Bladder Cancer Symptoms

The most common symptom of bladder cancer is blood in the urine, or hematuria. Hematuria that is visible to the naked eye is known as gross hematuria. Hematuria that can be seen only with the aid of a microscope is known as microscopic hematuria. Eighty to ninety percent of bladder cancers will have either gross or microscopic hematuria occurring frequently or intermittently.

Another symptom of bladder cancer is painful urination, or dysuria. Dysuria is not as common as hematuria and pain is not always a good indicator of the existence of bladder cancer. A symptom less commonly reported is frequent urination or the sensation of having to urinate frequently. While any or all of these symptoms may be associated with bladder cancer they can also be symptoms of a urinary tract infection, bladder stones or benign tumors.

Diagnosis and Testing

If evidence of hematuria is found, the patient may be referred to a urologist. A urologist is a doctor that treats diseases of the urinary tract. The urologist will get a detailed medical history including all symptoms, a family medical history, and the patient’s cigarette smoking and occupational history. Once all risk factors have been noted, the urologist may examine the bladder using a number of different diagnostic tools.

IVP and Cystoscopy

One of the least invasive tests is an intravenous pyelogram (IVP). A radioactive dye is injected into a blood vessel through an IV. This dye highlights the entire urinary tract (kidneys, ureters and bladder) so it is visible on x-ray. The x-ray technician will take a series of x-rays in rapid succession. These x-ray films are given to the doctor who will make note of any distortion of shape or irregularities in the urinary tract.

If the IVP does show irregularities in the bladder, the urologist will perform a cystoscopy, a direct examination of the bladder using a cytoscope. To make cystoscopy more comfortable, a local anesthesic will be used to numb the area surrounding the urethra. The cystoscope, a tiny camera with a light at the end, is inserted into the urethra. This allows the urologist to inspect the bladder and note any tumors or irregularities. The doctor records these irregular areas noting the size and location of any tumors present.

During cytoscopy the urologist may also do a “bladder wash.” A bladder wash allows the doctor to obtain cells from inside the bladder. These cells will then be evaluated in a laboratory for the presence of cancer.

Bladder Tumor Biopsy

If a tumor is present, the urologist may choose to do a transurethral biopsy. Frequently, a bladder tumor biopsy is performed under general anesthesia. The cystoscope is passed through the urethra and biopsy samples are collected. In some cases, a biopsy is the only way to know for sure if cancer is present. In the early stages of bladder cancer, a biopsy may remove the entire tumor and may be all that is required for treatment.


Beers, M. H.,