If you have ever experienced blood mixed in your urine, it is natural to be alarmed. However, when hematuria appears once or twice and then disappears, many people dismiss it as simple fatigue. This is especially true if there is no pain.
However, painless hematuria can be an important signal sent by urinary system diseases, including bladder cancer. In particular, if hematuria appears for the first time after the age of 50, it is necessary to identify the cause even if the symptoms have disappeared.
Core risk factor "Smoking"… Quitting smoking lowers the risk of recurrence
The bladder is an organ that stores urine produced by the kidneys before expelling it from the body. Bladder cancer is a type of cancer that develops in the urothelial cells lining the inside of the bladder, and is considered one of the representative urinary system cancers alongside prostate cancer and kidney cancer. It mainly occurs in older age groups, with men developing it approximately 3 to 4 times more frequently than women.
The most prominent risk factor for bladder cancer is smoking. Carcinogens in tobacco are absorbed from the lungs into the bloodstream and then excreted through urine. During this process, repeated exposure of the bladder mucosa to carcinogens can increase the risk of cancer development.
From a lifestyle perspective, the most important factor is quitting smoking. Quitting smoking not only helps prevent bladder cancer but also reduces the risk of recurrence and progression after treatment. In addition, risk factors include △aging △exposure to chemicals in industries such as dyes, rubber, and leather △chronic bladder irritation △long-term use of urinary catheters △bladder stones △a history of pelvic radiation therapy △and certain anticancer drugs.
The most common signal is "painless hematuria"
The most common symptom of bladder cancer is hematuria. Hematuria associated with bladder cancer is often painless. Urine may appear pink or bright red, or it may look dark brown or cola-colored. There are also cases where blood is not visible to the naked eye and hematuria is detected only through urine tests.
The problem is that hematuria can disappear on its own after appearing once or twice. Consequently, some people do not seek medical attention even when there is an actual abnormality. Of course, not all hematuria indicates bladder cancer; it can arise from various causes such as urinary tract infections or urinary stones. What matters is identifying the cause if hematuria occurs.
Symptoms may also include frequent urination, a sudden and difficult-to-control urge to urinate, pain during urination, and a sensation of incomplete bladder emptying. In advanced cases, pelvic or flank pain may appear.
Bladder cancer treatment varies depending on the "depth of invasion"
When hematuria occurs, urine tests and urine cytology are performed, and imaging examinations such as CT (computed tomography) are conducted as needed. Cystoscopy is a crucial examination for confirming bladder cancer. It involves inserting a thin endoscope through the urethra into the bladder to directly observe the interior of the bladder. This allows for the confirmation of tumor location, size, and number.
If suspicious lesions are found, tissue samples are taken to determine the type of cancer and the extent of invasion into the bladder wall. Bladder cancer treatment varies depending on how deeply the cancer has invaded the bladder. For early-stage bladder cancer limited to the bladder mucosa or the layer beneath it, transurethral resection of bladder tumor (TURBT) is often performed. This method involves removing the tumor by inserting an endoscope through the urethra without making an incision in the abdomen.
Depending on the risk of recurrence, intravesical chemotherapy or BCG (immunotherapy derived from tuberculosis bacteria) immunotherapy may be administered into the bladder. On the other hand, if the cancer has invaded the muscle layer of the bladder, as in muscle-invasive bladder cancer, more aggressive treatment is required. A representative treatment is radical cystectomy.
After bladder removal, a new urinary drainage pathway is created to allow urine to be expelled from the body, taking into account the patient's condition and kidney function. Recently, robotic-assisted cystectomy has also been performed. With the development of new treatments such as immune checkpoint inhibitors and ADCs (antibody-drug conjugates), treatment options for advanced bladder cancer are expanding.
Is it over once surgery is done?… Management is needed to prevent recurrence
Compared to other cancers, bladder cancer has a relatively good prognosis when detected in the early stages. However, since recurrence is common even after treatment, regular follow-up observation is important. Bladder cancer is not a disease that ends with a single treatment; it requires continuous management. Patients must undergo regular cystoscopy and urine cytology tests according to their risk level.
Lifestyle management is also important, including practicing smoking cessation, consuming adequate fluids, maintaining regular exercise, and eating a balanced diet. Above all, if hematuria reappears, it should not be dismissed simply because previous examinations or treatments were received.
If blood is seen in the urine, it should never be ignored even once. Identifying the exact cause is the first step in maintaining bladder health. A small change discovered in the urine today could be an important signal for protecting health tomorrow.
External contributor - Professor Chung Seung-il, Department of Urology, Hwasun Chonnam National University Hospital
in THEBIO
