Bladder Cancer Symptoms and Diagnosis — Early Diagnosis is a Key to Survival

Joseph R. Anticaglia, MD
Medical Advisory Board

Bladder cancer ranks as the fourth most common form of cancer among men, and sixth among women. Men get it three times more frequently compared to women, although women may be diagnosed when their cancer is at a more advanced stage. Smoking is the most significant risk factor for bladder cancer; and the presence of blood in the urine is a red alert, a danger sign, signaling doctors to rule out cancer as the underlying reason for this bloody finding.

The bladder is a hollow, muscular organ in the lower pelvis that stores urine , the liquid waste material made by the kidneys. The urine travels from the kidneys by way of the ureter, a narrow tube, to the bladder. When you urinate, the muscular walls of the bladder contract forcing urine out of the bladder, and out of the body through a small tube called the urethra. Multiple tissue layers make up the wall of the bladder.

Layers of the bladder Urological Associates of Piedmont

Urothelial carcinoma, also called transitional cell carcinoma, is the most common histological type of bladder cancer. Histological type is how the cancer cells look under the microscope. Other less common types of bladder cancer include squamous cell carcinoma, and adenocarcinoma. Urothelium is the continuous lining of the urinary tract from the bladder up to the kidney.

What’s crucial is the differentiation, the distinction between nonmuscle invasive and muscle invasive bladder cancers. Urothelial cell cancers are nonmuscle invasive cancer meaning they remain confined to the inner linings of the bladder, and has a much more favorable prognosis compared to the cancer that invades the muscle layer of the bladder (see grading below)

Armando worked for a paint manufacturing company for 27 years, and looked forward to retiring in three years when he’d be 65 years old. He smoked a pack of cigarettes a day for about 40 years. He visited his family doctor because of blood in the urine.

“Over the past 2 weeks, I noticed blood in the urine, but not all the time. Today, the urine is not colored pink. I don’t have any pain, no pain, ‘no nothing.’ What’s going on? His doctor said,

“The urinalysis and urine culture showed you have blood and cancer cells in the urine. I’m going to refer you to a urologist, a specialist who knows much more than I do about treating your kind of urinary problem.”

“Slow down. What is my problem? How did this happen?

“You have cancer, and there’s a likelihood that it involves the bladder. Inhaling chemicals from smoking cigarettes, and being exposed to the chemical fumes at work caused your kidneys to filter the toxic substances, and pass them on to the bladder. Over time, smoking , and being exposed to chemicals at work can damage the cells lining the wall of the bladder. The cells mutate, that is, change from normal cells to cancer cells.”

“We need the advice of the specialist, and more tests to better understand the type of cancer, and the best treatment for you. The good news is that most bladder cancers are diagnosed at an early stage when the treatment is highly successful. I’ll be working with the urologist, and you to provide you with the best care possible.”

Symptoms, and Signs

Besides the important finding of blood in the urine (hematuria), other symptoms of bladder cancer mainly deal with problems of urination such as pain on urination, frequent urination, the feeling the need to urinate, but not being able to do so, as well as pain on the side of your back below the rib cage.

Frequently, bladder cancer can be painless without other symptoms. It may be suspected on an image study (X-ray) done for another reason. However, once blood is identified in the urine, cancer and other causes for the hematuria need to be ruled out.

Risk factors

A risk factor is anything that increases the possibility of you getting a disease such as cancer. Smoking is the most important risk factor for bladder cancer, accounting for approximately 50% of all cases. People who smoke are three time more likely to get bladder cancer compared to non-smokers.

Other factors include exposure to toxic chemical substances, family history to this cancer(genetic component), being past the age of 70, and chronic urinary tract infections. Radiation treatment to the pelvis, and certain chemotherapy drugs are also risk factors for bladder cancer.


Urinalysis is a simple test that looks at your urine to find problems that need to be treated such as why there is blood in the urine. Urine Cytology is a test that checks your urine sample for cancer cells. But the definitive diagnosis of bladder cancer requires a look at the bladder, and a tissue biopsy.
Cystoscopy is a procedure to examine the bladder. A cystoscope is a tube-like instrument with a light at the end of it used to view the inside of the bladder. It may have an attachment to remove a piece of tissue for a biopsy from the bladder, the essential diagnosis procedure. It has been done as an office procedure, and as outpatient surgery.
Imaging studies are procedures used to demonstrate the likelihood of the presence of cancer, and whether the cancer is localized to the bladder, or has spread to different parts of the body. They also evaluate the kidneys and the tubes that go from the kidneys to the bladder, called the ureters. They include computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scan.
Genetic Analysis (Diagnosis) looks at mutations, and variants of the gene composition of an individual to guide clinicians as to the best treatment choices, and to monitor whether the treatment is effective.
Smoking is the most important risk factor for bladder cancer. Blood in the urine is the most common symptom of bladder cancer. A biopsy is needed to make a definitive diagnosis of the cancer. A future article will discuss factors that influence bladder cancer survival.


  1. American Cancer Society; Key Statistics for Bladder Cancer; January 3. 2023
  2. Kaylan Saginala et al; Epidemiology of Bladder Cancer; Med Sci (Basel), March 8, 2020
  3. American Cancer Society; Bladder Cancer Risk, October 2017
  4. Mayo Clinic, Bladder removal surgery (Cystectomy); June 3, 2022
  5. NHS What Do Cancer Stages and Grades Mean? December 16, 2021
  6. Cancer. net Bladder Cancer: Introduction 12/2 021
  7. Saad Aldoussari, MD. and Wassim Kassouf, MD Update on the management of non-muscle invasive bladder cancer. Can Uro Assoc J., February 4, 2010
  8. Qingyuan Zheng et al; Accurate Diagnosis and Survival Prediction of Bladder Cancer; October 2022


  1. Hematuria — blood in the urine.
  2. NHGRI — National Human Genome Research Institute from Bethesda, MD
  3. Urothelium is the continuous lining of the urinary tract from the bladder up to the kidney. Urothelial cells, also called transitional cells, are specialized epithelial cells.
  4. Figure—Layers of the Bladder; Urological Associates of Piedmont

This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.