Can Recurrent UTIs Be A Sign Of Cancer?

Urinary tract infections or UTIs affect any part of your urinary system, including the urethra, bladder, ureters, or kidneys. 

They mainly involve the lower parts of the urinary tract.

UTIs can show no symptoms, but if severe, they can lead to several complications. 

Some signs of UTIs and certain cancers might be similar, such as having blood in the urine or even pelvic pain. 

However, making a precise diagnosis requires the healthcare team to rule out cancer in anyone experiencing recurrent UTI symptoms.

Signs and symptoms of a UTI

​​Can you have UTI symptoms without a UTI? Yes, symptoms such as painful urination and an urgent and frequent need to urinate can be signs of sexually transmitted infection. 

An accurate diagnosis is the first step toward effective treatment, so if you or someone you know is exhibiting symptoms of urinary tract infection, seek medical attention immediately. 

However, one must know what signs and symptoms a person with urinary tract infections may show before being able to determine whether medical attention is required. 

Symptoms vary between different types of UTIs. Complicated UTIs are often more severe and can lead to complications. 

Some of the commonly noted symptoms include:

  • Cloudy, dark, or strange or strong-smelling urine, mixed with blood in some cases
  • Frequent urge to urinate, but incomplete voiding
  • Pain or pressure in the lower abdomen or back
  • Burning sensation during urination
  • Blood in urine or hematuria
  • Nausea and vomiting
  • Frequent urination
  • Fever and chills
  • Vaginismus
  • Pelvic pain
  • Tiredness [2]

UTIs often don’t show symptoms in people with robust immune systems. For instance, the incidence is 15 percent or greater in women and men aged 65 to 80 years and as high as 40 to 50 percent after age 80 but lower in younger adults. 

However, these are asymptomatic in older adults. Therefore, they will require frequent health check-ups and preventive measures. [3]

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What causes recurrent UTIs?

Recurrent urinary tract infections occur when a person has two episodes of acute bacterial cystitis with its associated symptoms within the last six months. Alternatively, it is when someone has three or more episodes of UTIs within the year. [1] 

Recurrent urinary tract infections are difficult to treat and decrease quality of life. Hence, understanding what causes recurrent urinary tract infections will improve detection, treatment, and prevention. 

Several conditions may increase your chance of getting a UTI, such as the following:

  • Abnormalities in the urinary tract
  • Medical conditions such as diabetes, multiple sclerosis, stroke, spinal cord injury
  • Specific birth control methods, for example, diaphragms
  • Weakened immune system
  • Use of catheters in the urinary tract
  • Pregnancy
  • Menopause
  • Kidney stones
  • Multiple sexual partners
  • Urinary surgery

Additionally, recurrent UTIs are much more common in women. This is because women tend to have a shorter urethra than men, and thus, the distance bacteria travel to the bladder is shorter. 

What can mimic a UTI?

Although UTIs seem commonplace, they may occasionally be misdiagnosed for other conditions. 

What can mimic the symptoms of a UTI? Several infectious and non-infectious illnesses can lead to symptoms similar to urinary tract infections, which we discuss below.

Sexually transmitted infections

STIs such as gonorrhea, trichomoniasis, chlamydia, and mycoplasma can cause painful urination since it causes the urethra to be inflamed and lead to urethral discharge. A culture sensitivity test can differentiate a UTI from an STI.

Vaginal infections

Infections such as those caused by Gardnerella, candida, or mycoplasma can irritate the vulva and cause discomfort or burning while urinating. 

Also, bacterial vaginosis, caused by the alteration of bacterial flora of the vagina, can imitate UTI symptoms.

Overactive bladder

This usually means the bladder muscles are not functioning normally, which results in a sensation of having to urinate often and more frequently at night. 

These symptoms are similar to that of UTIs. However, this condition is typically due to prostate enlargement, menopause, aging, and other conditions such as neuronal problems and chronic diseases like diabetes.

Bladder prolapse

Bladder prolapse is a condition often caused by weak supportive tissue, causing the bladder’s posterior wall to fall through the vagina. It is more common in women, but men can get it too.

