What Every Woman Should Know about Bladder Cancer

Doctor and patient

Even though it may be nothing to worry about, blood in your urine can be a sign of bladder cancer. It's best to make an appointment with your doctor.

Summary

Though bladder cancer is much less common in women than men, women often face a worse prognosis. Urologic surgeon Sherri Donat offers advice to women about a possible diagnosis.

Bladder cancer is often considered a disease of older men. It’s the fourth leading type of cancer among men and not even in the top ten for women, according to the National Cancer Institute. But these odds may also work against the nearly 20,000 women who are diagnosed with the disease in the United States each year.

Some studies have shown that women with bladder cancer may face a worse prognosis than men. One possible reason is that doctors and even women themselves may not take the warning signs of bladder cancer seriously enough.

Memorial Sloan Kettering urologic surgeon Sherri Donat explains what women should know about bladder cancer.

If you see blood in your urine, don’t ignore it.

Blood in the urine is called gross hematuria. It is the most common sign of bladder cancer. This is true in both men and women, says Dr. Donat. But in women, blood in the urine is often overlooked as a possible sign of bladder cancer, since it has a far less serious explanation for most people.

“When the hematuria is painless, the tendency is to think it’s nothing to worry about, but this symptom is not something to ignore,” says Dr. Donat. She advises making an appointment with your doctor if you see blood in your urine.

What does the blood look like? The simple answer is that it varies. It may be faint in color, with a pinkish tinge, or it may be bright red or the color of tea. You may see it consistently, or the blood may come and go. It may be totally painless or associated with such symptoms as burning during urination or increased frequency or urgency to urinate.

Most women [with blood in their urine] are presumed to have a UTI, and are treated with antibiotics even if the culture is negative.
S. Machele Donat
S. Machele Donat urologic surgeon

The two most common causes are urinary tract infection (UTI) and postmenopausal uterine bleeding.

“Most women [with blood in their urine] are presumed to have a UTI,” Dr. Donat explains, “and are treated with antibiotics even if the test results are negative,” often delaying the time it takes to get a referral to a urologist.

As a result, women tend to be diagnosed with bladder cancer at a later stage, giving the disease time to grow and spread. “This delay is likely what accounts for the worse prognosis that women sometimes experience,” says Dr. Donat. “On the other hand, men tend to receive a more aggressive evaluation and an earlier referral to a urologist than women when they present with the same symptoms.”

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Ask your doctor for a referral to a urologist.

For women diagnosed with a UTI, Dr. Donat has this advice: “Make sure your doctor sends a urine culture for testing,” she says. “If you did have a culture, make sure it came back positive to confirm that you actually have an infection. If the culture was negative or your bladder symptoms continue despite treatment, don’t be afraid to ask your doctor for a referral to a urologist to get a formal evaluation.”

Urologists specialize in diseases of the urinary tract. They can diagnose problems in both women and men.

Tests can sometimes distinguish the bleeding associated with bladder cancer from postmenopausal uterine bleeding, but the results are not always clear-cut. “Your gynecologist can send a catheterized urine sample for testing to determine the source of the blood and to evaluate for gynecologic causes of the bleeding,” Dr. Donat explains. “If your gynecologic exam fails to identify the source of the bleeding or is inconclusive, or if your irritative bladder symptoms persist, you should also seek out the expertise of a urologist.”

Hematuria may originate in the bladder or the kidneys, says Dr. Donat, so a urologist needs to check both. This is best done with a special CT scan of the urinary tract called a CT urogram and by looking in the bladder with a lighted telescope called a cystoscope. This procedure, called a cystoscopy, is usually done in an office in just a few minutes and does not require anesthesia, says Dr. Donat. A urine test called a cytology may also be sent to check for cancer cells in the urine.

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Take steps to reduce your bladder cancer risk.

The best way to lower your bladder cancer risk is to quit smoking. “Smoking is the number one risk factor for bladder cancer, says Dr. Donat. “There is some data to suggest that women metabolize carcinogens from smoking differently than men. In fact, woman may have a 30 to 50% greater risk of bladder cancer than men who smoke at comparable levels.”

