最后更新: 2026 年 8 月 15 日
Bladder cancer is the commonest cancer of the urinary tract, and it announces itself in a very particular way: blood in the urine, without any pain at all. That absence of pain is exactly what makes it dangerous, because pain is what usually sends people to a doctor.
One point before anything else, because it is the reason diagnoses get delayed. The bleeding is usually intermittent. It appears for a day or two, then stops completely, and the urine looks entirely normal again. That is not the problem resolving — the tumour does not go away when the bleeding does. A single episode of painless blood in the urine deserves investigation, even if it never comes back. Waiting to see whether it happens again is the most common and most costly mistake with this disease.
The two major 风险因素
1. Smoking
Tobacco is by far the largest risk factor: roughly 50% of bladder cancer patients have smoked, and smokers carry up to six times the risk of non-smokers. The risk rises with both how long and how heavily you smoked.
Two things are worth knowing about that. First, the elevated risk persists for decades after quitting — which means a man who stopped fifteen years ago should still take painless hematuria seriously rather than assuming smoking is behind him. Second, quitting is still worth it: the risk falls over time, and it also lowers the chance of a tumour coming back after treatment. The risk from electronic cigarettes is not yet established.
2. Occupational exposure
10–20% of cases are attributed to work exposure — chemicals used in making dyes, paint, rubber and petroleum products, inhaled over years. This is a modifiable risk: proper industrial safety practice and protective equipment genuinely reduce it. If your work has involved these, it is worth mentioning to your doctor, since it changes how seriously a single episode of hematuria should be taken.
What the assessment involves
The purpose of the workup is to find or exclude a tumour, and to distinguish it from the other things that cause blood in the urine — infection and stones being the commonest.
A full history and examination come first, then urine tests, then CT with contrast to image the whole urinary tract. The decisive investigation is cystoscopy — passing a telescope into the bladder to look directly at the lining. Nothing else sees the inside of the bladder as reliably, and the same procedure allows a suspicious area to be biopsied and a tumour resected, so it is diagnostic and therapeutic at once.
The encouraging part is that bladder cancer found early is very treatable. Most cases are non-muscle-invasive at diagnosis and are managed endoscopically, without removing the bladder. What decides the outcome, more than almost anything else, is how quickly the first episode of bleeding is investigated. If a tumour is found and treated, regular surveillance afterwards becomes part of the picture too.
If you have experienced painless blood in urine or would like a bladder cancer evaluation, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. 预约咨询。如需预约 Samitivej Sriracha Hospital 的门诊,请致电泌尿外科,电话: 088-022-1445.
Frequently Asked Questions about Bladder Cancer
The most classic and common symptom of bladder cancer is painless hematuria – blood in the urine without any associated pain. This is the hallmark warning sign that should prompt immediate urological evaluation. Because it is painless and often intermittent, patients sometimes ignore it or assume the problem has resolved when the urine clears, which can delay diagnosis. Any episode of blood in urine, even a single occurrence, warrants investigation.
Yes. Smoking is the single most significant risk factor for bladder cancer, responsible for approximately 50% of cases. Smokers have up to six times the bladder cancer risk of non-smokers. The risk increases with both the duration and intensity of smoking. Importantly, quitting smoking reduces risk over time but elevated risk persists for decades after cessation.
Workers with chronic occupational exposure to aromatic amines and other chemicals used in the production of dyes, rubber, paint, and petroleum products account for 10–20% of bladder cancer cases. Other risk factors include older age, male sex, chronic urinary tract infections, and certain medications such as cyclophosphamide used in chemotherapy.
Bladder cancer diagnosis typically involves a combination of urine cytology (microscopic examination for cancer cells), CT urography with contrast (to assess the entire urinary tract), and cystoscopy (direct endoscopic visualization of the bladder interior). Cystoscopy allows for biopsy and transurethral resection of suspicious lesions, serving as both a diagnostic and therapeutic tool.
Yes. When detected early, bladder cancer has excellent treatment outcomes. Non-muscle-invasive bladder cancer (the most common type) is treated with endoscopic resection and intravesical therapy, with high survival rates. Muscle-invasive cases require more aggressive treatment including radical cystectomy or chemoradiation. Early detection through prompt evaluation of hematuria is critical to achieving the best outcomes.
免责声明: 本文由曼谷医院总院的董事会认证泌尿科医师索拉维·维拉索蓬（Soarawee Weerasopone）博士撰写并审核。本内容仅供教育目的，不构成医疗建议。通过私人消息渠道不提供任何医疗建议、诊断或处方。在开始任何医疗治疗之前，请务必咨询合格的医疗保健专业人员。.
医学撰写与审核：Soarawee Weerasopone 医生（Pom 医生）——曼谷医院总院认证泌尿科医师，自 2016 年起从事泌尿外科临床工作。进修：台湾长庚纪念医院机器人手术学（2019 年） · 临床观察员：东京顺天堂大学附属医院泌尿内视镜学（2022 年） · 研究学者与临床观察员：美国贝勒医学院斯科特泌尿外科系（2025–2026 年）。.
Soarawee Weerasopone 医生（Dr. Pom）是 Bangkok Hospital Headquarters 的委员会认证泌尿科医生，专长于男性健康、机器人手术（da Vinci Xi）及肾结石治疗。他于 2019 年在台湾 Chang Gung Memorial Hospital 完成男科学及机器人手术与微创泌尿外科两项临床专科进修，2022 年在东京 Juntendo University Hospital 完成腔内泌尿外科观摩学习，并于 2025–2026 年在贝勒医学院 Scott 泌尿外科师从 Mohit Khera 教授完成研究学者及临床观察员任职。
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