Different factors increase the risk, including frequent heavy lifting, multiple pregnancies, and prolonged labor. In the early stage, it mimics UTIs as there are symptoms such as pelvic pain, urgency, and frequent voiding.

Pregnancy

Pregnant women are more prone to UTIs than non-pregnant women, and pregnancy presents with lower urinary tract symptoms. It is associated with incomplete urination, more urination at night, and problems with incontinence. 

Prostatitis

In men, the prostate can be inflamed and lead to increased frequency of urination, pelvic pain, pain with urination, and other indicators of infection.

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Interstitial Cystitis

Interstitial cystitis is also known as bladder pain syndrome or BPS. Since the bladder is inflamed in this condition, it is similar to a urinary tract infection. 

It is one of the specific diseases which can be mistaken for a UTI, but the difference is that in this case, no bacterial infection exists in the bladder. 

Kidney stones

Symptoms of kidney stones can include pain in the abdomen, nausea, vomiting, and blood in the urine, which are all similar to UTI symptoms. They are typically caused by minerals and salt deposits within the urinary tract.  

Cancer

Although not as common, certain types of cancer may cause a person to have similar symptoms as a UTI. For instance, kidney and bladder cancer can cause blood in the urine and lower abdominal pain. [4, 5, 6]

Can recurrent UTIs be a sign of cancer?

Occasionally, recurrent UTIs can be a sign of cervical or bladder cancer. Depending on the cancer stage, the clinical presentation could include blood in the urine and pain. 

For example, the associated symptoms of UTIs are also signs of bladder cancer, including a burning sensation when urinating and painful urination. 

However, because there are related symptoms similar to cancer, it doesn’t mean you should assume it is cancer if you have a UTI. [7]

Your healthcare provider will ensure that the correct diagnosis is made beyond only clinical presentation. There are often more benign causes of frequent UTIs, such as urinary tract obstructions or incomplete treatment of the preliminary UTI with antibiotics. 

Can frequent UTIs be a sign of something else?

Other UTI symptoms include irritation or pain when urinating or a frequent and urgent need to urinate, and they can also be symptoms of bladder cancer. 

Because UTIs and bladder cancer share symptoms, bladder cancer can be challenging to diagnose. 

Therefore, if a patient has a UTI or is experiencing blood in the urine, it’s strongly recommended that they monitor their health to keep track of their symptoms and how long they’ve had them.

UTIs are often cured easily, so once they return, people wonder if it could be something more serious. 

However, if you seek help, your doctor will rule out other causes such as kidney stones, poor drainage of the kidney or bladder, or cancer, all of which are rare causes of UTI. 

Occasionally, recurrent UTIs can lead to a life-threatening urosepsis when the bacteria spread around the body, causing fever, pain, confusion, difficulty breathing, and extreme tiredness. 

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When should I worry about a recurring UTI?

Don’t panic because the infection returns within six months for 25% to 30% of women who’ve had a urinary tract infection. 

UTIs can affect anyone, and reoccurrences happen. However, if it happens more than twice in 6 months or thrice in a year, there might be a serious underlying problem. 

Also, if the symptoms of the recurring UTI get worse, that should be another red flag. If the condition gets worse, contact your doctor.  

How often is too often for UTIs? 

On average, every woman is at risk for 1 UTI per year. For men, the average is a little lower. 

But If someone has two UTIs in six months or three within a year, tests will be needed by the healthcare team to find the cause so the appropriate treatment plan can begin with patient monitoring.  

You should see your healthcare provider if you get frequent UTIs or call your doctor if you have three or more urinary tract infections in 12 months. [8] 

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Can UTIs increase the risk of cancer?

Yes, but there is controversy on whether urinary tract infection is a risk factor for urinary bladder cancer. 

Preliminary data supported a link between recurrent UTIs and increased bladder squamous cell carcinoma risk. However, squamous cell carcinoma is a rare type of bladder cancer (<5% of cases), so the overall impact of this potential association would be genuine. Thus,  E. coli infections, particularly UTIs, might play a role in the development of bladder cancer. [9] 

Signs of bladder cancer

About 83,730 new bladder cancer cases are diagnosed annually in the United States. Unlike UTIs, which predominantly affect women, bladder cancer may affect men thrice as much as women. [11] 

Symptoms include:

  • Blood in urine
  • Difficulty in urinating
  • Low back pain
  • Rapid weight loss
  • Loss of appetite
  • Swollen feet
  • Extreme weakness and tiredness

If you or someone you know is exhibiting symptoms of bladder cancer, seek medical attention immediately. ​​Cancer is typically due to the unregulated growth of cells in your body. 

