Despite a significant increase in bladder cancer cases in Korea, many Koreans don't know much about the disease. Even when they have visible red urine (visual hematuria), a typical symptom of bladder cancer, they don't think about the risk of bladder cancer.

That shows why the Korean Urological Oncology Society is launching the “Bladder Cancer Red Balloon Campaign” this year.

“Bladder cancer is increasing in many people, but we don't know much about it yet. One of the things you should always pay attention to when you have bladder cancer is 'red urine,'” said Professor Koo Ja-yoon of the Department of Urology at Dongnam Institute of Radiological and Medical Sciences on the YouTube channel ,“I am a doctor.”

Professor Koo explained that the Korean Urological Oncology Society is conducting a bladder cancer campaign with red balloons, which means, “If you see red urine coming out of a round bladder, be alert.”

So, how serious is the increase in bladder cancer patients in Korea? According to the National Cancer Registry Statistics 2022 released in 2024, the number of bladder cancer cases in Korea was 5,261, a 44 percent increase from 3,655 in 2012, about 10 years ago.

“According to the most recent National Cancer Registry Statistics, bladder cancer is the 10th most common cancer among men, and the incidence rate is increasing very rapidly compared to 10 years ago, but there is still a lack of awareness about bladder cancer,” Professor Koo said.

So why is the number of bladder cancer patients in Korea increasing so dramatically?

Professor Ha Yun-sok of the Department of Urology at Kyungpook National University Chilgok Hospital said, “I think it can be said that the incidence rate has increased due to the increasing number of older adults and better access to hospitals as we become an aging society. In the United States and the United Kingdom, bladder cancer is among the top five male cancers.”

In particular, bladder cancer is more common among older men than women.

Professor Kim Kyung-hwan of the Department of Urology at Pusan National University Hospital said, “In the case of bladder cancer, about 85 percent of all patients are over 60. About three-quarters of all bladder cancer patients are men, and men tend to be three times more likely to develop the disease.”

Why is bladder cancer more common in men, then? It's because the risk factors for bladder cancer include smoking and chemicals, including dyes, leather treatment, and pesticides, and men are more likely to smoke or work in jobs that involve these chemicals.

“Aromatic amines come out (from tobacco and chemicals),” Professor Koo said. “When they enter the respiratory tract, they can cause bladder cancer, so I think there are more cases of bladder cancer in men than in women because of their occupation and smoking history.”

The typical symptom of bladder cancer is painless hematuria, but there are many other symptoms of bladder irritation.

“The most typical symptom of bladder cancer is 'red urine,' which is just blood in the urine without pain, and other symptoms include residual urine, frequent urination, urgency urination, and in more advanced cases, 'urinary retention,' which is the inability to pass urine without pain or urine at all,” Professor Kim said.

Just because hematuria is a common symptom of bladder cancer doesn't mean that “hematuria is synonymous with bladder cancer.

“The most common causes of hematuria are inflammation or stones,” Professor Koo said. “However, it is important to differentiate whether it is bladder cancer or not because the prognosis and survival rate of bladder cancer varies greatly depending on when it is detected.”

“If you have residual urination, frequent urination, urgency, and pain due to bladder cancer, it means that the cancer has already metastasized beyond the bladder and is very advanced, and in such cases, even if it is diagnosed, it is too late, and the treatment methods are limited, and even if it is treated, it becomes a fatal cancer with a survival rate of less than 10 percent in severe cases,” Koo explained.

Visible hematuria may be present in 30-40 percent of cases, and if the urine is yellow and repeatedly shows blood on a microscopic urinalysis, it may be present in 1-5 percent of cases. For this reason, if you notice hematuria, whether it's visual hematuria or microscopic hematuria, on examination, you should be alert to the possibility of bladder cancer and seek urological care.

What happens if you have symptoms of bladder cancer and overlook them?

“The most unfortunate patients are women with bladder cancer,” Professor Koo said. “Anatomically, women have a shorter urethra and are more prone to cystitis. Most women think, 'Oh, it's cystitis,' and take antibiotics, and if it doesn't bleed, they endure it, and if it doesn't get better, they take medication, and they often miss bladder cancer.”

So, if you have persistent symptoms of hematuria or bladder irritation, it's essential to keep bladder cancer in mind and get evaluated by a urologist. “If antibiotics don't cure your cystitis, I recommend you go to a urologist and get checked out,” Koo said.

The cure rate for bladder cancer, like many other cancers, is lower the later it is diagnosed. What's more, bladder cancer has an added blow. Late diagnosis makes it harder to preserve the bladder and exposes patients to other quality-of-life threats, such as incontinence.

“The bladder has four layers (mucosal layer, submucosal layer, muscle layer, and serosa layer), and the mucosal layer is the innermost part that encloses the space where urine collects,” Professor Kim said, noting that bladder cancer is divided into muscle-invasive and non-muscle-invasive bladder cancer depending on whether or not the muscle layer is invaded, and that treatment outcomes are lower if cancer invades the muscle layer beyond the mucosal layer.

“Non-muscle invasive bladder cancer can be considered a benign cancer with a five-year survival rate of more than 90 percent if treated well,” Kim said. “If it invades the muscles, the outcome is worse, and if it metastasizes, the five-year survival rate drops to less than 5 percent.”

So, how is bladder cancer treated?

“In stage 1, we operate with an endoscope down the urethra. However, there are high-grade and low-grade cancers. If there is a low-malignant cancer, it is treated, and if there is a high-malignant cancer, it should be operated (to remove the bladder) in the second stage,” Professor Koo said.

“(At this point) you have to take out the bladder altogether and make a bladder out of the intestine or urinate, so the earlier you detect bladder cancer, the better in any way,” Koo said, emphasizing that if you have red urine, you should be aware of the risk of bladder cancer and go through the process of assessing your risk of bladder cancer.