Interpreting Bladder Cancer Symptoms in Men vs. Women: What You Should Know

MSK medical oncologist and genitourinary cancer specialist Emily Feld

Medical oncologist Emily Feld says the same bladder cancer symptoms may be interpreted differently in woman compared with men.

  • Bladder cancer does not affect men and women in the same ways.
  • Knowing the warning signs of bladder cancer can lead to early diagnosis, which greatly improves outcomes.

Bladder cancer is the sixth most common cancer in the United States. But there are differences between men and women when it comes to their risk for the disease, how quickly it is diagnosed, and their prognosis (outcome).

Bladder Cancer Symptoms in Men and Women

Symptoms are mostly the same in men and women. The most common symptom of bladder cancer is blood in the urine, known as hematuria. (It is usually not painful.)

Other signs of bladder cancer include:

  • Irritation, pain, or burning while urinating 
  • Feeling a need to urinate immediately, even when the bladder is not full 
  • Pelvic pain
  • Unexplained weight loss

Blood in urine may be interpreted differently in men vs. women

While the symptoms may be similar for both genders, how they are interpreted can be different. In women, blood in the urine may be overlooked as a possible sign of bladder cancer, since it has a far less serious explanation for most people. Blood in the urine may be assumed to be a urinary tract infection or confused with postmenopausal uterine bleeding.

“Symptoms of bladder cancer can be very similar to those of urinary tract infections, which are common in women,” says Memorial Sloan Kettering Cancer Center (MSK) medical oncologist and genitourinary cancer specialist Emily Feld. “If blood in the urine is being attributed to a urinary tract infection, it is important to check a urine culture to confirm you actually have an infection. If the culture is negative and/or your symptoms persist despite treatment with antibiotics, you should have a urologist evaluate you. Hematuria, even when it is painless, is not something to ignore.”

Always see a doctor if you notice blood in your urine

Anyone who sees blood in their urine should notify a doctor or urologist immediately. Doctors typically investigate hematuria first with a urinalysis and urine culture. In women, tests can also distinguish if the bleeding is due to postmenopausal uterine bleeding. If there is no evidence of infection or postmenopausal bleeding, the next step is a CT scan that focuses on the entire urinary tract, known as a CT urogram.

“Blood in the urine can come from either the bladder or upper urinary tract (the kidneys and ureters), and a CT urogram will evaluate the entire urinary system,” Dr. Feld says.

Along with a CT urogram, doctors may perform a cystoscopy. This is a direct visualization of the bladder with a lighted camera, called a cystoscope. Usually done in the office, it takes only a few minutes and does not require anesthesia. In addition, doctors can order a test called a urine cytology to check for cancer cells in the urine.

Bladder Cancer Risk in Men vs. Women 

In the United States, men are three to four times more likely than women to be diagnosed with bladder cancer. According to the American Cancer Society, the chance men will develop bladder cancer during their life is about 1 in 27. For women, the chance is about 1 in 89. 

The higher risk for men may be because of an increased likelihood of exposure to cancer-causing chemicals. This exposure includes tobacco use (mainly smoking) and chemicals that are commonly used in certain jobs, including the textile, dye, rubber, leather, paint, and printing industries.

“Toxins in cigarettes and other chemicals are excreted in urine,” says Dr. Feld. “Those carcinogens have prolonged contact with the bladder before they are ultimately released.”

How To Lower Your Bladder Cancer Risk

For most men and women, the best way to lower bladder cancer risk is to quit smoking. Smokers are overall twice as likely to develop bladder cancer compared with nonsmokers.

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

Other risk factors for bladder cancer include:

  • Family history of bladder cancer
  • Chronic bladder problems and urinary tract infections
  • Chronic use of urinary catheters
  • Age older than 70
  • Prior chemotherapy or radiation

Bladder Cancer Treatment in Men vs. Women

As with most cancers, there are more treatment options for bladder cancer when it is detected early. Most people require a combination of therapies to treat bladder cancer successfully.

“At MSK, we have the benefit of a multidisciplinary team of experts who are highly specialized in urology, radiation oncology, medical oncology, radiology, and pathology,” Dr. Feld says. “We all work very closely together to deliver the highest quality care to our patients.”

Men and women with very early-stage bladder cancer can be cured with a combination of surgery and treatments delivered directly into the bladder, known as intravesical therapy.

For men and women with disease that is more advanced but still confined to the bladder, a common treatment is removal of the bladder in a surgical procedure known as a radical cystectomy. The urologic surgeon will likely also remove lymph nodes and/or some of the organs near the bladder. This may include the prostate in men and the uterus and ovaries in women.

It’s important to know that expert bladder cancer care means not only lifesaving treatments but also preserving quality of life. A recent study showed that people who had their bladder removed at MSK recover well from the surgery and have a good quality of life.

Our experts can help people lead normal lives and maintain urinary and sexual function through a variety of surgical techniques, including minimally invasive approaches and other specialized procedures to preserve or reconstruct the bladder.

Radiation is an alternative treatment for select patients with bladder cancer. “The decision between choosing surgery or radiation for treatment of bladder cancer is dependent on multiple factors, including a patient’s preference, their other health issues, and the characteristics of their particular cancer,” Dr. Feld says. “Both surgery and radiation are often combined with chemotherapy to improve outcomes.”

For patients whose bladder cancer has spread beyond the bladder, doctors often use chemotherapy. In recent years, there have been major advances in new treatments for this disease, including antibody-drug conjugates and checkpoint inhibitors. Researchers at MSK have been at the forefront of developing these new treatments.