Bladder cancer takes root in the bladder's inner wall, or urothelium.

Whether it’s from a simple cut, a nosebleed, or a serious injury, seeing your own blood is rarely a good sign. After all, unless you’re donating blood, your blood is supposed to remain inside your body, not on the outside. The same holds true if you see blood in your urine. While it could be a sign of a benign problem, blood in the urine is one of the most common bladder cancer symptoms—one that should never be ignored.

Bladder cancer is one type of cancer that can be detected early. You just have to recognize the signs of bladder cancer and seek your doctor’s help. Once you’ve been diagnosed with bladder cancer, you and your physician need to keep a watchful eye for repeat occurrences of the disease.

Don’t Ignore Bladder Cancer Symptoms

The bladder wall has four layers:
• An innermost lining known as the urothelium
• A thin layer of connective tissue containing blood vessels and nerves
• A thick muscular layer
• An outer layer of fatty tissue

Bladder cancer is considered non-invasive if it is contained to the urothelium, or invasive if it has advanced into the thick bladder muscle. Low-grade bladder tumors tend to grow slowly and stay within the urothelium, while high-grade cancers grow more quickly and are more likely to invade the muscle. The majority of newly diagnosed bladder cancers are low-grade, non-invasive tumors.

If you have bladder cancer, you may experience pain or a burning sensation when you urinate, an increased urge to urinate, or a need to urinate more frequently. (Note that these symptoms are more likely to be caused by noncancerous conditions, such as infections, overactive bladder, or, in men, benign prostate enlargement, also known as benign prostatic hyperplasia or BPH.) People with more advanced bladder cancer may develop pelvic, back, or abdominal pain.

But out of all bladder cancer symptoms, blood in the urine (hematuria) is usually the first to herald the disease. The blood may be copious enough to change the color of the urine to pink, orange, or (less commonly) a deeper red. Oftentimes, hematuria occurs intermittently, and your urine may clear up for weeks or months before you notice blood in it again. In other cases, hematuria is visible only under a microscope and is found as a result of urine tests conducted as part of a routine checkup or when other symptoms are present.

Blood in Urine: What It Might Mean

If you have blood in your urine, that doesn’t necessarily mean you have bladder cancer. Hematuria sometimes may signal a benign condition, such as a urinary tract infection or bladder or kidney stones.

Regardless of the cause, never ignore hematuria. If you do, you might miss out on an opportunity to identify bladder cancer in its earliest, most treatable, stages.

On the Lookout for Bladder Cancer Symptoms

Diagnosing bladder cancer may begin with a simple urinalysis to check for blood in the urine, and it also may include a microscopic review of a urine sample. In addition, your doctor may order testing that identifies the presence of several molecular markers associated with bladder cancer.

The key test for diagnosing bladder cancer is a cystoscopy, in which a physician inserts a thin scope through the urethra to view the bladder lining and biopsy suspicious tissue. Most bladder cancers confined to the urothelium can be scraped away during a cystoscopy, in a treatment known as transurethral resection. Your physician also may order bladder imaging tests.

Experts generally do not recommend routine screening for people at average risk of bladder cancer. However, if you’ve already been treated for the disease, you should schedule regular visits with your doctor. Bladder cancer often returns, so if you’re treated for the disease you must undergo follow-up surveillance involving periodic testing with cystoscopy and other tests. Additionally, to prevent recurrences of bladder cancer, you may receive immunotherapy with bacillus Calmette-Guerin (BCG), a weakened bacteria injected into the bladder that triggers your immune system to attack cancer cells.

For further reading, consult our University Health News post on testicular cancer.

Originally published in May 2016 and updated.