MSK offers a Tobacco Treatment Program to support anyone trying to quit.

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If you’ve been diagnosed with bladder cancer, seek out a team of experts.

Most people require a combination of therapies to treat bladder cancer successfully. “The best plan is different for each person,” says Dr. Donat. “This customized treatment approach requires the expertise of multiple specialists.”

At MSK, most people with bladder cancer meet with a urologic surgeon and medical oncologist as well as a radiation oncologist when needed. This close collaboration helps ensure that MSK patients receive the best care possible. “The benefit of MSK is that we bring world-class expertise in each type of treatment to bear for every individual we care for, and we are on the forefront of developing new treatments,” says Dr. Donat.

It’s also important to know that expert bladder cancer care means not only lifesaving treatments but preserving your quality of life and, if possible, your bladder. “We want all of our patients — female and male — to feel their best after bladder cancer surgery,” says Dr. Donat. “As surgeons, we do that through a variety of techniques, including minimally invasive approaches and other specialized techniques to preserve or reconstruct the bladder and to maintain sexual function.”

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Comments

I wish all that is said here were true of MSK- 5 ish years ago my partner was treated at MSK for bladder cancer- despite no evidence of prostate cancer he was told “while we are in there” we might as well remove your prostate- no discussion about whether or not he was sexually active or the consequences of the prostate removal- classic assumption about an older/elderly male. He was assured that following the bladder surgery he would be able to do everything he could do before it/ it took over six months for them to explain the ramifications of the removal of his prostate .

Dear J.S., we’re very sorry to hear that your partner was not happy with his experience at MSK. Our Patient Representatives are committed to ensuring that patients’ rights are respected and that their concerns are addressed. You can contact them at 212-639-7202 to discuss this in more detail. Thank you for your comment and best wishes to you.

I get UTI at the drop of a hat but the doctors do a clean catch sample to diagnose accurately. I had b/c 15 years ago with no spread and needed no chemo. Should I worry?

Dear Karen, we recommend you discuss your concerns with a doctor who is familiar with your medical history. Thank you for your comment and best wishes to you.

Dr Donat and the team at MSK is great. I had baldder cancer 10 years ago and it was Dr Donat and Dr Herr who swooped in and performed the surgery necessary to make me cancer free. Very caring doctors who take great pride in what they do. Thank you

Dear James, we’re so glad to hear that you’re still cancer free. We have forwarded your comment to Dr. Donat and Dr. Herr. Thank you for sharing your story and best wishes to you.

I did not see blood in my urine but it was picked up during a urine analysis. I had a sonogram and cystoscope. Both tests came up negative and I was told not to worry. As far as I know I did not have a urine culture. Should I still be concerned?

Dear Susanne, we recommend that you discuss your concerns with your doctor and ask whether any additional tests are needed at this time. Thank you for your comment and best wishes to you.

my dear Dr. Donat and MSKCC ... since 2005, I am still here, thanks to you! the definitive place and people for cancer care! thank you always ...

Dear Linda, thank you for your kind words! We have forwarded your comment to Dr. Donat. Best wishes to you.

My father was treated for bladder cancer by Dr. Herr for several years. As a physician I expressed my concern that his recurrences were increasing frequent and spreading in the bladder and questioned whether he needed more aggressive treatment. I was reassured by Dr. Herr that the recurrences were superficial and my father would not die of bladder cancer. When my father began losing weight and developed a low grade fever I asked Dr. Herr for help and advice. No referral to an oncologist was ever made or additional tests were done or recommended. Ultimately I ordered additional tests which showed worsening kidney function and a CT scan which revealed a blocked ureter due to spread of the cancer which was removed by surgery. Only then was a referral made to an MSK oncologist. A PET scan was ordered to rule out organ involvement. I accompanied my dad to this visit and was told that if there was no organ involvement chemotherapy might be beneficial, but otherwise it was unlikely to help. We were given Rxes for chemo as well as Rxes to combat side effects of chemo with the presumption the PET scan would be negative. Unfortunately the PET scan showed both lung and liver metastasis. Instead of getting a call from the oncologist with these results I was called by a nurse to schedule a follow-up visit after my father completed his first round of chemo. This was not the coordinated team care that I expected from an institution with MSK's reputation.

