Bladder Cancer Symptoms: What You Should Know

Written by Alyson Powell Key
Medically Reviewed by Melinda Ratini, MS, DO on April 29, 2025
8 min read

Bladder cancer starts in your bladder or in the lining of your bladder, a hollow organ that stores your urine before it leaves your body. As the cancer cells grow, they form a mass called a tumor that can spread to surrounding tissue and eventually to your lymph nodes (part of your body's immune system) or to other organs.

Blood in urine

The most common – and often, the first – symptom of bladder cancer is blood in your urine. It may be just a little, or it can be enough to change the color of your pee. It may turn orange, pink, or darker red.

You may see blood one day but not the next. If you have bladder cancer, the blood eventually comes back. In some cases, you can’t see blood in your urine. "Sometimes there's asymptomatic bloody urine, meaning it's microscopic," explains Joseph Feliciano, MD, a urologist at Lehigh Valley Health Network in Pennsylvania. Your doctor or lab tech will only detect it with a urine test, which prompts more testing that may include "a referral for a cystoscopy and a CAT scan."

Blood in your urine is most likely not a sign of cancer, but rather evidence of an infection, a bladder or kidney stone, or another condition. Be sure to pay attention to other symptoms, as they may help doctors diagnose your condition. For example, blood in your urine along with pain in your sides, back, or groin can be signs of kidney stones.

Some people have a higher chance of getting bladder cancer, including those exposed to certain industrial chemicals and those with a family history of the disease. But "the number one risk factor is a smoking history," says Feliciano. "There's a carcinogen in cigarette smoke, and once it's inhaled, it gets into the bloodstream and filtered through the kidneys." These toxic chemicals build up in the urine, which then sit in the bladder, exposing the bladder lining to the chemicals for long periods.

Bladder cancer vs. bladder infection or UTI symptoms

A bladder infection, which is a type of urinary tract infection (UTI), shares many symptoms with bladder cancer, making it hard to tell the difference between these conditions without seeing a doctor.

Here's a breakdown of how the conditions are the same and different:

Similar symptoms

  • Peeing more than normal
  • Pain or discomfort when you pee
  • Pelvic pain or pressure 
  • Blood in your urine (hematuria)

Differences in symptoms

Bladder infections and UTIs: These conditions often include symptoms such as cloudy or strong-smelling urine. Bacteria typically cause these symptoms, and they may get better with antibiotics. UTIs can also cause a fever, fatigue, chills, pain in your lower back or below your ribs, and nausea and vomiting, if the infection spreads. 

Bladder cancer: If you've treated a UTI and your symptoms don't go away, especially unexplained blood in your urine without pain, this may be a sign of bladder cancer. Bladder cancer symptoms don't respond to typical treatments for infections. Talk to your doctor for an accurate diagnosis and treatment.

Other symptoms

Make an appointment if you have any of these other symptoms:

  • Your urine changes color.
  • You feel like you have to pee – even if your bladder’s not full.
  • You can’t pee, or you pee very little.

Once bladder cancer starts to spread, you may notice that:

  • You can’t pee, even when you feel like you have to.
  • Your lower back hurts.
  • You’re losing weight without trying.
  • You’re not as hungry as usual.
  • You have swollen feet.
  • Your bones hurt.
  • You often feel extremely tired or weak.

Again, see your doctor if any of these things happen to you. 

What are the 5 warning signs of bladder cancer?

There are more than five, but these are the biggest bladder cancer signs:

  1. Blood in your urine
  2. Peeing more than usual
  3. Pain or burning when passing urine
  4. Having trouble peeing
  5. Frequent bladder infections

Make an appointment with your doctor if you notice blood in your pee or have these other symptoms:

  • Pain when you begin to pee, or after
  • The urge to pee more than normal
  • You have trouble peeing
  • Bladder infections that don't go away with treatment

Once a doctor has diagnosed you with bladder cancer, they'll try to find out whether it has started to spread and how far. This process is called staging. Your cancer will be given a staging number depending on where the cancer is and how much it has spread. The higher the number, the more serious the cancer is.

In stage I, the cancer has spread into the connective tissue of your bladder or just below the lining but hasn't reached the muscle layers yet.

Symptoms include:

  • Blood in your urine
  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder's not full
  • Frequent bladder infections

In stage II, the cancer has spread to the inner or outer muscle layer of the bladder wall, but it hasn't gone through the muscle to reach the fatty tissue that surrounds the bladder. If the cancer has spread to the inner layer, it's called stage IIa; if it has spread to the outer layer, it's called IIb.

