Bladder cancer most commonly presents with blood in the urine, or hematuria. Hematuria is classified as either visible by eye, which is gross hematuria, or under microscopic laboratory examination, microscopic hematuria. Depending on the amount of blood in the urine, the urine may appear yellow, orange, brown, dark or bright red. Bladder cancer may cause burning or discomfort with urination and/or more frequent urination. In addition, bladder cancer may cause obstruction of the urinary system, leading to flank pain and discomfort. Advanced bladder cancer may present with weight loss, fatigue, difficulty or inability to urinate, abdominal and/or lower back pain.
Evaluation for hematuria should include cystoscopy and imaging of the kidneys, ureters, and bladder with CAT scan or Magnetic Resonance Imaging (MRI). A positron emission tomography (PET) scan may also be helpful at times to identify whether cancer has spread beyond the bladder. In addition, cystoscopy must be performed to visualize the lining of the bladder and urethra. Suspicious lesions visible on cystoscopy are biopsied to adequately determine the grade and stage of bladder cancer, if present. The depth of cancer invasion into the layers of the bladder wall determines the available treatment options.