Bladder Cancer in Women - Verywell Health

Bladder cancer is cancer that starts in the cells of the bladder—a hollow muscular organ in the lower pelvis that collects urine.

Older men have the highest rates of bladder cancer. Every year around 64,000 cases of bladder cancer are diagnosed in men, whereas only around 19,000 are diagnosed in women. Over 90% of cases occur in people over age 55.

Despite bladder cancer occurring more often in men, it tends to carry a worse prognosis for women.

When caught early, most cases of bladder cancer are highly treatable. Unfortunately, women are less likely than men to have their bladder cancer caught early.

Women's early symptoms, such as blood in the urine and painful urination, are easily mistaken for other more common conditions like postmenopausal bleeding and urinary tract infections (UTIs). Because women's bladder cancer tends to be detected at a more advanced stage, it often carries a worse prognosis.

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Types of Bladder Cancer

There are several types of bladder cancer.

• Urothelial carcinoma (transitional cell carcinoma): Urothelial carcinoma is by far the most common type of bladder cancer, accounting for over 90% of all cases. This cancer starts when the urothelial cells that line the bladder start to grow out of control. Urothelial cells also line other parts of the urinary tract. If you are diagnosed with bladder cancer, your entire urinary tract will be checked for tumors.
• Non-transitional carcinomas: Less common types of bladder cancer include squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. 

Bladder Cancer Symptoms

Many cases of bladder cancer are asymptomatic, and the early signs and symptoms of bladder cancer tend to be mild and intermittent.

Blood in the urine (hematuria) is the most common early sign of bladder cancer. The blood may affect the urine's color, giving it a faintly pink or tea-colored cast, or it may appear bright red.

Blood may not be present all the time; it can disappear for days or weeks at a time and then recur. Sometimes the amount of blood is so small that it's only detectable with a urinalysis, a test used to analyze the content of the urine.

Changes in urination are another common early symptom. Changes in urination may include:

• Frequency: Bladder cancer can lead to passing urine more often, including waking frequently at night to urinate. 
• Urgency: You may feel like you need to urinate right away, even when your bladder is not full.
• Painful urination: A painful or burning sensation may accompany urination.
• Pain: Bladder cancer sometimes causes back pain, stomach pain, or bone pain.
• Other symptoms: More advanced bladder cancer can cause unexplained fevers, sweating, unexplained weight loss, or loss of appetite and fatigue.

Most of the time, a medical condition other than bladder cancer is causing these symptoms. Still, it's wise to see a doctor and get yourself checked out.

Causes and Risk Factors

As with many cancers, both hereditary and environmental factors affect your risk of bladder cancer. The bladder receives urine from your kidneys, which filter your blood. The bladder, therefore, has high levels of exposure to various environmental toxins and carcinogens.

Age is the most important risk factor. Over 90% of bladder cancers occur in those over age 55, and 80% occur in those 65 and older.

Smoking is the main modifiable risk factor. Smokers have a three times higher risk than nonsmokers. Smoking accounts for about 50% to 60% of all cases.

Exposure to certain industrial chemicals, such as those used in paints and dyes, is thought to account for another 20% of cases. Other factors—like genetics, hormones, using certain herbal supplements, and consuming contaminated drinking water—can also affect your risk.

Diagnosis

Bladder cancer is typically diagnosed by reviewing a patient's health history and physical symptoms. Your doctor will also perform a physical exam of the pelvis to look for an abnormal mass. For women, this means a recto-vaginal exam.

A cystoscope (a long thin tube with a small camera and light attached at one end) may be used to view the inside of the bladder and to take a biopsy.

Diagnosis is then confirmed by the presence of abnormal cells in the urine, bladder tissue, or by recently developed urine tests that detect cancer biomarkers.

Disparity in Cases

Bladder cancer is three to four times more common in men than in women. The American Cancer Society estimated the diagnosis of 64,280 new cases in men and 19,450 new cases in women in 2021 in the United States, and that bladder cancer would cause 12,260 deaths in men and 4,940 deaths in women.

Why is bladder cancer more prevalent among men? One reason is that men smoke at higher rates than women, and smoking is the biggest risk factor for bladder cancer. Gender differences in smoking were especially pronounced in the past, so older men are much more likely to be current or former smokers than are older women.

Men may also have more workplace exposures to certain industrial chemicals linked to bladder cancer. Other factors, like hormonal differences, may further contribute to men's elevated risk.

Although men are more likely to be diagnosed with bladder cancer, women generally face a worse prognosis. Outcomes are particularly poor for African-American women. 

Caught early, bladder cancer is very treatable. Unfortunately, early bladder cancer symptoms in women are often misattributed to a UTI or postmenopausal bleeding, leading to delays in diagnosis.

A recent study found that men with blood in their urine were 65% more likely to receive a referral to a urologist. Thus, women's cancers are often detected at a more advanced stage.

Women in remission from bladder cancer also have higher recurrence rates than men. 

Treatment

If you are diagnosed with bladder cancer, the proper treatment plan will help optimize your health and chances of recovery. Your specific treatment plan will depend on the stage of the cancer (how far it has spread) and the grade of the cancer (how abnormal the cancer cells look), as well as other factors.

A Word From Verywell

If detected early, bladder cancer is highly treatable. Because doctors often assume the early symptoms of bladder cancer in women are the result of other, more common conditions like UTIs, postmenopausal bleeding, or bladder inflammation (cystitis), diagnosis in women is often delayed.

It is critical to be your own advocate. Make sure that if a UTI is suspected, your doctor confirms the presence of a bacterial infection. If no infection is found or if your symptoms do not resolve with antibiotic treatment, ask for a referral to a urologist. Although most of the time your symptoms will be caused by something other than bladder cancer, it is still important to get them checked out.

Frequently Asked Questions

• While bladder cancer can affect women of any age, it is very rare among younger women. Fewer than one in 100,000 women under 50 will develop bladder cancer. The average age of diagnosis is 73.
  

• When diagnosed early, bladder cancer is highly treatable. The average five-year survival rate for bladder cancer is 77%.

  For the lowest grade of bladder cancer, stage 0, the five-year survival rate is 96%. More advanced stages have lower survival rates.

  It's important to remember that survival rates are only averages and that the prognosis for many cancers continues to improve with advances in treatment. 

  Even after complete remission is achieved, bladder cancers recur up to 80% of the time. For low-grade cancers, women have a higher risk of recurrence than men. Ongoing monitoring after having bladder cancer is required.

• The most common early symptoms of bladder cancer (increased urination, urgency, blood in the urine) mirror those of a UTI. Doctors sometimes believe a woman's symptoms are due to a UTI, without confirming an infection.

  If your doctor suspects you have a UTI, make sure a urine culture confirms the presence of a bacterial infection.

  Bladder cancer and UTIs often co-occur. If treatment with antibiotics fails to alleviate your symptoms, you should request a referral to a urologist. 
  

• An ultrasound uses sound waves to create images of internal organs. Although an ultrasound can be used to detect bladder cancer, it is not as accurate as a cystoscopy. Cystoscopy involves inserting a flexible tube attached to a small light and camera through the urethra into the bladder. This allows the doctor to view the inside of the bladder and take tissue samples.

  Ultrasounds sometimes assist with diagnosis by assessing tumor size and whether the cancer has spread outside the bladder.