The presence of blood in the urine, known as hematuria, is the predominant symptom of bladder cancer. Sometimes it can be confused with other urinary problems. The Spanish Association of Urology (AEU) emphasizes the importance of not ignoring these signs.
The AEU warns that, although hematuria is not directly related to cancer, it should always be evaluated by a specialist to rule out complications, reviews EFE Health. Early detection significantly improves prognosis and may make less invasive treatments possible.
Identifiable risk factors
Smoking is identified as the greatest risk factor in the development of bladder cancer, increasing the risk up to three times in smokers.
Other factors that contribute to risk include occupational exposure to industrial substances and parasitic conditions. Recent studies also suggest a possible relationship with the human papillomavirus (HPV).
Other symptoms to take into account
Additional symptoms of bladder cancer, beyond hematuria (blood in the urine), include signs that may indicate disease progression and should be closely monitored.
Common urinary symptoms. These are part of the irritative voiding syndrome and usually appear in deeper tumors: pain or burning when urinating, increased urinary frequency, urgency to urinate even with an empty bladder, difficulty in starting urination or a weak stream, and getting up frequently at night.
Breakthrough symptoms. In more advanced stages or with spread, the following arise: inability to urinate, lower lumbar pain (unilateral), belly or pelvic pain, bone pain, loss of appetite and involuntary weight, swelling in the feet or legs, extreme fatigue and weakness.
Key recommendation. These signs are not exclusive to bladder cancer and may be due to infections or other causes, but their persistence warrants immediate medical consultation to rule out complications.
Screening Exams
To determine the cause of hematuria (presence of blood in the urine), the doctor usually combines a medical history, physical examination and a series of complementary tests.
Basic laboratory exams
- Complete urine analysis (uroanalysis): Hematuria is confirmed, bacteria, leukocytes, and proteins are looked for and the morphology of the red blood cells is examined to determine whether the bleeding is glomerular or from the lower urinary tract.
- Urine culture: Use US if there is suspicion of a urinary tract infection (that is, if there are symptoms such as burning when urinating, increased frequency or fever).
- Blood test: Kidney function (creatinine, urea), hemoglobin (to rule out anemia) and, if applicable, coagulation tests or other markers are evaluated.
Imaging tests
- Kidney and bladder ultrasound: It is the first imaging test; allows you to see kidneys, bladder, presence of stones, tumors or structural abnormalities.
- Computed tomography of the belly and pelvis (CT uropyelotomography): US is used to detect stones, tumor masses, blockages or inflammation of the kidneys in more detail than ultrasound.
- Uro-MRI or magnetic resonance urography: In some cases, it is used to evaluate the urinary system, especially if contrast or CT cannot be used.
Targeted invasive procedures
- Cystoscopy: A thin endoscope is introduced through the urethra and into the bladder to directly visualize the bladder and urethra, and detect tumors, inflammation, stones, or lesions.
- Kidney biopsy: It is performed if a glomerular disease (for example, glomerulonephritis) is suspected based on hematuria, urine protein, impaired kidney function, or family history.
Additional tests according to suspicion
- Genetic or hemoglobinopathies tests: If you are thinking about sickle cell anemia, Alport syndrome or other hereditary diseases.
- Autoimmunity tests (e.g. ANA, ANCA): When autoimmune disease or vasculitis is suspected as a cause of glomerular hematuria.23
In practice, the doctor selects these tests based on the type of hematuria (gross or microscopic), age, sex, associated symptoms, and initial urine and blood results. If you want, you can indicate your age and symptoms and I will explain which tests would be most likely in your case.
Progress in treatments
Recently, the impact that immunotherapy and conjugated antibodies have in the treatment of this cancer has been highlighted, improving patient expectations.
The monitoring details the use of circulating tumor DNA (ctDNA) and new therapeutic targets, which predicts a more personalized and effective future in oncological treatments, according to SEOM.
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