The short answer
The most common sign of bladder cancer is blood in the urine, which is often rusty to bright red. Other signs include urinating often or pain when urinating. Blood in the urine should always be checked.
Blood in the urine is the most common sign of bladder cancer.
The urine is often rusty to bright red, or the blood may be seen only on a test.
Other signs include needing to urinate often or pain when urinating.
Blood in the urine has many causes, but should always be checked.
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The simple version
The bladder stores urine until it leaves the body. The most common sign of bladder cancer is blood in the urine. It is often rusty to bright red. Blood in the urine has many causes. It should always be checked.
Signs to know
Possible signs include:
- Blood in the urine, the most common sign, which may be visible or found only on a test
- Needing to urinate more often than usual
- Pain or a burning feeling when urinating
- Feeling a strong need to urinate without being able to
- Waking at night to urinate
- In more advanced disease, inability to urinate, pain on one side of the lower back, belly pain, bone pain, weight loss without trying, loss of appetite, foot swelling, or tiredness
Blood in the urine should always be checked, even though it is usually not cancer.
Blood in the urine is usually not cancer, but check it anyway
Blood in the urine has many possible causes. The NCI lists urinary tract infections and kidney or bladder stones among them. A doctor, not you, should work out which it is. Sometimes the urine looks completely normal and blood shows up only when a sample is tested. Either way, blood in the urine can be a sign of bladder cancer. So any episode of blood in the urine deserves a doctor visit. Do not wait to see if it happens again.
Why urinary symptoms alone are trickier
Needing to urinate often, or pain when urinating, overlaps heavily with common conditions. Urinary tract infections are a common example. Symptoms like these, without blood in the urine, point less clearly to bladder cancer. Still, tell your doctor about urinary symptoms that last or keep coming back.
Smoking is the biggest risk factor
The American Cancer Society estimates that smoking causes about half of all bladder cancers. If you smoke or used to smoke, mention this when you report urinary symptoms. It may change how quickly your doctor wants to investigate further.
What tests come next
The NCI says evaluation typically starts with a urine sample. What comes next depends on that result and on your history. The American Cancer Society lists cystoscopy as the main test. The doctor may also order imaging such as a CT scan of the kidneys, ureters, and bladder. In a cystoscopy, where a thin lighted tube goes into the bladder through the urethra so the lining can be seen. Your care team decides which tests you need.
What a urine test can show
A urine test, called a urinalysis, can detect blood that is not visible to the eye, along with signs of infection. Some clinics also use a urine cytology test, which looks at cells shed into the urine under a microscope for signs of cancer. This test is not perfect on its own. The American Cancer Society says not finding cancer on this test does not always mean you are cancer free.
If blood in the urine comes and goes
Blood in the urine can show up once and then stop. That does not mean the cause is gone. Any episode of visible blood in the urine deserves an evaluation, even if it does not happen again right away.
What to ask your team
Ask whether blood in your urine needs a cystoscopy or other tests. Ask whether your symptoms could be an infection or stones instead of cancer. Ask what your smoking history means for your risk. Ask what tests you need next.
Sources
Common questions
What is the most common sign?
Blood in the urine (hematuria) is the most common sign. The urine is often rusty to bright red, or the blood may be found only on a urine test.
What other symptoms occur?
Other possible signs include needing to urinate more often, pain or burning when urinating, or feeling the need to urinate without being able to.
Does blood in the urine mean cancer?
Usually not. The NCI says infections, kidney or bladder stones, or other kidney problems could be the cause. But because it can be a sign of bladder cancer, it should always be checked.
What raises the risk?
Smoking is the biggest risk factor for bladder cancer. Certain workplace chemical exposures also raise risk.
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Last updated: 2026-10-02Next planned review: 2027-07-07
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Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes, and this is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and then compared with the sources listed on it, looking for statements those sources do not back up. That check is not a sentence-by-sentence record and can miss errors. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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