Women Should Look Out for These Bladder Cancer Signs and Symptoms

Bladder cancer causes changes in your body you may notice through specific symptoms related to urine. Some signs are a reason for concern and mean you should see a doctor right away.

"Anytime a person sees blood in their urine with their own eyes—called gross hematuria—alarm bells should go off," said Mary Beth Westerman, M.D., a urologic oncologist in New Orleans and an assistant professor and co-director of urologic oncology at Louisiana State University.

The symptoms are often due to an infection in the urine, which can be checked with a urine culture and treated, Westerman said.

"Infections are still much more common than bladder cancer in women, so these symptoms aren't a reason to panic, but women should not be afraid to advocate for themselves if things don't seem to be improving," she said.

Primary symptoms of bladder cancer

Although your symptoms may be caused by reasons not associated with cancer, it is important to see a doctor for a checkup if you notice any, which may include:

• Increased frequency of urination
• Burning, irritation or pain when urinating
• Need to urinate constantly, even if the bladder is not filled
• Blood in the urine (may not be present all the time or may not be visible)
• Trouble urinating completely
• Pelvic pain
• Nighttime visits to the bathroom
• Weight loss
• Fatigue
• Loss of appetite

How to distinguish symptoms

Women suffer from urinary tract infections (UTIs) more frequently than men. For this reason, many symptoms are mistaken, ignored or interpreted differently, which can lead to later diagnosis and more advanced cancers.

"Often, women don't see blood with their eyes, but have symptoms like having to go to the bathroom more often, have a strong urge to go, burning, pain or discomfort," Westerman said, adding that when these symptoms are observed with an infection, it is important to have the urine checked for bacteria and sent for a culture.

Following treatment, you should reexamine the urine to ensure there is no microscopic hematuria, or blood that can only be seen under the microscope. Westerman further warned that symptoms of infection should dissipate within 24 hours of starting antibiotic treatment.

"If a woman has these symptoms, but the urine cultures don't grow bacteria, the symptoms only get a little better or keep coming back, then they should ask to be seen by a urologist," Westerman said.

The main causes of bladder cancer

Bladder cancer begins when bladder cells multiply rapidly and develop mutations. The tumor first destroys part of the bladder tissue, but later the abnormal cells can spread to other areas of the body through metastasis.

Some people inherit genetic mutations that predispose them to bladder cancer. However, it is not one of the primary causes, because bladder cancer is more often associated with exposure to toxic substances that cause changes in DNA.

Although scientists don't know why bladder cells suffer these changes, there are risk factors that can increase your chances, such as:

• Smoking
• Exposure to chemicals: aromatic amines, perchloroethylene, polycyclic aromatic hydrocarbons, among others
• Chronic catheter use
• Radiation exposure
• Frequent bladder infections
• Exposure to drinking water contaminated with arsenic

Types of bladder cancer

Urothelial carcinoma

Urothelial carcinoma is the most common type, a cancer that typically comes from the cells that line the innermost part of the bladder, Westerman said. Also known as transitional cell carcinoma, this type can form in other areas of the urinary tract, such as the urethra and ureters.

Squamous cell carcinoma

Most squamous cell carcinomas are invasive and development is considered rare.

"It is more common in people who have Foley catheters in their bladder for many years," Westerman said.

Adenocarcinoma

Adenocarcinoma is a rare bladder cancer that develops in the glands that line the organ. It is usually invasive.

Small cell carcinoma

Small cell carcinoma starts in the nerve cells and is a very rare type of bladder cancer.

Sarcoma

Sarcomas of the bladder often begin in the muscle cells of the organ.

Your doctor further classifies bladder cancer according to spread: whether it remains in the lining of the bladder or has moved into deeper layers of the bladder or the tissues of other organs.

"It can be low grade or high grade," Westerman explained. "High-grade cancers can become invasive, meaning they can grow into the deeper layers of the bladder. The grade and how deep the cancer grows determines what treatment options we recommend."

Categorization according to the degree of invasion includes:

• Non-muscle-invasive bladder cancer
• Muscle-invasive bladder cancer
• Metastatic bladder cancer

In advanced cases of bladder cancer in women, the cancer sometimes grows all the way through the bladder and into the vagina or other nearby organs, Westerman said. It can also spread to the lymph nodes and distant parts of the body.

The treatment depends on all of these factors. After observing the characteristics, your doctor can tell you what the best alternatives are and guide you through the process.

"Based on all of these things, I come up with a treatment plan together with my patients that includes their preferences and values as well," Westerman said.

Tests and diagnosis of bladder cancer

When you experience symptoms concerning bladder cancer, your doctor may perform a series of tests, such as:

Cystoscopy

"[Cystoscopy] allows us to look directly into the bladder and see what is inside," Westerman said, adding that the procedure is performed with a camera inserted through the urethra and into the bladder. The process takes about five minutes and is done in the office.

Imaging tests

A CT urogram, which means a CT scan with contrast, is commonly used so the doctor can see the kidney and bladder, Westerman said.

Urinalysis

With urinalysis, your doctor can analyze your urine and rule out an infection.

Cytology

With a cytology test, your doctor looks for signs of cancer cells through a urine sample, analyzed under a microscope.

"To make a diagnosis, we perform a biopsy and resection by putting a camera through the urethra and into the bladder and removing the tumors," Westerman said. "These are sent to the pathologist, who looks under the microscope to determine whether it is a cancer or not."