Okay, let's tackle this question. The question is about how cancer of the urinary bladder commonly presents. I need to recall the typical symptoms and signs of bladder cancer.

First, the core concept here is the clinical presentation of bladder cancer. Bladder cancer often presents with specific symptoms that are important for diagnosis. The most common symptom I remember is hematuria, which is blood in the urine. It can be gross (visible) or microscopic. Other symptoms might include dysuria (painful urination), frequency, urgency, or lower abdominal pain. But hematuria is the most characteristic.

Why is hematuria the correct answer? Bladder cancer, especially urothelial carcinoma (the most common type), usually starts in the urothelium lining the bladder. As the tumor grows, it can erode blood vessels, leading to bleeding into the urine. This blood isn't usually associated with pain initially, which is why it's a key differentiator from conditions like UTIs or stones. The presence of painless hematuria, especially in older adults, is a red flag for bladder cancer. Other symptoms like frequency or urgency might come later due to irritation from the tumor.

Now, the wrong options. Let's say the options were A. Painless hematuria, B. Dysuria, C. Frequency, D. Suprapubic pain. The correct answer is A. So why are the others incorrect? Dysuria (B) is more common in infections or stones because of inflammation or obstruction. Frequency and urgency (C) can occur due to bladder irritation or tumors, but they're not as specific as hematuria. Suprapubic pain (D) might be seen in more advanced cases with obstruction or infection but again isn't the initial presentation.

Clinical pearl: Painless hematuria in a middle-aged or older adult is a classic presentation of bladder cancer. Remember the mnemonic: "Hematuria + Age >40 = Bladder cancer alert." Always consider bladder cancer in patients with painless hematuria, especially if they are smokers or have a history of exposure to certain chemicals.

So, putting it all together, the correct answer is painless hematuria, which is option A.

**Core Concept**
Bladder cancer (urothelial carcinoma) typically presents with **painless hematuria**, a hallmark sign due to tumor-induced vascular erosion. Other symptoms like dysuria or frequency are less specific and often overlap with benign conditions.

**Why the Correct Answer is Right**
Painless hematuria occurs when a bladder tumor erodes blood vessels in the urothelium, releasing blood into the urine without causing pain (unlike UTIs or calculi). This symptom is often the first and most consistent finding, especially in non-muscle-invasive bladder cancer. Gross hematuria may be intermittent, leading to delayed diagnosis.

**Why Each Wrong Option is Incorrect**
**Option B:** Dysuria is more characteristic of infections (UTIs) or calculi due to mucosal inflammation.
**Option C:** Frequency/urgency occurs in interstitial cystitis or BPH, not typically in early bladder cancer.
**Option D:** Suprapubic pain suggests advanced disease with obstruction or metastasis, not the initial presentation.

**Clinical Pearl / High-Yield Fact**
Painless hematuria in adults over 40 is a

✓ Correct Answer: A. Haematuria