Bladder cancer symptoms: blood in urine and other signs

The NHS says the main symptom of bladder cancer is blood in your pee. Blood in your pee may be bright pink, red or dark brown. The NHS says to get it checked even if you have no other symptoms, it is the first time it has happened, there is only a small amount of blood, or you are not sure it is blood.

The NHS lists other symptoms, which are very common and can be caused by other conditions.

• Pain, burning, stinging or itching when you pee.

• Getting lots of urinary tract infections.

• Needing to pee more often.

• Needing to pee very suddenly.

• Losing your appetite and losing weight without trying to.

• Pain in your back and lower tummy.

• Aching, pain or tenderness in your bones.

• Feeling very tired for no reason and feeling generally unwell.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have blood in your pee, even if you do not have any other symptoms, it is the first time it has happened, there is only a small amount of blood or you are not sure if it is blood.

The NHS says to see a GP if you think you may have bladder cancer, and tells people to try not to be embarrassed because GPs are used to talking about these symptoms. Having these symptoms does not definitely mean you have bladder cancer, but it is important to get checked. If symptoms are caused by cancer, finding it early may mean it is easier to treat.

Many people with these symptoms do not have cancer. The NHS says blood in urine could come from anywhere in the urinary tract, and lists the causes below. It may also not be blood: beetroot can turn pee pink, some medicines can turn pee red or brown, bleeding may be from the bottom or vagina, or it may be during a period.

The NHS says it is not always known what causes bladder cancer, and lists factors that make it more likely. One of the main causes is smoking.

• Being over the age of 60.

• Being a man.

• Smoking or using chewing tobacco.

• Having had a urinary catheter in for a long time.

• Having had radiotherapy for cancer before.

• Being overweight.

• Having a close relative with bladder cancer.

• Having certain conditions, such as diabetes.

• Working with chemicals, such as those used in the textile industry, or handling carbon or crude oil.

• Having had an infection called schistosomiasis (bilharzia).

At a GP appointment, the NHS says, depending on your symptoms a GP may need to check inside your bottom (rectal examination) or vagina to feel for lumps, and you may need a blood test or a urine sample. You can ask for a male or female doctor, and for a chaperone. The GP may refer you for more tests or to a specialist, which may be an urgent referral. This does not definitely mean you have cancer.

NICE guideline NG12 says a suspected cancer pathway referral for bladder cancer should be made for people aged 45 and over with unexplained visible blood in the urine without a urinary tract infection, or visible blood that persists or recurs after successful treatment of a UTI, and for people aged 60 and over with unexplained non-visible blood in the urine and either pain on peeing or a raised white cell count.

The NHS says the main test is a cystoscopy. A thin camera is passed through the urethra to see inside the bladder. It may be uncomfortable but should not be painful, and you have painkilling medicine or it may be done under general anaesthetic. A small sample of the bladder lining may be taken (a biopsy). You may get results on the same day or after a few days.

If you are told you have bladder cancer, you will usually need more tests such as an ultrasound, MRI or CT scan, blood tests or a bone scan to find out the size, type and stage. A clinical nurse specialist will be your main point of contact.

The NHS says bladder cancer can often be treated, depending on the type, size and position of the cancer, whether it has spread, and your general health. You will usually be offered surgery, and may also have chemotherapy, radiotherapy and targeted medicines.

Surgery can remove the cancer from the bladder lining, remove all or part of the bladder and create a new way to pee, or unblock the tubes that carry pee. Chemotherapy may be given before surgery or radiotherapy, at the same time as radiotherapy, after surgery, or if the cancer has spread, either into the bladder or into a vein. Targeted medicines and immunotherapy are sometimes used if there is a higher chance of the cancer coming back after surgery. If the cancer cannot be cured, treatment aims to slow growth and help with symptoms, with palliative care team support.

The NHS says you cannot always prevent bladder cancer, but there are things you can do to lower your chance of getting it: try to quit smoking, try to lose weight and wear protective clothes and masks if you work in a job where you are exposed to harmful chemicals. It also says it is important to get any symptoms checked by a GP.

On the NHS, blood in your pee is assessed through an urgent GP appointment or NHS 111, with referral to a urologist for tests and a clinical nurse specialist as your main contact if cancer is diagnosed.

Some people choose to see a private urologist, particularly to get a cystoscopy or scan sooner. In general terms the tests are the same. It is worth asking how results and any treatment plan will be shared with your GP, and whether the team will coordinate with an NHS cancer multidisciplinary team if cancer is found.