Dear Barbara, we’re very sorry to hear that your father’s cancer has spread. Our Patient Representatives are committed to ensuring that your rights are respected and that your concerns are addressed. We have sent them your concern, and you can contact them directly at 212-639-7202 to discuss this in more detail. Thank you for your comment and best wishes to you and your father.

I just had symptoms of blood in the urine and have had a history of kidney stones. Went to a urologist immediately and I am having a CT scan today. Hope I’ll be fine.

Please advise procedure for making an appointment with doctor at MSK re breast cancer consultation

Thank you

My father passed away six years ago from bladder cancer. He had gone for radiation treatment for a low grade prostate cancer at a local hospital. Although he had rods implanted in his prostate to track it, the hospital do not do so. As a result, the radiation mostly hit his bladder. My father was diagnosed with muscle invasive bladder cancer 4 years after his prostate cancer radiation treatment ended. He died a year to the day after his bladder cancer diagnosis.

Dear Judy, we are very sorry for your loss. Thank you for sharing your experiences and best wishes to you.

I’ve been seeing my Urotogist since this started - Terrible burning pins and needles in my upper arms that go up my neck and into my head. I’ve also been to a neurologist and internist. They all look at me like I’m crazy and tell me that they have NO idea what this is. They never heard of this before. I’m not taking
Trospium Chlr Er 60 mg - every morning and Myrbetrig 50mg every night and it seems to keep the pins and needles away 99% of the time. They have done a Cyscoposy. ( please excuse the spelling) twice and I’m scheduled for a third one on August 1st. Am I headed in the right direction ??????? Thank you.

Dear Rosemary, we’re sorry to hear about what you’re going through. We recommend that you continue to discuss your concerns about your symptoms and side effects with your care team. Unfortunately we are not able to provide guidance for treatment on our blog, but if you’re interested in arranging a consultation with one of our experts to discuss the course of your treatment, you can make an appointment online or call 800-525-2225. Thank you for your comment and best wishes to you.

A friend with lung cancer a few years back at MSKCC was told there was nothing more they could do and sent to clinical trials. She was a very sweet person who never complained and a dentist, but she said the conditions for patients at the clinical trials facility were very poor and in major contrast to the rest of the hospital - long waits in a large mass of people in a stark room with bright overhead lights, etc.. I know you are a large business and these people no longer bring in much profit possibly, but surely you could provide a more nurturing environment for them and demonstrate some care and respect for those who are most defenseless. What is your priority?

Dear Elizabeth, we are very sorry to hear that your friend was not happy with her care at MSK. Our Patient Representatives are committed to ensuring that patients’ rights are respected and that their concerns are addressed. You can contact them at 212-639-7202 if you’d like to discuss this in more detail. Thank you for your comment.

My father was treated surgically for bladder cancer in 2006 by Dr Herr. He has remained cancer free since then. In September he will celebrate his 96th birthday. Kudos to the team at MSK!

Dear Jane, we’re glad to hear your father is doing well. We will share your message with Dr. Herr. Best wishes to your family and a very happy birthday to your father.

I have a question with regard to Breast reconstruction. I am aware that the reconstructed breast will never be an exact match but is it possible to reconstruct to make the breast a D cup size from muscle on one’s back? Is this procedure considered a relatively normal procedure, not withstanding the fact that all procedures carry their own risks.?
This is just a general question, not specific to any prognosis. Thank you for taking the time to read and respond.

Dear Effie, we sent your question to one of our surgeons who specializes in breast reconstruction. She explained that the latissimus muscle is a flat, thin muscle that can be used as a carrier for skin from the back and is generally used to resurface the breast, when needed.  It generally does not provide significant volume alone, thus would not generally create a “D cup” size, for example. Thank you for your comment and best wishes to you. 

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