While men are four times more likely to develop bladder cancer as they age, women and African Americans are more likely to be diagnosed with the disease at a later stage, when treatment is less likely to be curative. The key to an early diagnosis is a timely visit to a urologist, a specialist who is trained to evaluate problems related to the bladder and urinary tract.
The challenge, however, is knowing when it is appropriate to see a urologist. Symptoms of bladder cancer overlap with other conditions, such as urinary tract infections (UTIs), which are much more common in women than bladder cancer.
Understanding more about the risks and symptoms of bladder cancer can help you know when to talk to your doctor about a possible check-in with a urologist.
How do I know if I have a high risk of bladder cancer?
Bladder cancer is more common in men, people over 40, and people who are white. People with an inherited condition called Lynch syndrome also have a higher risk of bladder cancer.
Smoking, exposure to certain chemotherapy drugs, and certain occupational chemicals can also increase the risk of bladder cancer. Chronic urinary tract infections and bladder infections also increase the risk.
What are the signs and symptoms of bladder cancer?
Blood in the urine, painful urination, a frequent urge to urinate, and low back pain are all symptoms of bladder cancer.
What could be causing my symptoms besides bladder cancer?
Several symptoms of bladder cancer also occur with urinary tract infections (UTIs). This overlap can cause delays in diagnosis, particularly in women. Women experience UTIs much more frequently than men. When they report frequent or painful urination or blood in the urine to a doctor, they are often presumed to have a UTI.
“Men rarely get UTIs, so when they present with blood in the urine, it prompts their doctor to order evaluation by a urologist, who can definitively rule out or diagnose bladder cancer,” says Stephanie Berg, DO, a Dana-Farber medical oncologist in the Lank Center for Genitourinary Oncology at Dana-Farber. “In contrast, women might go through multiple rounds of antibiotics for a UTI before their doctor considers sending them to a urologist.”
Studies have shown that African American patients of all genders are also less likely than white men to be referred to a urologist when reporting symptoms of bladder cancer. For anyone experiencing frequent UTIs, or UTIs that don’t go away with treatment, or persistent blood in the urine or painful urination, Berg recommends having a conversation with a trusted primary care physician about a referral to a urologist.
Blood can also be mistaken for gynecological conditions, including irregular menstruation, or post-menopausal bleeding, that a gynecologist can help evaluate.
“Many people understandably seek treatment for a UTI at an urgent care center, but it’s important to maintain a relationship with a doctor and get regular care from someone you trust and who knows you and your history,” says Berg.
What does a urologist do to detect bladder cancer?
A urologist may perform a CT (computed tomography) scan or a cystoscopy, which is a visual inspection of the inside of the bladder. The cystoscopy process is quick and employs a tiny camera inserted via thin tubing through the urethra into the bladder.
“Cystoscopy is the most direct and fastest way to get a diagnosis,” says Berg. “It isn’t possible to feel a tumor in the bladder because the bladder is tough muscle. You need that direct visual inspection.”
Cystoscopy can also detect kidney stones, which can also cause blood in the urine.
How is bladder cancer treated if it is found at an early stage compared to a later stage?
Bladder cancer discovered before it spreads to distant organs is typically treated with chemotherapy, immunotherapy, and surgery with the intent to cure the cancer. Once bladder cancer has spread to distant organs, patients receive chemotherapy, immunotherapy and possibly radiation therapy, but the disease cannot be cured.
Both women and African Americans have a lower rate of survival of bladder cancer five years after diagnosis. This may be because they are less likely to be referred to a urologist for evaluation than white men, which might lead to delays in diagnosis and potentially diagnoses at a more advanced stage of disease.
“These disparities are just beginning to be recognized and discussed among physicians,” says Berg. “They are important for us to understand and learn more about because delays in diagnosis and treatment can have a big impact on our patients’ lives.”