What Every Woman Should Know about Bladder Cancer Symptoms

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.

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 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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