Ask the Doctors 3/17

Dear Doctors: What are the symptoms of bladder cancer? I have a close friend who just got diagnosed with it and has begun treatment. We’re both wondering if there were physical signs that could have let him know that something was wrong.

Dear Reader: Bladder cancer is a common malignancy that causes more than 16,000 deaths each year. It’s the fourth-most-common type of cancer in men, and it has a strong link to smoking. Although it was previously thought that smoking tripled someone’s risk of developing bladder cancer, newer research suggests that up to half of all cases may be connected to tobacco use.

The disease typically begins in the specialized cells that form the inner lining of the bladder, which is the stretchy, muscular sac that holds urine before it leaves the body. Known as the urothelial cells, they are found throughout the urinary tract, including the kidneys and the ureters, which are the tubes that connect the bladder to the kidneys. And while it’s possible for cancer to form in urothelial cells in any location, it occurs most often in the bladder.

Once established, bladder cancer tumors can penetrate into the deeper layers of muscle that make up the bladder. As the disease advances, cancer cells can reach the lymph nodes, move to surrounding tissues and spread to other parts of the body.

The most common symptoms of bladder cancer include frequent urination, discomfort while urinating and difficulty in urinating. One of the earliest symptoms is the presence of blood in the urine.

This can range from enough blood to affect the color of the urine to amounts that are small enough that they require a urinalysis to detect. Blood in the urine may appear only occasionally. Weeks, or even months, can go by during which the urine remains clear.

In its earlier stages, bladder cancer often doesn’t cause pain. It’s possible for a man with prostate issues, which can also affect ease and frequency of urination, to overlook the symptoms of bladder cancer because they are similar. When the cancer becomes more advanced, lower back pain may occur. This is typically present on just one side of the body. Pain in the hips or pelvis is also possible.

While bladder cancer is common in men, it is not seen as often in women. In fact, it’s not even in the top 10 cancers that women get. Due to an overlap of symptoms, signs of bladder cancer in women can be mistaken for a urinary tract infection. This can lead to a delay in diagnosis and treatment and may contribute to the disease being deadlier in women than in men. Another symptom unique to women is postmenopausal uterine bleeding. Just as with blood in the urine, this should not be ignored.

Someone experiencing the symptoms of bladder cancer should see their doctor. Depending on the stage, treatment includes surgery, chemotherapy, radiation therapy and targeted immunotherapy. When it is caught and treated early, bladder cancer has a very good survival rate.

Send your questions to askthedoctors@mednet.ucla.edu.