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11 Things Every Woman Needs to Know About Bladder Cancer

Is bladder cancer even on your radar? It should be. Here's what you need to know about the fifth most common cancer in the United States, and how you can spot the warning signs.

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Bladder cancer is frequently overlooked

Bladder cancer symptoms are subtle, especially in women. Men may see some blood in their urine—it may be pinkish or even red in color. Women get that too, along with painful urination. Unfortunately, the symptoms are similar to getting a urinary tract infection—a UTI. (Women may also think they’re simply getting their period.) “Patients are often treated multiple times and for many months for a chronic UTI,” says Arjun Balar, MD, medical oncologist and the director of Genitourinary Medical Oncology Program at NYU Langone Medical Center. It’s not until symptoms get much worse—where you’re seeing much more blood and experiencing pelvic pain and discomfort—that cancer even comes on the radar. “Women will say ‘this feels unlike any UTI I’ve ever had,” he explains. Learn about other common reasons you get UTIs.

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Men are at higher risk…

The disease is more common in men—their cases outpace women by three to one. Although the American Cancer Society reports that rates of this cancer have been dropping in women, recent research indicates that some women are actually at an increased risk: Occupations that expose women to certain chemicals—hair stylist being one—may put them at an increased risk for the disease, according to a 2015 study in JAMA Oncology, though the uptick may also be due to increased screening and detection, the researchers note.

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But women are more likely to die from bladder cancer

Because it’s looked at as an old man’s disease, bladder cancer is frequently missed in women. “That’s one of the contributing factors of why women are more likely to come in with more advanced stages of disease,” says Dr. Balar. However, 2010 research suggests that late diagnosis can’t fully explain the discrepancy between male and female mortality rates; there seems to be other unknown factors at play in lowering women’s survival chances.

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Lots of UTIs won’t worsen your chances

Far from it. Though there are some forms that are associated with chronic UTIs, these tend to be the minority, says Dr. Balar. Squamous cell carcinoma of the bladder is one, which makes up 5 percent of all cases. The takeaway: Just because you get UTIs, don’t assume that you’re at a higher risk for bladder cancer. Be open with your doctor about any concerning symptoms.

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The primary risk factor?

Yep: smoking. In both women and men, 80 percent of cases are attributed to lighting up, says Dr. Balar. “I see so many lifelong smokers who were only worried about lung, head and neck, or esophageal cancer,” he says. “But you have to think about bladder, too,” he says. Other causes? Dr. Balar also notes that another 5 percent are hereditary and the remaining 15 percent are linked to chemical exposures, like a class of compounds called aromatic amines. People who work in chemical, dye, and rubber industries, for instance, may be at risk, which potentially includes hair stylists, reports a review of research published in the journal Environmental Health. Here are more benefits to quitting smoking—today.

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Put it all into perspective

If you don’t smoke and don’t have a family history, your risk is likely pretty low, says Dr. Balar. Post-menopausal women often get more UTIs thanks to a drop in estrogen, which prompts bacteria to develop and increases risk of an infection. However, if your symptoms don’t get better despite multiple courses of antibiotics, ask your doctor about bladder cancer.

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Diagnosis

Your doctor will ask whether anyone in your family has battled the cancer, and may conduct a physical exam to check for evidence of a tumor. (Here’s where you can find out more about cancer risk factors.) There’s also a urine test to check for blood and other substances. If your doctor suspects cancer, he or she would refer you to an urologist who would do a procedure called a cystoscopy. That’s when a specialist places a thin tube with a video camera through the urethra and into the bladder to view bladder walls.

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Treatment

Doctors determine if the cancer is localized (it’s only in the bladder) or has spread. If it’s local—which the majority of bladder cancers are—doctors will perform what’s called a transurethral resection of bladder tumor (TURBT), where a scope is inserted into the bladder to scrape the tumor from the inside walls, explains Dr. Balar. Depending on the stage of the cancer, some patients may be candidates for radiation therapy or chemotherapy post-surgery. In some cases, chemotherapy prior to surgery can shrink tumors and make removal easier. Here’s what cancer patients want you to know.

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Docs are saving lives

Previously, when bladder cancer had spread to surrounding muscles or other organs, the outlook was pretty bleak. About one in eight of all bladder cancers in the U.S. are diagnosed at stage four—which means the cancer has metastasized. “It was incurable at this stage with very few treatment options, and the average survival was 12 to 15 months,” says Dr. Balar. However, advancements in the last three years have completely changed the course of treatment. With the development of immunotherapy, which boost the body’s own immune system to target cancer, prognosis is looking up. “It’s a little too early to say how the drugs impact survival rate, but what we’ve seen is that a subset of patients respond extremely well, and this is potentially life-saving for them,” he says. In fact, some have a complete disappearance of cancer and lead healthy, normal lives within two to three years of starting treatment. Here are some other genius cancer breakthroughs doctors want you to know about. 

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Reach out to loved ones

When actress Marilu Henner met her now-husband Michael Brown, she wasn’t prepared for what she’d find in the bathroom: a bit of blood in the toilet. He had been dealing with the symptom for two years, he said, but his doctor told him it could be a kidney stone or even stress. She pressed him to go in again, and that’s when he was diagnosed with cancer. Their experience prompted the couple to write Changing Normal: How I Helped My Husband Beat Cancer. “Sixty-two percent of people say they’d be afraid to talk to their partner about something like blood in their urine,” she notes. “It’s such a private topic, but you can bring it up with humor, sensitivity, and being a good listener,” she says. Marilu is also involved with BCAN (Bladder Cancer Advocacy Network), where patients and their caregivers can find more info.

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Consider a second opinion

Michael’s doctor told him he was able to go in and “lobb [the cancer] off.” But that didn’t sit right with Marilu who encouraged him to get a second opinion. “The first doctor was so cavalier and dismissive. I had done my homework. After two years of having blood in his urine, it didn’t sound like the answer was an easy fix,” she says. Sure enough, the second doctor revealed his cancer was dangerous and could spread into other organs. After immunotherapy, he went into remission and has been for 13 and a half years.

Jessica Migala
Jessica Migala is a freelance health and fitness writer with more than a decade experience reporting on wellness trends and research. She's contributed to Health, Men's Health, Family Circle, Woman's Day, and O, The Oprah Magazine, among other publications. Jessica lives with her husband and two young sons in the Chicago suburbs.