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Blood in urine is never normal

Image from iStockPhoto signifying bladder health

Image from iStockPhoto.

Blood in the urine does not necessarily indicate bladder cancer, but it does warrant a visit to a urologist, says Srinivas Vourganti, MD, an assistant professor of urology at Upstate.

Bladder cancer occurs mostly in older people, and smokers are three times as likely to be diagnosed as nonsmokers. Also, men are three or four times more likely than women to get bladder cancer during their lifetime. The usual first symptom: blood in the urine.

Patients are evaluated through a combination of X-rays, urine and blood tests and a procedure called cystoscopy that allows a doctor to visualize the inner lining of the bladder. Any abnormal growths are removed and examined to identify cell type, aggressiveness and how deep the tumor was attached.

About half of bladder cancers are confined to the smooth mucosal lining of the bladder, but the cancers can spread into the deeper layers, or beyond the bladder. “Each depth of invasion is associated with worse outcomes,” Vourganti explains.

Treatment varies. The more advanced diseases may require radiation therapy and/or medications, or the removal of the bladder. Tumors confined to the lining can be removed, but they are like weeds with a tendency to grow back. Vourganti says that is why bladder cancer has the largest economic impact among cancers. “There is an intensive surveillance that has to happen to prevent its progression,” he says.

Cigarette smoking or exposure to industrial chemicals called aromatic amines contributes to many bladder cancers. (Aromatic amines are sometimes used in the dye industry; workers at high-risk for exposure include makers of rubber, leather, textiles or paint products, painters, machinists, printers, hairdressers and diesel truck drivers, according to the American Cancer Society.)

With every heartbeat, our kidneys make small amounts of urine, which is stored in our bladder until we void. Since many toxins in our body are filtered out through the urine – including the carcinogens from cigarettes and aromatic amines -- the bladder is exposed to these toxins.

That makes smokers who work with cancer-causing chemicals at especially high risk of developing bladder cancer.