What You Need to Know About Bladder Cancer

July 2, 2020

According to the American Cancer Society, bladder cancer effects approximately 700,000 people in the United States.There will be an estimated 80,000 new cases in 2020. The biggest risk factor for bladder cancer is smoking cigarettes. Other risk factors include Actos (a medication for diabetes), dietary supplements containing aristolochic acid, drinking water containing high levels of arsenic and exposure to certain chemicals used in manufacturing of textiles and dyes. There does not appear to be an inherited risk for bladder cancer.

The first sign of bladder cancer is often blood in the urine. It is not always visible blood, and might be detectable only by a laboratory examination of the urine by a microscope. Other symptoms of bladder cancer can include urinating more frequently and/or a sense of needing to urinate more urgently, needing to urinate more often during the night, pain with urination, an inability to urinate, and/or pain in the lower abdomen.

These symptoms may be present with other conditions and are not always due to bladder cancer. A simple urinary tract infection, kidney or bladder stone, enlarged prostate or interstitial cystitis (bladder pain, urgency and frequency of urination), among several other non-cancer conditions may cause these symptoms.  It is important to see your provider when you have urinary symptoms, especially visible blood in your urine to determine the cause. Your primary care provider may perform some initial blood or urine testing, or refer you to an urologist if needed. 

A urologist is a surgeon who specializes in how the urine system works.  The urologist may look inside your bladder with a camera via a procedure called cystoscopy. CT scans are helpful in some cases to look at the bladder, kidneys, lymph nodes and the ureters (tubes that connect each kidney to the bladder).  If there is a concern for cancer a biopsy may be performed or you may need surgery to remove the lesions.  Like many cancers, it is crucial to find bladder cancer at the earliest possible stage.  Early detection allows the highest cure rate and sometimes can decrease the amount of surgery that needs to be performed..  If bladder cancer is detected, there are many effective treatment options to help cure or control the cancer, lessen symptoms and hopefully preserve normal urination.  Depending on the stage of the cancer, treatment may require the involvement of multiple specialties including urology, radiation oncology and medical oncology in addition to primary and supportive care providers.  The key takeaway is to get prompt medical attention for any concerning symptoms, especially blood in the urine and to speak with your provider about smoking cessation.

Ivy Altomare

Co-Authored by:
Helen Tackitt, DNP, RN, FNP-BC, NE-C 
Director of Clinical Practice and Education 
Duke Cancer Network 


Helen Tackitt

Ivy Altomare, MD, 
Associate Professor of Medicine
Division of Medical Oncology
Duke University Medical Center
Duke Cancer Network.