Symptoms include:

  • Blood in your urine
  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder is not full
  • Frequent bladder infections

These symptoms can be caused by things other than stage II bladder cancer but need to be checked out right away.

In stage IIIa, the cancer has now spread to the bladder muscles and wall and gone into the layer of fatty tissue that surrounds the bladder. It may have spread to reproductive organs like the prostate, uterus, or vagina but not to the lymph nodes. Or it might have spread to one lymph node in the pelvis that is not near the major arteries of the pelvis, known as the common iliac arteries.

In stage IIIb, the cancer has spread to more than one lymph node in the pelvis that's not near the common iliac arteries. Or it has spread to at least one lymph node near the the common iliac arteries.

Symptoms include:

  • Blood in your urine
  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder is not full
  • Frequent bladder infections

They may also include: 

  • Being unable to pee
  • Lower back pain on one side of the body
  • Pelvic pain
  • Weight loss
  • Loss of appetite
  • Swollen feet
  • Fatigue or tiredness

These symptoms may be caused by health issues other than stage III bladder cancer. See your doctor right away to find out the cause and best treatment.

At stage IVa, the cancer has spread to the abdominal wall or the pelvic wall. Or it's spread to the lymph nodes above the common iliac arteries.

In stage IVb, the cancer has spread to other organs or body parts, such as the lungs, bones, or liver.

Symptoms include:

  • Blood in your urine
  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder is not full
  • Frequent bladder infections

They may also include: 

  • Being unable to pee
  • Lower back pain on one side of the body
  • Pelvic pain
  • Weight loss
  • Loss of appetite
  • Swollen feet
  • Fatigue or tiredness
  • Bone pain

These symptoms are not unique to stage IV bladder cancer. See your doctor to find out what's causing your symptoms. 

If the cancer has spread to other parts of your body, you might have symptoms specific to that body part. For instance, if the cancer has spread to the lungs, you might be coughing and short of breath.

Men are four times more likely to get bladder cancer than women. But women generally are diagnosed when their cancer is more advanced. 

This is because the main symptom of the disease, blood in urine, is often linked to having a period or to menopause, so women delay going to the doctor about it. Even when they do go, the doctor may misdiagnose it as postmenopausal bleeding or a urinary tract infection, which is very common in women.

If you're a woman and seeing blood in your urine, be sure to get it checked out, particularly if you're no longer having a period. Pay attention to whether you have other signs of bladder cancer as well, like:

  • Peeing more than usual
  • Pain or burning when passing urine
  • Feeling the urge to pee even if your bladder is not full
  • Frequent bladder infections 

 

Men have a much higher risk of bladder cancer than women because they're more likely to smoke tobacco (which has a lot of toxins) and they're more likely be exposed to cancer-causing chemicals in factory work – for instance, in the paint, printing, and textile industries. All these toxins have to pass through the bladder before coming out the body. 

The signs of bladder cancer are the same for both men and women.

Symptoms of urinary bladder cancer are often similar to those of less-threatening conditions, like a urinary tract infection. The main bladder cancer sign is blood in your urine, but other symptoms include peeing more than usual, pain or burning when peeing, feeling the urge to pee even if your bladder isn't full, and frequent bladder infections. If you have any of these, see a doctor.  

Does bladder cancer spread quickly?

It can, depending on the type of bladder cancer you have. The most common type, urothelial carcinoma, also known as transitional cell carcinoma, spreads slowly. It may come back after treatment. More than 90% of bladder cancers fall in this category. Other types of bladder cancer may spread faster.

How long can bladder cancer go undetected?

Bladder cancer is often found early because it has obvious symptoms, like blood in your urine. But in women, this might be mistaken for post-menopausal bleeding or something else. It may take a year or more before doctors make a proper diagnosis.

Can bladder cancer be detected with a urine test?

Yes, doctors may be able to detect bladder cancer in your urine by using a test called urine cytology. In this test, they view a urine sample under a microscope to look for cancer cells.

How curable is bladder cancer?

Bladder cancer is often curable, especially when doctors find it early. 

How long can you have bladder cancer without knowing?

There's no specific timeframe, but a delayed bladder cancer diagnosis is possible, especially in women. Women may connect blood in their urine to their period or menopause. Plus, doctors may misdiagnose women with a UTI or another condition unrelated to cancer.