Does blood in my urine mean cancer?

Blood in urine is never normal and can signify several health problems. Most causes are not related to cancer and may include urinary tract infections, stone disease, use of blood thinners, trauma or other issues. 

But while many of these can be minor concerns, blood in urine is also one of the few warning signs of cancers of the urinary tract. This means that full assessment and evaluation are crucial to rule out, or diagnose early, possible cancer anywhere along the urinary tract, which includes the bladder, kidneys, prostate, ureters or urethra.

Early diagnosis of urinary tract cancers is associated with higher chances of cure and improved outcomes. 

What is blood in urine? 

The medical term for blood in urine is hematuria. Blood you can see because your urine is pink or red is called gross hematuria. Most commonly you may have microscopic blood, amounts too small to see, but can be detected through a urine test.  

Primary care physicians frequently order a urinalysis – microscopic laboratory testing of a urine sample – as part of a routine patient checkup. A urinalysis can provide valuable information about the status and amounts of proteins, white blood cells, red blood cells, and levels of sugar, bilirubin and other compounds not identified by a blood test. 

A urinalysis can help your doctor detect and monitor various health conditions and sometimes will discover there is blood in the urine. 

What causes blood in the urine?

Even if blood in the urine is just microscopic, and though most cases are not cancer, this result 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. This is one of the most common causes of blood in urine, especially among women, and can be treated with antibiotics.
• Kidney stones. Also known as urinary stone disease, kidney stones occur when hard mineral and salt deposits form inside your urinary tract. Depending on the size, location and kind of stone and the severity of the symptoms, it can be treated with medication, external shockwave applications or surgery, usually endoscopic.
• Enlarged prostate. Treatment for this may be medical or surgical. 

Any blood in your urine — whether visible or microscopic — needs further evaluation. This can include imaging of the urinary tract, urine culture tests to check for any bacteria or yeast infections, urine cytology tests to examine cells shed in the urine for abnormalities like cancer and a possible cystoscopy. A cystoscopy is a procedure that uses a flexible scope inserted into the urinary tract to allow the doctor to see the interior of the bladder to check for (or rule out) any tumors, lesions or other abnormalities. This procedure is typically done in the doctor’s office under topical anesthesia. 

Don’t wait for symptoms to get checked out

Urinary tract cancers don’t always have symptoms, especially in the earliest stages. Prostate cancer often has no symptoms at all, which is why consistent PSA screening is critical. More than half of patients diagnosed with kidney cancer have no symptoms even when a kidney mass is found. Patients diagnosed with bladder cancer often do have microscopic blood in their urine.

What if cancer is suspected?

If you have blood in your urine, your doctor may suspect cancer when symptoms persist despite a negative urine culture and antibiotic treatment. Imaging scans, usually a CT or MRI, may be recommended, and PET scans may also be advised. 

The goal of imaging is to diagnose the presence and location of any cancer and determine whether it is confined to the organ or has spread to regional lymph nodes or distant sites. Your doctor may also order a biopsy to get critical information about the kind of cancer you may have. 

Whether or not you have blood in your urine, be sure to tell your doctor about any urinary tract symptoms you experience, such as urinary frequency, burning or urgency.