The secret to stopping bladder cancer is early detection

Bladder cancer is the fourth leading cause of cancer death in America.  The large majority of these cancers (90%) originate in the lining of the bladder, known as the urothelium or transititional epithelium. Once bladder cancer metastasizes, or spreads outside the bladder, only 5% of persons live two years after the diagnosis.

The goal is to detect bladder cancer before it metastasizes.  The best thing that you can do is to arm  yourself with  knowledge about the signs and symptoms of bladder cancer so you can detect it in the early stage of the disease.

What are the warning signs of bladder cancer?

The most common sign of bladder cancer is blood in the urine, known as hematuria. Hematuria can be "gross hematuria", where the blood in the urine is visible to the naked eye, or "microscopic hematuria", where the blood is so small that it can only be viewed under a microscope. It is unlikely that you will be aware of microscopic hematuria unless a urinalysis is ordered by your physician for the microscopic evaluation of your urine.

There should never be any blood in the urine.  When you have "gross hematuria" (blood in the urine that you can see when you urinate), this is a potentially ominous sign of bladder cancer.  While there are several causes of gross hematuria, such as a prostate infection, gross hematuria should never be taken lightly.  In fact, if you are over the age of 50, any blood in the urine is presumed to be caused by bladder cancer until proven otherwise by inspection of the inner bladder known as cystoscopy.

If you are diagnosed with hematuria, ask your doctor: Do I have gross or microscopic hematuria?  Do I have protein in my urine known as proteinuria (you should not have protein the urine).  You should ask: Have I ever had hematuria before?  What is the most likely cause of the hematuria?  What tests will you order to rule out bladder cancer as the cause of the hematuria?

There are other signs and symptoms of bladder cancer, but blood in the urine is the big one.  The other signs include a frequent urge to urinate, pain when you urinate and lower back pain.  These signs and symptoms are not specific to bladder cancer and are also caused by non-cancerous conditions, including prostate infections and cystitis.

Here's a special tip: If you have blood in your urine and your doctor tells you not to worry about it, INSIST UPON CYSTOSCOPY!  Some doctors minimize the significance of blood in the urine, i.e., "everyone your age has it" or "it's probably just inflammation of the prostate", but the standard of care for primary physicians is to order cystocopy when a person over the age of 50 has blood in his/her urine.

Of course, the hematuria may have a perfectly benign cause, such as prostatitis or an infection of the prostate.  However, the most deadly causes should be ruled out first and in the case of hematuria, bladder cancer is the most deadly cause.

Another tip:  Insist upon a referral to a urologist for the evaluation of hematuria.  A urologist is a specialist who treats disorders of the urinary tract and treating bladder cancer is among this specialist's forte.  You want a urologist treating your hematuria, not a primary care physician.

When bladder cancer has been diagnosed, you want to ask these questions

The bladder is a hollow organ in your lower abdomen that stores urine.  Bladder cancer starts in the lining of the bladder and can spread through the wall of the bladder.  The wall of the bladder has several layers and once the tumor extends through the bladder wall, it can grow into nearby organ, such as the prostate gland in men.  When bladder cancer spreads outside the bladder, cancer cells are often found in nearby lymph nodes.

Tumors are categorized as low stage (superficial) or high stage (muscle invasive). Invasive tumors grow down into the deep layers of bladder tissue, while supeficial tumors affect only the bladder lining.  You should ask your doctor whether the tumor is "superficial" or "invasive".

The "grade" of the cancer is an estimate of the speed of tumor growth a suggested by cell features seen under a microscope.  The type of cancer cells for bladder cancer is almost always transititional cell and the cancer cells are classified to three grades that correspond to well, moderately and poorly differentiated cells.  Your doctor should be able to tell you whether the cancer cells are high grade or low grade based upon the cellular features of the cancer cells under a microscope.  A "low grade" tumor is indolent and slow growing while a "high grade" tumor is aggressive and fast growing.

When tumors infiltrate the bladder, some or all of the bladder may have to be removed (radical cystectomy) adn the urinary system is diverted.  The goal is to detect bladder cancer before it invades the all of the bladder and spreads to surrounding organs and tissues.

If you have questions or want more information, I welcome your phone call

I welcome your phone call if you have any questions.  You can always request my free book, The Seven Deadly Mistakes of Malpractice Victims, on the home page of my website at  Please feel free to send a link to this article to a friend or family member.