Bladder cancer is a type of cancer called carcinoma that most often occurs in the inner lining of the bladder. The disease is caused by abnormal cellular growth leading to a malignant tumor. The most common sub-type of bladder cancer is transitional cell carcinoma (also called urothelial carcinoma), which develops in the urothelial cells that line the inner walls of the bladder. Doctors can often diagnose bladder cancer in the early stages when it is highly treatable. Identifying the signs is key to early detection, treatment, and recovery.

Blood in the urine

Blood in the urine or hematuria is the most common, and often the first, sign of bladder cancer. It occurs when the tumor inside the bladder is bleeding. The bloody urine may be bright red, orange, or pink and occur regularly or intermittently. Blood particles might also be microscopic and detected only in a urinalysis ordered by a doctor. In the early stages of bladder cancer, blood in the urine could be the only sign.

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Frequent or urgent urination

A person with bladder cancer may feel the need to urinate frequently or urgently. The frequency of normal urination depends on several factors, particularly the amount of daily water intake. Most healthy adults urinate between four to eight times a day. More frequent urination may indicate a disease of the bladder, including cancer. The need to urinate suddenly and immediately can be another sign and can cause leaking or involuntary urinating.

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Urinary retention

On the other end of the spectrum, cancer in the bladder may present with urinary retention. Complications include an inability to urinate when the urge arises, trouble initiating a urine stream, interrupted urination, and straining when attempting to empty the bladder. The individual might also feel the urge to urinate immediately after emptying the bladder. Urinary retention is often a result of obstruction of the urinary tract by the tumor or the development of blood clots in the bladder.

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Pelvic mass

Neither the person with cancer nor a doctor can feel an early-stage tumor in the bladder. In the later stages of the disease, the physician may be able to locate a palpable mass in the pelvis. This typically indicates that the tumor has progressed, and the cells have invaded the deeper layers of the bladder walls. A palpable mass may also indicate that the cancer has begun to metastasize or spread.

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Recurrent urinary tract infections

Bladder cancer does not necessarily cause urinary tract infections (UTI), but the symptoms and signs may be mistaken for a UTI. The presentation of bladder cancer and a UTI are quite similar. Upon hearing the symptoms and detecting blood in the urine in a urinalysis, a physician might misdiagnose the more common infection and prescribe an antibiotic. If an individual is getting consistent UTIs for no other apparent reason, however, this can indicate a more serious underlying condition such as bladder cancer.

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Weight loss

Weight loss is a sign common to most cancers, including that of the bladder. The changes occur for several reasons, including the body's immune response to the cancerous cells and loss of appetite. The immune system releases substances called cytokines intended to fight the malignant cells. This release can affect metabolism, resulting in the loss of muscle and fat.

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Anemia occurs when the blood contains too little hemoglobin, the red blood cell component responsible for transporting oxygen through the bloodstream. Anemia may develop in bladder cancer due to the processes underlying the growth of the malignant tumor, which can deplete the body of vitamin B12 and iron. Anemia presents with shortness of breath, swelling of the hands and feet, and a rapid heart rate.

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Untreated bladder cancer will metastasize to other parts of the body, commonly the liver, lungs, and bones. Worsening signs and symptoms of bladder cancer are often evidence of metastasis. Signs of metastasis also depend on the areas to which the cancer has spread. Liver cancer causes abdominal swelling and jaundice; a persistent cough and trouble breathing may indicate lung cancer. Bone cancer leads to weak and fragile bones that break easily and bone pain.

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Pain and irritation

People with bladder cancer often experience pain and irritation when urinating, which often causes a burning sensation. Bloating and discomfort in the lower abdomen and generalized pain in the back and pelvis might also occur. Painful urination is common in the early stages of bladder cancer, but more advanced or radiating pain will not usually develop until later stages.

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Fatigue and weakness

Feeling tired and weak is a common symptom of most types of cancer, particularly in the later stages. The same substances released by the immune system that cause cancer-related weight loss — cytokines — also cause fatigue. Anemia and lack of appetite can also lead to these symptoms.

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Change in urine color

One less common but potential sign of bladder cancer is a noticeable change in the color of your urine. Instead of the typical yellow or pale yellow, your urine might appear dark, brown, or even greenish. This discoloration can result from the presence of abnormal substances in the urine, which may be indicative of bladder issues.

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Swollen lymph nodes

Bladder cancer that has advanced may lead to changes in the lymph nodes. Swollen lymph nodes, especially in the groin area, may indicate that the cancer has started to spread to nearby lymphatic tissues. If you notice persistent or painless swelling in your lymph nodes, it's vital to consult with a healthcare provider to investigate any underlying concerns.

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Skin changes

In rare instances, bladder cancer may give rise to noticeable skin changes, often localized in the lower abdominal or pelvic area. These skin alterations can encompass various manifestations, including redness, discoloration, or skin irritation. While skin changes might not be a common symptom of bladder cancer, they can be associated with the condition in some cases. The development of skin changes is typically a result of the tumor's impact on the surrounding tissues. Bladder cancer, especially in advanced stages, can exert pressure on nearby structures, leading to alterations in blood flow and tissue integrity. This can manifest externally on the skin as changes in color or texture.

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Speech and swallowing difficulties

While less common, advanced bladder cancer can sometimes cause difficulties with speech and swallowing. This symptom may result from the tumor's impact on nerves and muscles in the neck and throat area.

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Persistent hip pain

Persistent hip pain can be a concerning symptom when associated with bladder cancer. While not as common as other symptoms, it may occur due to the advanced stages of the disease its potential spread to surrounding areas. Bladder cancer primarily develops within the inner lining of the bladder. However, as the cancer progresses, it can infiltrate nearby tissues and organs, and in some cases, it may extend into the pelvic region, affecting structures like the hip bones and surrounding muscles and nerves. When bladder cancer reaches this advanced stage, it can exert pressure or directly affect the nerves and tissues in the hip area.

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