Non-muscle-invasive bladder cancer (NMIBC) often develops quietly. Some people with early-stage bladder cancer have mild symptoms — or none at all.

NMIBC means there are cancer cells inside the bladder, but they haven’t spread into the muscle layer of the bladder wall. In more advanced cases, bladder cancer may cause back pain.

If you develop new or worsening symptoms, talk to your healthcare team. They can help find out what’s going on and make sure you get the right treatment.

Here are four symptoms people with NMIBC may experience.

🗳️ Which symptom of NMIBC has affected you most?

Blood in the urine

Pain during urination

Frequent or urgent need to pee

Fatigue

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Blood in the urine is often the first sign of bladder cancer. This is called hematuria, and it can make your pee look orange, pink, or red.

Sometimes, however, the amount of blood in the urine is so little that it doesn’t affect the color (microscopic hematuria). It may go undetected until you have a urine test.

Hematuria may come and go. It happens when blood vessels in or near the tumor leak or break, releasing small amounts of blood into the urine.

Although blood in the urine is one of the most common early symptoms of NMIBC, it doesn’t always mean you have cancer. Other possible causes include:

• Urinary tract infections (UTIs)
• Kidney stones or kidney infections
• Injuries to your urinary system
• An enlarged prostate
• Menstruation

Blood in the urine can also be a side effect of treatment, such as after transurethral resection of a bladder tumor (TURBT) — a common surgery for low-grade bladder cancer. If you have surgery, your healthcare provider can let you know the difference between normal signs of healing and potential complications such as excessive bleeding.

Urinary Tract Infections and Bladder Cancer

People with bladder cancer may be more likely to get UTIs, especially after surgery or catheter use. In addition, urinary retention (not fully emptying your bladder) can raise the risk of UTIs. Some medications can contribute to urinary retention.

NMIBC can sometimes cause pain or a burning sensation while you pee. This may happen when a tumor causes irritation or a blockage.

Besides cancer itself, painful urination can also be caused by urinary tract infections or cancer treatment side effects. Other possible causes include:

• Kidney or bladder stones
• Yeast infections
• Sexually transmitted infections (STIs), such as genital herpes or gonorrhea
• Bladder irritation from some soaps or perfumes

If you’re feeling discomfort while urinating, let your healthcare provider know. They can check for infections or other possible causes.

Early-stage bladder cancer can cause changes in how often or urgently you need to urinate. You might feel like you have to go more often than usual or have a sudden, strong urge to pee even if your bladder isn’t full.

These symptoms may happen when a tumor or cancer cells irritate the lining of the bladder, making the bladder more sensitive or unable to hold as much urine.

Changes in urinary habits often have other explanations, too, and are common among older adults. However, it’s important not to ignore these symptoms. If you notice new urgency, are peeing more often, or begin having accidents, be sure to talk with your urologist or oncologist.

Fatigue is a common symptom for people living with any type of cancer. Unlike urinary symptoms, fatigue isn’t necessarily specific to NMIBC. Sometimes it’s caused by a lack of sleep or the stress, worry, or pain that may come with a cancer diagnosis.

In addition, anemia (low red blood cells) and other health conditions can contribute to fatigue.

Cancer fatigue is a type of tiredness that doesn’t get better with rest. Cancer and its treatments may also affect how your body works, contributing to fatigue. This is unusual in early cancer stages.

Fatigue can affect your mood, sleep, and ability to do everyday tasks. If you’re feeling persistently worn out, talk to your doctor. They may suggest:

• Changes to your diet or daily routine
• Light physical activity
• Stress-reduction or relaxation techniques
• Adjustments to your treatment plan

Side Effects of Treatment

Some NMIBC symptoms can also be side effects of bladder cancer treatment. If you notice new or worsening symptoms, schedule a follow-up consultation with your doctor to pinpoint the cause.

Bacillus Calmette-Guérin Therapy

Bacillus Calmette-Guérin (BCG) therapy — available as Tice BCG — is a type of immunotherapy for bladder cancer. BCG is placed directly into the bladder through a catheter, a method known as intravesical therapy.

As it stimulates your immune system to fight cancer cells, BCG can cause:

• Burning or pain during urination
• More frequent or urgent need to pee
• Blood in the urine
• Fatigue

BCG may also cause fever, body aches, and chills.

“I have pain for a day or two after BCG treatments. It mostly only happens when urinating,” shared one MyBladderCancerTeam member. “I’m usually back to normal after a week.”

Although rare, BCG can cause a dangerous systemic infection that spreads throughout the body. Contact your cancer care team if you have a fever, chills, or flu-like symptoms, especially if they last more than 48 hours. Seek medical attention right away if you have a high or persistent fever.

Immunotherapy and Other Newer Therapies

Immunotherapy drugs such as pembrolizumab (Keytruda) and durvalumab (Imfinzi) are used to treat certain cases of NMIBC. Durvalumab is used with BCG.

These medications are given through the vein and work by helping the immune system recognize and attack cancer cells. These drugs can cause side effects throughout the body, including fatigue, diarrhea, skin rash, itching, and muscle or joint pain.

Two newer treatments, nadofaragene firadenovec-vncg (Adstiladrin) and nogapendekin alfa inbakicept-pmln (Anktiva), are also used to treat NMIBC in certain situations. These medications are also given through intravesical therapy and can cause burning, pain, and blood in the urine.

Intravesical Chemotherapy

Doctors can also give intravesical chemotherapy. Because the medication is delivered directly into the bladder, side effects throughout the body are less likely. However, it may still cause burning and blood in the urine.