Bladder cancer affects approximately 550,000 people yearly. It is the 10th most common cancer globally, the 6th most common cancer in men, and the 17th most in women. Men are four times more likely to develop bladder cancer than women, and it usually affects older adults.

What is bladder cancer?

Bladder cancer is a malignant condition that may form in the cells of the urinary bladder.

When someone has this type of cancer, the cells of their bladder grow uncontrollably. This can manifest as a tumor (mass), that over time, may spread to distant organs.

Transitional cell carcinoma, also referred to as urothelial carcinoma, is the most common type of bladder cancer.

Symptoms of bladder cancer

Bladder cancer can present with a variety of signs and symptoms, such as:

Hematuria (Blood in the urine) – This is the earliest sign of bladder cancer in most cases, and is the usual reason patients seek consultation.
Pain or burning during urination
Difficulty urinating
Increased frequency of urination, even at night
Urinary urgency – the need to urinate immediately, despite your bladder not being full

When to seek consultation with a medical professional

Gross hematuria, visible blood or red-tinge in the urine, is a common sign that warrants medical attention.

Patients who develop this type of hematuria, usually seek medical care immediately. Because of this, doctors can make an early diagnosis.

Early detection increases the chances of successful treatment.

Microscopic hematuria, on the other hand, is blood in the urine detected by a healthcare professional via medical test.

Risk factors in the development of bladder cancer

The following are risk factors that increase the likelihood of development of bladder cancer in patients:

Age – Bladder cancer is more commonly seen in the elderly. Around 9 out of 10 people with bladder cancer are over the age of 55.
Race – Although more research is needed, current statistics state that Caucasians have the highest risk of developing bladder cancer compared to Blacks and Hispanics, while Asians have lower rates of bladder cancer.
Gender – As mentioned earlier, bladder cancer affects men more often than women.
Smoking – Smokers are 3 times more likely to develop bladder cancer. It is the cause of approximately half the cases of bladder cancers seen in both men and women.
Workplace exposure to organic chemicals – Such as in rubber, leather, textiles, and paint producing factories.
Schistosomiasis – The infection with Schistosoma haematobium or blood fluke is a well known risk factor in the development of bladder cancer, particularly squamous cell carcinomas.
Chronic bladder irritation – this can be due to recurring urinary tract infections, kidney or bladder stones, or in patients with extended use of urinary catheters.
Bladder Birth Defects – Exstrophy of the bladder, wherein the bladder and abdominal wall are fused together after fetal development.
Cancer of the urothelial tract – Developing cancer at any part of the urinary tract, from the kidneys to the urethra, increases the risk of developing bladder cancer, even when treatment of the initial carcinoma is completed.
Chemotherapy and radiation therapy – Long term exposure to chemotherapeutic medication and pelvic radiation therapy can increase the incidence of cancer development.
Intake of nephrotoxic medications and herbal supplements – Drugs such as phenacetin and supplements containing aristolochic acid can increase the risk of bladder cancer.
Hereditary conditions- Lynch syndrome, Cowden disease, Retinoblastoma gene mutation

Benign bladder conditions

While bladder cancer is the most common condition that causes bloody urine, benign/hemorrhagic cystitis is a more common cause.

Several other conditions may present with blood in the urine, this includes:

Benign prostatic hyperplasia – Enlargement of the prostate gland can compress the urethra, causing difficulty urinating and may present with microscopic amounts of blood in the urine.
Urinary tract infections –Infections of the urinary tract can lead to inflammation and damage of the cells lining the interior of these organs, leading to bleeding, whether gross or microscopic.
Viral infections – Such as hepatitis, an infection of the liver that causes inflammation
Kidney or bladder stones – Stone formation along the urinary tract has several causes and can be made of different materials, which may be struvite (due to infections), calcium oxalate, calcium phosphate, or uric acid stones (associated with gout)
Endometriosis – A condition where the cells that normally line the uterus are found elsewhere in the body. It rarely affects the bladder, however if present, will demonstrate blood in the urine as a clinical finding.
Excessive exercise – Known as exercise-induced hematuria Can cause blood in the urine, however this depends on the intensity of the exercise and level of hydration of the patient
Sexual activity – Associated with sexually transmitted infections, which may present as hematuria.
Trauma – Direct injury to the kidneys or urinary bladder can present as hematuria.

Key Takeaways

Changes in bladder habits may be a warning sign to seek consultation with a physician, particularly in patients presenting with hematuria.

Hematuria is linked to bladder cancer, even though it is not the most common cause. This affords the opportunity for physicians to screen you for possible malignancy if they deem it necessary. Bladder changes are usually benign, and are rarely due to cancer.

Learn more about the common symptoms of cancer, here.

Symptoms of Bladder Cancer to Watch Out For