Symptoms

See what the symptoms of bladder cancer can be, and when you should see a GP.

These are the possible symptoms of bladder cancer. Your symptoms are unlikely to be cancer, but it’s important to get them checked by a doctor.

Blood in the urine

Blood in the urine is the most common symptom of bladder cancer. 4 out of 5 people with bladder cancer (80%) have some blood in their urine. Doctors call blood in the urine haematuria (pronounced heem-at-you-ree-ah).

You may actually see the blood. It usually looks bright red. Rarely, it may look dark brown (old blood). Sometimes the blood might be there one day and not there the next, with the pee (urine) remaining clear for weeks or months. If a person has bladder cancer, blood eventually reappears. If you ever see blood in your urine, you should go to your GP.

Sometimes the blood is there in such small amounts that you can’t see it. But a urine test will still show if blood is present.

The bleeding is not usually painful but tell your doctor whether or not you had any pain when you peed (passed the urine) with the blood in it as it will help them to make their diagnosis.

It can also help your doctor if you tell them whether:

there is blood only when you start to pee
the blood is mixed with all the urine you pass
Blood in the urine does not always mean you have bladder cancer. More often it is caused by other things like an infection, benign (non-cancerous) tumors, stones in the kidney or bladder, or other benign kidney diseases. But it’s important to have it checked by a doctor so the cause can be found. Do not delay seeking medical advice, go to your GP at the first sign of blood in urine.

Problems with passing urine

Your doctor may want to check out other problems you may have peeing (passing urine) if you have them. These include:

needing to pass urine very often (frequency)
needing to pass urine very suddenly (urgency)
pain when passing urine
These symptoms are much more likely to be caused by other conditions rather than cancer. You are more likely to have a urine infection, particularly if you do not have blood in your urine. For men, the symptoms could be caused by an enlarged prostate gland.

But do tell your doctor straight away if you have these symptoms. If you have an infection, it can usually be cleared up very quickly with antibiotics. And it is always best to check for cancer as early as possible, so that it can be diagnosed while it is easier to treat.

When to see your doctor

You should see your doctor if you:

notice blood in your urine
need to pass urine very often
need to pass urine very suddenly
have pain when passing urine
Your symptoms are unlikely to be cancer. But it’s important to get them checked by a doctor.

Tests your GP might do

Urine sample

You may have to give a urine sample to be sent away for testing. This is to see whether your symptoms could be due to a urine infection or something else.

Internal examination

Your GP may want to examine you internally. This is because the bladder is very close to the bowel, the prostate in men, and the womb in women.

Your doctor puts a gloved finger into your rectum (back passage) or vagina to see if everything feels normal. They will refer you to a specialist (called a urologist) at a hospital if they think there’s any chance your symptoms could be due to a cancer.

Diagnosing bladder cancer

If your GP thinks you might have bladder cancer, you will be referred to a specialist called a urologist who specialises in looking after the urinary tract and the bladder. They may do a cystoscopy (a look into your bladder) and possibly a bladder biopsy to tell if you have bladder cancer. For this test, a special type of cystoscope is put into the bladder through the urethra, the tube that brings your pee (urine) from your bladder out of your body. The doctor uses it to take a tiny piece of the bladder to test for cancer. The sample of your bladder is sent to a specialst doctor called a pathologist who will look at it under a microscope for signs of cancer. If there is cancer, the biopsy can help tell whether the cancer is just on the surface of the bladder or if it’s gone into the inner layers of the bladder wall. It normally takes several days for the results of your biopsy to come back. A biopsy is the only sure way to tell if you have cancer and what kind of cancer it is.

The doctor may take more than one sample. That is because sometimes cancer starts in more than one area of the bladder. Any samples are sent to a lab and looked at under a microscope for signs of cancer.

Salt water washings of the inside of the bladder may also be collected to look for cancer cells. This is when a salt water solution is inserted into the bladder using a tube, then the salt water is removed, saved, and looked at under a microscope.
Other tests to find out more about the cancer. Some of them are:

X-ray: Dye is put into a vein for a special x-ray of the kidneys, ureters, and bladder. The dye highlights these so the doctor can better see them and any tumors. This test is sometimes called a KUB X-ray or if dye is used it is called an  IntraVenousPyelogram (IVP)

CT scan: This is sometimes called a “CAT scan.” It is a special kind of x-ray that takes detailed pictures to see if the cancer has spread outside the bladder. The scans can also help show your doctor where to place a needle during a biopsy.

MRI scan: MRIs use radio waves and strong magnets instead of x-rays to take detailed pictures. MRI scans can be very helpful in finding cancer that has spread outside the bladder.

Ultrasound: This test uses sound waves to make pictures of the organs inside your body, like the bladder and kidneys. It can help show the size of a bladder cancer and if it has spread.

Bone scan: A bone scan can help show if bladder cancer has spread to the bones. This test is not done often unless you have symptoms such as bone pain.
If bladder cancer is found, two features of the cancer help the doctor know how best to treat it:

Invasiveness: The biopsy can show how deeply the cancer has grown into the bladder wall.

If the cancer stays in the inner layer of cells without growing into the outer layers, it is called non-invasive bladder cancer.
If the cancer grows into the outer layers of the bladder, it is called invasive bladder cancer. Invasive cancers are more likely to spread and can be more challenging to treat.

Grade: The grade refers to how the cancer looks under the microscope.

Low-grade bladder cancers look more like the normal bladder. (G1)
High-grade bladder cancers look less like the normal bladder. These cancers are more likely to grow and spread and can be harder to treat. (G2-3)