If Bladder Cancer Isn’t On Your Radar, It Should Be — 5 Things to Know

Bladder cancer is the 10^th leading cause of cancer death in the United States. Yet, it's typically not on people's “cancer radar”.

"A lot of urology topics don't get talked about in the community," says MU Health Care urologist Crystal Valadon, MD. "As a result, people don't understand their risk or recognize the signs of bladder cancer. And a bladder cancer diagnosis is especially distressing if you don't know much about the disease or the support that exists."

To give you a better sense of risk factors, symptoms and prognosis, Dr. Valadon shares five facts about bladder cancer that everyone should know:

1. Smoking Is the #1 Bladder Cancer Risk Factor

Most people think smokers mainly have to worry about lung cancer. But smoking also plays a major role in the development of bladder cancer.

Consider these facts:

• Smoking is the most common risk factor for bladder cancer.
• A smoker's bladder cancer risk is three to four times higher than that of a nonsmoker.
• Smoking contributes to 50% of all bladder cancers.

So, what's the connection? There are more than 70 cancer-causing chemicals in tobacco. When you use tobacco, those chemicals get into your blood, pass through your kidneys and collect in your urine. As urine sits in your bladder for hours waiting to be emptied, it exposes the bladder to high levels of toxic chemicals.

"Is smoking associated with lung cancer? Absolutely," Dr. Valadon says. "But people don't often realize the link that exists between smoking and bladder cancer. It is the leading risk factor."

Research also strongly suggests that if you continue to smoke after a bladder cancer diagnosis, the cancer is likely to progress and come back.

While there is not yet conclusive evidence linking nicotine to cancer, experts believe there may also be a connection between vaping and bladder cancer. E-cigarettes don't contain tobacco, but 90% of the nicotine you breathe in while vaping is excreted through the urine and spends time in the bladder. The exposure can damage the cells in the bladder lining, which increases the risk of cancer.

2. Non-Smokers Are Still at Risk for Bladder Cancer

While smoking is the most common risk factor, it's not the only bladder cancer risk factor. Other factors that increase your risk include:

• Age: 90% of the people diagnosed with bladder cancer are older than age 55.
• Having a chronic indwelling catheter: Having a catheter in place for a long period can cause constant irritation to the bladder, which increases cancer risk.
• Sex: Men are more likely to develop bladder cancer than women.
• Workplace exposure to chemicals: Working around chemicals associated with things such as rubber, textiles, paints and dyes is the second-most significant risk factor for bladder cancer

"If your work exposes you to toxic chemicals, it's critical to pay attention to your safety protocols," Dr. Valadon says. "Take the appropriate precautions to minimize your exposure to those chemicals during your daily life."

3. Blood in the Urine Is the Most Common Symptom of Bladder Cancer

Having blood in your urine — even if it comes and goes — is never normal. It's an early sign of bladder cancer and is also associated with other conditions, such as:

• Advanced prostate cancer
• Bladder stones
• Enlarged prostate
• Kidney stones
• Renal masses
• Tumors located anywhere in the urinary tract

"Having blood in your urine is normally the first sign of bladder cancer — a tumor in your bladder is bleeding," Dr. Valadon says. "Approximately 80% of patients who have bladder cancer will present with blood in the urine."

In most cases, the blood in your urine will be visible with your naked eye. Urine is typically clear or pale yellow — or more orangey if you are under-hydrated. Blood gives urine a pink tinge.

"Your first reaction to seeing blood in the toilet should always be that this is not normal," Dr. Valadon says. "Err on the side of caution. If you are concerned or questioning whether it is blood in your urine, talk to your primary care provider or get your urine evaluated by a urologist. No matter what's causing it, it's best to act sooner."

It's important to note that you can have traces of blood in your urine that you can’t see (called microscopic hematuria). It's not uncommon for bladder cancer to be detected when an unrelated lab test shows microscopic blood in the urine.

4. Bladder Cancer Symptoms Often Mimic UTI Symptoms

Urinary tract infections (UTI) are bacterial infections that can develop in any part of the urinary system, including the bladder. They are relatively common — more than half of women will have a UTI at some point — and can be treated with antibiotics.

But it's never a good idea to assume your symptoms point to a UTI — especially because many of those symptoms can also indicate bladder cancer. Symptoms that UTI and bladder cancer have in common include:

• Blood in the urine
• Burning or pain with urination
• Increased urgency to pee
• Peeing more often than usual

"When there is a tumor aggravating your bladder, it can cause any and all of these symptoms," Dr. Valadon says. "But cancer is rarely the first thought when these symptoms arise. That's why you shouldn't wait to be evaluated by your doctor."

Your doctor will test your urine for infection, and any blood in your urine should resolve when the infection is treated. If not, the cause of the blood will require closer analysis. Your doctor will consider your risk factors for bladder cancer and your symptoms, possibly ordering imaging to provide a closer look at your bladder.

Lower back pain, pelvic pain or unexplained weight loss, are additional signs of undiagnosed bladder cancer.

5. Most Bladder Cancer Is Not Life-Threatening, But It Is Lifelong

If a bladder tumor is identified, your doctor will perform an endoscopic procedure to scrape out the tumor to learn more about it. Based on those findings, bladder cancer can be classified into two categories:

• Low-grade cancer is not likely to spread outside of the bladder and will not affect your life expectancy. But it still requires treatment, is likely to come back and can cause symptoms that can affect your quality of life.
• High-grade cancer has the genetic capability to be dangerous and spread. Your doctor will look at how deep the tumor is in the bladder wall to determine the best treatment path.

Low-grade bladder cancers account for 70% of all diagnosed cases. The good news is that it is rare for low-grade bladder cancers to progress to high-grade or become invasive. However, low-grade bladder cancer requires lifelong management, since it will keep coming back.

"Determining whether bladder cancer is low-grade or high-grade is an important first step, because high-grade cancer is aggressive and life-threatening," Dr. Valadon says. "Although the majority of bladder cancers are low grade, diagnosis is still critical."

Next Steps and Useful Resources

• Want to discuss more with a doctor? Find a urologist or primary care doctor.
• Want to learn more about bladder cancer? See our services.