Is blood in my urine a sign of cancer?

Person holding an empty urine sample cup

Blood in the urine can signify a number of health problems. While most of these are minor concerns, it’s important to get a definitive diagnosis quickly.

“Blood in urine is never normal,” says urologist Ahmed Aly Hussein Aly, MD, of Roswell Park Comprehensive Cancer Center. “Although the majority of causes are not related to cancer and can include urinary tract infections, stone disease, use of blood thinners, trauma and many other issues, blood in urine is also one of few warning signs of cancers of the urinary tract.

“A full assessment and evaluation are crucial to either rule out a possible cancer anywhere along the urinary tract — including the bladder, kidneys, prostate, ureters or urethra — or diagnose it right away. Early diagnosis of these cancers is associated with higher chances of cure and improved outcomes.”

What is blood in the urine?

Physicians call blood in the urine hematuria. Visible blood (that you can see is there) because your urine is pink or even red is called gross hematuria, but more commonly the only way a person would know they have hematuria is through microscopic analysis of the urine.

Primary care physicians frequently order a urinalysis (laboratory testing of a urine sample) as part of a routine workup for their patients. “A urinalysis can provide valuable information that helps your doctor monitor and detect various health conditions,” Dr. Aly explains. “Urine testing provides information about the presence of proteins, different cells such as white blood cells and red blood cells, as well as sugar, bilirubin and other compounds.” Sometimes a urinalysis will discover that there is blood in the urine.

Causes of blood in urine

Even if the blood found in your urine is just microscopic, and even though most causes are not cancer, the presence of blood in your urine warrants further assessment. If you have other urinary symptoms, such as urgency, weak urine flow, or burning with urination, your doctor will determine whether you need more specific types of testing. Blood in the urine may be caused by:

  • Urinary tract infection, especially in women, is one of the most common causes of blood in urine. These infections can be treated with antibiotics.
  • Urinary stone disease is another common cause. Treatment depends on the size, location and type of the stone and the severity of symptoms, and can be treated with medication, external shockwave applications, or surgery, usually endoscopic.
  • Benign prostate enlargement in men can also result in hematuria. Treatment for this may be medical or surgical.
  • Cancer in the urinary tract, which includes the kidneys, ureters, bladder, prostate and urethra.

“The work up for visible or microscopic blood is pretty standard and includes imaging of the urinary tract, urine culture and cytology, and cystoscopy, visualization of the interior of the bladder using a flexible scope, which is usually done in the office under topical anesthesia,” Dr. Aly explains.

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What if cancer is suspected?

Your doctor may suspect cancer when symptoms persist despite a negative urine culture and antibiotic treatment. If your doctor suspects you might have cancer, you will undergo imaging studies, usually a CT scan or MRI. PET scans may also be advised. “The goal of imaging is to first diagnose the presence and location of any cancer, and second, to determine the stage of the cancer — whether it is confined to the organ or has spread to the regional lymph nodes or to distant sites,” Dr. Aly explains. In addition, your doctor may order a biopsy to get critical information about the kind of cancer.

Don’t wait for symptoms to get checked out

Urinary tract cancers don’t always have symptoms, especially not in the early stages. “Prostate cancer usually presents with no symptoms at all and that’s why screening is critical,” Dr. Aly adds. More than half of patients diagnosed with kidney cancer have no symptoms, even when a kidney mass is found. Patients with bladder cancer often have blood in their urine, but it may be microscopic.

Be sure to tell your doctor about any other symptoms you may be experience, whether or not you have blood in your urine, such as increased urinary frequency, burning, urgency, or weakness, fatigue, unintentional weight loss, loss of appetite or flank pain.