This cancer is usually diagnosed after blood shows up in the urine.
At first, bladder cancer may not cause any symptoms, or the symptoms may be very subtle.
Eventually, symptoms can include:
- Blood in the urine — either enough to be visible (with larger amounts, the urine may appear cola-colored), or smaller amounts that can only be seen under a microscope
- Frequent or urgent need to urinate
- Pain or burning with urination
- Pain in the back or pelvis
More advanced cases of bladder cancer can cause:
- Inability to urinate
- Back pain, usually confined to one side
- Pelvic or rectal pain
- Decreased appetite
- Unintended weight loss
- Swelling in the feet and lower legs
- Bone pain or fractures
Diagnosing Bladder Cancer
Bladder cancer may first be suspected when you start passing blood in your urine.
Once there is reason for suspicion, your doctor will do a careful check of your medical history to determine whether you have any risk factors for bladder cancer.
You will also need a complete physical exam, including a pelvic exam for women and a rectal exam for men.
This exam may reveal the presence of a pelvic mass, which can be a sign of bladder cancer.
Tests used to diagnose bladder cancer include:
Urinalysis: Testing a urine sample in a laboratory can reveal blood, infection, or other abnormalities.
Urine culture: A sample of urine is put in a special dish in a laboratory to see if any bacteria or fungi grow.
Urine cytology and/or tumor markers: A urine sample is examined to see if cancer cells are present, or if substances produced by tumors can be identified.
Cystoscopy: A lighted fiber-optic scope is passed through the urinary opening (urethra) into the bladder.
The inside of the bladder can then be examined, and tiny instruments can take a small sample of bladder tissue (biopsy) for testing.
Fluid may be introduced and then tested for the presence of cancer cells.
Imaging tests: X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), ultrasound, or other imaging tests may be ordered to visualize the bladder.
You may be asked to drink a contrast dye, which makes the bladder easier to see in certain tests. Imaging may also be used to guide a very thin needle into a tumor for biopsy.
Stages of Bladder Cancer
If you are diagnosed with bladder cancer, your doctor will perform further tests to determine the stage of the cancer.
Staging bladder cancer involves assessing the growth of the tumor and checking whether the cancer has spread to other areas of the body.
Knowing the cancer's stage is important in deciding the best course of treatment.
Some of the tests used to stage bladder cancer include:
- Chest X-ray
- CT scan
- Bone scan
The stages of bladder cancer range from 0 to IV, with additional sub-categories to describe the tumor and where the cancer has spread. The most advanced stage is IV.
The following are brief descriptions of each stage:
Stage 0: The cancer is non-invasive and has grown only on the inner lining of the bladder.
Stage I: The cancer has spread to the connective tissue beneath the inner lining of the bladder, but not to the muscle of the bladder wall.
Stage II: The cancer has spread to the muscle of the bladder wall, but not to the fatty tissue surrounding the bladder.
Stage III: The cancer has spread to the fatty tissue surrounding the bladder — and possibly to the prostate, vagina, or uterus — but not to lymph nodes or organs outside the region.
Stage IV: The cancer has spread to the pelvic or abdominal wall, lymph nodes, or distant organs such as the bones, lungs, or liver.