The common symptoms of bladder cancer are blood in your urine, burning sensations when you pass urine, and pain in the lower part of your stomach or back.
Whatever pain, discomfort or symptom you feel, it is always best to get things checked out by your GP.
Blood in the urine (haematuria)
Finding blood in your urine is the most common symptom of bladder cancer. It can happen suddenly and may come and go. Your urine may look pink, red or even brown, or you may see threads or clumps of blood in it.
However, sometimes blood in the urine can’t be seen and may be picked up through a simple urine test called a non-visible or microscopic haematuria. This test for non-visible blood is often performed if you have urinary symptoms –for example, pains when you pass urine.
If you see blood in your urine, it’s important to get it checked by your GP straight away.
Sometimes, people with a bladder cancer may feel a burning sensation when they urinate, or the need to urinate more often. These symptoms can be caused by an infection rather than cancer, and some people may need tests so a proper diagnosis can be made.
Pain in the lower stomach or back
Lower abdominal and back pain can be a symptom of many different conditions. But, if you experience these or any other symptoms, it’s important to get them checked by your GP. The earlier the cancer is diagnosed, the more likely it is for the bladder cancer treatment to succeed.
Based on your symptoms, your GP can use one of the following tests to reach the right diagnosis, and is likely to begin by asking you about your general health and then examining you. You might be asked to give a urine sample to be sent away for analysis to see if you have a urine infection –if you have a bladder cancer, the urine may reveal some cancer cells.
Your GP may also want to examine you internally. And, because the bladder is close to the prostate in men and the womb in women, your doctor may need to put a gloved finger into the rectum (back passage) or vagina to see if everything feels normal.
If the doctor thinks your symptoms could be due to a cancer, they will refer you to a hospital where you will see a consultant urologist, a specialist in diseases of the urinary tract.
Further hospital tests might require a blood or urine test, and may include advanced tests such as a cystoscopy, intravenous urogram, MRI, CT or ultrasound scans.
The main test used to diagnose bladder cancer, where a consultant or specialist nurse uses a cystoscope (a thin tube with a camera and light at the end) to examine inside your bladder. This is usually done under local anaesthetic using a flexible cystoscope.
You may be asked to drink plenty of fluids before yourcystoscopy and also asked to provide a sample of urine, which is checked for infection.
The consultant specialist gently passes the cystoscope into your urethra and inside the bladder to examine the whole entire lining of the bladder and urethra. This only takes a few minutes.
After this test, you may notice some burning or mild pain as you pass urine for the first couple of days or notice blood in your urine. This should clear up after a day or so, and you should drink lots of fluids to help flush out your bladder.
After the cystoscopy, the doctor will be able to tell you if they have seen a bladder tumour. They will then arrange for you to come into hospital to have a procedure under general anaesthetic. This will involve having another cystoscopy, but the doctor will pass instruments through the cystoscope under a general anaesthetic to take a small piece of tissue taken (biopsy), or to remove the tumour.
Intravenous urogram (IVU)
An intravenous urogram (IVU) is also sometimes called an intravenous pyelogram (IVP) and is an X-ray to examine your entire urinary system. The IVU can show what is causing your symptoms, and check the health of your urinary tract.
A CT urogram is a scan to examine the whole of your urinary tract and see if any blood is coming from the bladder or anywhere else.
An ultrasound test bounces sound waves off the inside of your body to create a picture of your organs, and can be used to check for blockages in the tubes (the ureters) that pass urine between the kidney and bladder.
An MRI scan uses magnets to create a picture inside the body, and can be used to see if a cancer has spread.
Stages of bladder cancer[xi]
The stage of a bladder cancer gives an idea of how quickly it might grow, and can be determined after the biopsy is examined under a microscope. This will influence the type of treatment you’re offered after surgery.
The most commonly used staging system is the TNM system, where each letter (T, N and M) describes a feature of the cancer:
- T is the size of the tumour (cancer).
- N is whether it has spread to the nearby lymph nodes (sometimes called glands).
- M is whether the cancer has spread to other parts of the body (metastases).
Stages of non-invasive bladder cancer
Non-invasive bladder cancer is labelled under three stages –CIS, Ta or T1:
- Carcinoma in situ (CIS)
Sometimes described as a flat tumour, where cancer cells are only in the inner layer of the bladder lining.
Cancer appears as a mushroom-shaped growth (papillary cancer) growing within the inner layer of the bladder lining.
Cancer growing into the layer of connective tissue beneath the bladder lining.
Cancer has grown into the superficial muscle.
Cancer has grown into the deeper muscle
Cancer has grown through the muscle into the fat layer.
Cancer in the fat layer can only be seen under a microscope (called a microscopic invasion).
Cancer in the fat layer can be seen on tests, or felt by your doctor during an examination under anaesthetic (macroscopic invasion).
Cancer has spread outside the bladder.
Cancer has spread to the prostate, womb (uterus) or vagina.
Cancer has spread to the wall of the pelvis or abdomen.
N stages of bladder cancer[xii]
The N stages describe whether cancer has spread to the nearby lymph nodes, and there are four of these stages in bladder cancer. The N stages are
No cancer in any lymph nodes
Cancer is present in one lymph node in the pelvis (your lower stomach, between the hip bones)
Cancer is in more than one lymph node in the pelvis.
Cancer is in one or more lymph nodes in the groin.
Lymph nodes can be examined and staged using a CT scan or MRI scan, or may be found if you need surgery to remove your bladder.
Grades of bladder cancer
Your consultant specialist may also talk to you about the grade of your cancer. This means how well developed the cells look under the microscope:
- Grade 1 or low-grade
Cancer cells look like normal bladder cells, are usually slow-growing and less likely to spread.
- Grade 2 or intermediate-grade
Cancer cells look more abnormal and grow slightly more quickly than grade 1 cancers.
- Grade 3 or high-grade
Cancer cells look very abnormal and are likely to grow more quickly. Carcinoma in situ (CIS) is always classed as high-grade.
[xi] Cancer Research UK, Bladder cancer stage and gradehttp://www.cancerresearchuk.org/about-cancer/type/bladder-cancer/treatment/bladder-cancer-stage-and-grade
[xii] Cancer Research UK, Bladder cancer stage and gradehttp://www.cancerresearchuk.org/about-cancer/type/bladder-cancer/treatment/bladder-cancer-stage-and-grade