosed with bladder cancer. This makes it the eighth most common cancer that affects men and the tenth most common cancer in the country.

Being exposed to harmful substances can increase your risk of developing bladder cancer. This means certain jobs put you at greater risk eg being a hairdresser or plumber, working in rubber manufacturing or iron and aluminium processing, or working with paint or dye. Smoking can also increase your risk of developing bladder and other cancers.

Bladder cancer refers to malignant tumours that usually start in the cells lining the inside of your bladder (urothelial cells). There are different types of bladder cancer — the most common is urothelial carcinoma, which makes up over 90% of cases. Other less common types of bladder cancer include adenocarcinoma, epidermoid carcinoma, small cell carcinoma and sarcoma. 

It’s important to get treatment for bladder cancer as soon as possible, but what are the symptoms you should look out for? 

Here are some common signs and symptoms – but keep in mind that these signs do not necessarily mean that you have bladder cancer and you should seek medical advice for a diagnosis.

1. Blood in your urine

The first and most common sign of bladder cancer is noticing blood in your urine (haematuria). This may occur regularly or at random and can be caused by bleeding from the tumour inside your bladder. The colour of the blood in your urine can vary — it may be bright red, pink or orange. 

Blood in your urine isn’t always visible to the naked eye and may only be detected with a microscope — this means it may only be picked up when your GP sends a sample of your urine off for testing. 

Blood in your urine might be the only symptom you notice with early-stage bladder cancer. While it can be a sign of other conditions, it’s always best to see your GP so they can do some tests to identify the cause.

2. Recurring urinary tract infections

A urinary tract infection (UTI) is an infection of your kidney, bladder and/or the tubes connected to them. Symptoms include a burning sensation when urinating, cloudy or smelly urine and needing to urinate more often or more urgently. If you get frequent UTIs without an obvious cause, this could be a sign of bladder cancer and you should see your doctor.

3. Unintentional weight loss

Unintentionally losing weigh can be a sign of bladder cancer. Cancer can trigger your immune system to release chemicals to attack the cancer cells. However, these chemicals can also affect how your body converts food into energy, causing a loss of fat and muscle. 

While there are many causes of unexplained weight loss, it is a good idea to see your GP if you lose more than 5% of your body weight in 6-12 months.   

4. Needing to urinate urgently or more often

Bladder cancer can cause changes in how often you urinate, giving you the urge to urinate more often or more urgently even when your bladder isn’t full. You may also find that you can’t make it to the bathroom in time. A healthy person usually urinates four to eight times a day depending on the amount of water they drink every day. Think about what’s normal for you and whether it’s changed recently.

5. Not being able to empty your bladder completely

Urinary retention is the inability to empty your bladder completely, even when it’s full. You may have lower abdominal pain, be unable to urinate at all and/or strain when trying to empty your bladder. You may also notice your urine stream is weak, have the urge to urinate again immediately after emptying your bladder and/or have urinary incontinence. 

6. Anaemia

Anaemia occurs when there is a decrease in the number of healthy red blood cells you have. Bladder cancer can cause your iron and vitamin B12 levels to decrease — both of these are needed for healthy blood cells. Symptoms of anaemia include shortness of breath, fatigue and a rapid heart rate.

7. A lump in your pelvis

In the later stages of bladder cancer, you may be able to feel a lump in your pelvis. This occurs when the cancer has grown into the muscle wall of your bladder — at this stage, it may have started spreading to other parts of your body too.  

If left untreated, bladder cancer can spread to nearby tissues, including your bones, lungs and liver. Symptoms will depend on where the cancer has spread to.

If it has spread to your bones, you may develop weak bones that fracture easily, persistent bone pain and/or lumps over your bones.

If it has spread to your liver, your abdomen may swell, your stools may appear white and chalky, and you may develop jaundice.

If it has spread to your lungs, you may feel constantly out of breath, have recurrent chest infections and a persistent cough.

8. Pain and irritation 

You may feel pain, irritation, burning or stinging when urinating. You may also experience general pain in your pelvis and back, as well as bloating and discomfort in your lower abdomen. 

Painful urination is a common sign in the early stages of bladder cancer. In the later stages, the pain may spread to other parts of your body.

9. Fatigue and weakness

People who have cancer often feel tired and weak, especially in the later stages. Bladder cancer uses up the nutrients in your body to grow, which leaves you feeling tired. You may also lose your appetite and develop anaemia, which can both cause fatigue and weakness.

Getting a diagnosis

Your doctor may suggest one of the following tests to diagnose bladder cancer:

• Biopsy — a small piece of tissue is removed from your bladder to look at under a microscope
• Cystoscopy — a thin tube with a camera on the end called a cystoscope is inserted into your bladder to check for signs of cancer
• Imaging tests — this may include a CT scan, an ultrasound scan and/or a retrograde pyelogram to analyse your urinary tract 
• Urine cytology — your urine sample is analysed under a microscope

Treatment

Treatment for bladder cancer depends on how advanced it is, including whether it has spread to other parts of your body, and whether and how deep it has grown into your bladder wall. Your doctor will also consider your overall health, how fast the cancer is growing and the size of the tumour.  

If you have early-stage bladder cancer, your doctor may recommend transurethral resection (TURBT) with fulguration (using heat to destroy small growths). You may then need intravesical therapy where liquid drugs are inserted directly into your bladder. 

If you have a fast-growing cancer, large or multiple tumours, your doctor may recommend surgery to remove your bladder (cystectomy). More advanced bladder cancer may also need the nearby lymph nodes to be removed (radical cystectomy).

If you have later stage bladder cancer, your doctor may recommend TURBT followed by chemotherapy and a radical cystectomy. 

If you’re concerned that you may have symptoms of bladder cancer, it’s important to see your GP. The earlier bladder cancer is caught, the more successful treatment is.