Bladder Cancer Symptoms and Warning Signs

Early signs of bladder cancer

Blood in the urine

This is the main warning sign. Blood can make urine look:

• pink, orange or bright red
• dark brown or cola-colored
• or look normal, with blood found only on a dipstick or microscope (microscopic hematuria)

Bleeding from bladder cancer is usually painless and often intermittent. It may appear once and then vanish for weeks or months. That pause does not mean the problem has gone. Any episode of blood in the urine deserves a check.

Irritation symptoms

Some bladder cancers, particularly carcinoma in situ (a flat, high-grade type), cause symptoms that mimic a urinary infection:

• needing to urinate more often, including at night
• sudden, urgent need to urinate
• burning or pain when passing urine
• a feeling of not emptying

When these symptoms keep coming back with no infection on urine tests, or do not respond to antibiotics, a bladder check is needed.

Advanced bladder cancer symptoms

As the tumor grows or spreads, symptoms can include:

• being unable to pass urine, or a weak stream
• lower back pain on one side, from a blocked ureter
• pain in the pelvis, bones or rectum
• swelling in the legs or feet
• tiredness, poor appetite and weight loss

What else causes these symptoms

Kidney cancer and prostate cancer can also cause blood in the urine. See temporary or benign blood in urine for harmless causes.

Bladder cancer symptoms in women

Women tend to be diagnosed later than men. Blood in the urine is often put down to a period, menopause or a urinary infection, and repeated infections may be treated without further tests. If you have blood in your urine outside your period, after menopause, or infections that keep returning, ask whether a cystoscopy is needed.

Who is at higher risk

• Smoking, current or past: the single biggest risk factor
• age over 55; men are about 3 to 4 times more likely to get it than women
• work exposure to dyes, rubber, leather, paint and some industrial chemicals
• previous pelvic radiotherapy or cyclophosphamide chemotherapy
• long-term catheters or chronic bladder inflammation
• arsenic in drinking water and, in some parts of the world, schistosomiasis infection

Tests for bladder cancer

1. Urine tests: to rule out infection and check for blood. Urine cytology looks for cancer cells.
2. Cystoscopy: a thin, flexible camera passed through the urethra to look inside the bladder. It takes a few minutes with local anesthetic gel and is the key test.
3. CT urogram: a scan with contrast dye that looks at the kidneys, ureters and bladder.
4. Ultrasound: sometimes used first, especially in younger people or pregnancy.
5. Biopsy (TURBT): if a growth is seen, it is removed through the urethra under anesthesia and examined.

A finding such as "a 1 cm mass on the bladder wall" on a scan needs a cystoscopy. Many small growths are low-grade, non-invasive tumors that are removed completely during that procedure. See the bladder cancer page for stages and treatment.

Frequently asked questions

What is usually the first sign of bladder cancer?

Painless blood in the urine is the first sign in most people. The urine may look pink, red or brown, or the blood may only be found on a test. It can come and go, so even a single episode should be checked.

Can bladder cancer cause symptoms like a UTI?

Yes. Some bladder cancers cause burning, urgency and frequent urination that feel like an infection. If these symptoms keep returning, urine cultures are negative, or antibiotics do not help, ask your doctor about further tests such as a cystoscopy.

Is blood in the urine always cancer?

No. Most blood in the urine is caused by infections, kidney stones, an enlarged prostate, vigorous exercise or menstruation. Cancer is found in a minority of people tested, but the risk rises with age and smoking, so visible blood should always be investigated.

Does bladder cancer cause pain?

Early bladder cancer is usually painless. Pain tends to appear when the tumor is large, has spread into nearby tissues or bones, or blocks the flow of urine from a kidney. Burning when urinating can occur with some early types.

What does a 1 cm mass on the bladder wall mean?

It means a growth was seen on a scan or cystoscopy. It may be a tumor, but blood clots, inflammation and benign growths can look similar. A biopsy or removal (TURBT) is needed to know. Small tumors are often low-grade and removed completely.