What Are the First Signs of Bladder Cancer?

It is unknown what causes most cases of bladder cancer, but genetic changes are thought to play a role. 

Risk factors for developing bladder cancer include:

• Smoking 
  • The main risk factor for bladder cancer
  • Accounts for about half of all bladder cancers in both men and women
• Certain medicines or herbal supplements
  • Pioglitazone (Actos), used to treat diabetes
  • Dietary supplements containing aristolochic acid (mainly in herbs from the Aristolochia family) 
• Workplace exposures to certain chemicals
  • Painters, machinists, printers, hairdressers (exposure to hair dyes), and truck drivers (exposure to diesel fumes)
  • Makers of rubber, leather, textiles, paint products, and printing companies
  • Aromatic amines, such as benzidine and beta-naphthylamine, sometimes used in the dye industry
• Not drinking enough fluids
• Gender
  • More common in men than in women
• Age
  • About 90% of people who develop bladder cancer are over 55 years
• Race and ethnicity
  • Whites are two times more likely to develop bladder cancer than African Americans and Hispanics
• Chronic bladder irritation and infections
  • Urinary infections (UTIs), kidney and bladder stones, bladder catheters left in place a long time, and other causes of chronic bladder irritation 
  • Schistosomiasis (bilharziasis), parasitic worm infection that can get into the bladder
    • More common in Africa and the Middle East; rare in the U.S.
• Personal history of bladder or other urothelial cancer
• Bladder birth defects
• Genetics and family history
• Chemotherapy or radiation therapy
  • Chemotherapy drug cyclophosphamide (Cytoxan)
  • Radiation to the pelvis 
• Arsenic in drinking water
  • Not a significant problem in the U.S. but may be in other parts of the world

Bladder cancer is diagnosed with a physical examination which may involve a digital rectal exam (DRE) and in women, a pelvic exam. 

Tests used to diagnose or rule out bladder cancer include: 

• Urine tests
  • Urinalysis
  • Urine cytology
  • Urine culture
  • Urine tumor marker tests
• Cystoscopy
• Biopsy using transurethral resection of bladder tumor (TURBT)
• Imaging tests
• Intravenous pyelogram (IVP)
• Retrograde pyelogram
• Computed tomography (CT) scans 
• Magnetic resonance imaging (MRI) scans
• Ultrasound
• Chest X-ray
• Bone scan

Treatment for bladder cancer may involve one or more of the following:

• Bladder cancer surgery
  • Transurethral resection of bladder tumor (TURBT) or a transurethral resection (TUR) is the most common treatment for early-stage or superficial (non-muscle invasive) bladder cancers
  • Surgical removal of all or part of the bladder (radical or partial cystectomy) is used for invasive bladder cancer
  • Reconstructive surgery after radical cystectomy
    • If the entire bladder is removed, patients need another way to store urine and pass it out of the body
• Intravesical therapy in which a liquid drug is administered into the bladder 
• Chemotherapy 
• Radiation therapy 
• Immunotherapy 
• Monoclonal antibodies
• Targeted therapy drugs