Although most bladder cancers are slow-growing, once they have spread to the bladder's muscular tissue, they often metastasize to sites such as the lungs, liver, bone, or lymph nodes.
The early stages of bladder cancer may not produce any noticeable signs or symptoms. The most common sign of bladder cancer is hematuria (bloody urine; urine that appears bright red or rusty). Hematuria is usually painless and may only appear occasionally over a period of months. Over 80% of all bladder cancer patients eventually do experience either gross (visible to the naked eye) or occult (visible only by microscope) hematuria.
When bladder cancer causes noticeable symptoms, they are usually the result of irritation brought about by tumor growth. "Irritative" voiding symptoms can include urination that is frequent, urgent, painful or difficult. This is referred to as dysuria. Irritative symptoms are more common among patients with "carcinoma in situ" (CIS or TIS, cancer that is "in place" and has not spread) type of bladder cancer than in patients with papillary, wart-like tumors. In fact, irritative voiding may be the only noticeable symptom of CIS. Since irritative voiding symptoms are also caused by bacterial infections and kidney stones, it is essential to see a physician to rule out these more common and less dangerous conditions. Any sign or symptom that lasts longer than 2 weeks should be evaluated by a health-care practitioner.
If a bladder tumor blocks a ureter (one of two tubes that carries urine out of the kidneys and into the bladder), a patient may experience pain in the flank. The flank is the side of the body between the ribs and the top of the hip. In some cases, tumor growth may constrict the urethra (the tube that passes urine from the bladder out of the body) and slow the flow of the urine stream. Bladder cancers that become necrotic (having areas of dead tissue) may shed pieces of dead tissue into the urine. Fragments of papillary tissue and calcareous (chalky) deposits are other forms of tumor-related matter that may be passed out with the urine.
If the tumor has spread outside of the bladder to surrounding tissues, the patient may experience pelvic pain. In addition, metastases from a bladder cancer may cause secondary symptoms, such as bone pain at the site of the new cancer or leg edema (swelling) due to involvement of the lymphatic system. Bladder cancer that has progressed to the point of organ invasion and metastasis eventually may cause the patient to lose weight and strength. Anemia (low red blood cell count), uremia (high blood levels of urea) and blood elevations of other metabolic by-products can also be caused by urinary tract obstruction and may accompany late-stage bladder cancer.