Bladder cells may become cancerous due to smoking, schistosomiasis, urinary tract infections, chronic catheter use, and chemicals such as hydrocarbons and certain dyes. 

Bladder cancer recurrence symptoms during the first two years of diagnosis warrant a rigorous surveillance schedule due to the morbidity of recurrence and progression of the disease. 

Risk-aligned surveillance entails cystoscopy at 3 and 12 months, followed by annual bladder cancer surveillance for low-risk and every three months for high-risk cancers. 

However, risk-aligned care is not the norm. Generally, patients with recurrent bladder cancer are treated with surgery, radiation, chemotherapy, or immunotherapy. [12,13]

When to see a doctor

Most healthcare providers recommend contacting your doctor as soon as you notice bladder or urinary tract symptoms. 

You should also see your healthcare provider if you get frequent UTIs. Call your doctor if you have three or more urinary tract infections in 12 months.

Conclusion

Urinary tract infection (UTI) is one of the most common bacterial infections, and the incidence in women is much higher than in men. The diagnosis of a UTI can be made based on a combination of symptoms and a positive urinalysis or culture, and its treatment is often simple. 

However, recurrent UTIs may indicate an underlying problem, so seek medical attention. Also, remember that STIs, kidney stones, and overactive bladder mimic UTIs.

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Sources

  1. Aggarwal N, Lotfollahzadeh S. Recurrent Urinary Tract Infections. [Updated 2022 Jun 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557479/#
  2. Geerlings S. E. (2016). Clinical Presentations and Epidemiology of Urinary Tract Infections. Microbiology spectrum, 4(5), 10.1128/microbiolspec.UTI-0002-2012. https://pubmed.ncbi.nlm.nih.gov/27780014/
  3. Bono MJ, Leslie SW, Reygaert WC. Urinary Tract Infection. [Updated 2022 Jun 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470195/
  4. Michels, T. C., & Sands, J. E. (2015). Dysuria: Evaluation and Differential Diagnosis in Adults. American family physician, 92(9), 778–786. https://pubmed.ncbi.nlm.nih.gov/26554471/
  5. Jido T. A. (2014). Urinary tract infections in pregnancy: evaluation of diagnostic framework. Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 25(1), 85–90. https://doi.org/10.4103/1319-2442.124496
  6. Adaji, S. E., Shittu, O. S., Bature, S. B., Nasir, S., & Olatunji, O. (2011). Bothersome lower urinary symptoms during pregnancy: a preliminary study using the International Consultation on Incontinence Questionnaire. African health sciences, 11 Suppl 1(Suppl 1), S46–S52. https://doi.org/10.4314/ahs.v11i3.70070
  7. DeGeorge, K. C., Holt, H. R., & Hodges, S. C. (2017). Bladder Cancer: Diagnosis and Treatment. American family physician, 96(8), 507–514. https://pubmed.ncbi.nlm.nih.gov/29094888/
  8. Dason, S., Dason, J.T., Kapoor, A. (2011). Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Canadian Urological Association Journal; 5(5): 316-322. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202002/
  9. El-Mosalamy, H., Salman, T. M., Ashmawey, A. M., & Osama, N. (2012). Role of chronic E. coli infection in the process of bladder cancer- an experimental study. Infectious agents and cancer, 7(1), 19. https://pubmed.ncbi.nlm.nih.gov/22873280/
  10. Vermeulen, S. H., Hanum, N., Grotenhuis, A. J., Castaño-Vinyals, G., van der Heijden, A. G., Aben, K. K., Mysorekar, I. U., & Kiemeney, L. A. (2015). Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancer study. British journal of cancer, 112(3), 594–600. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453642/
  11. American Cancer Society: Key statistics for bladder cancer.
  12. Chamie, K., Litwin, M. S., Bassett, J. C., Daskivich, T. J., Lai, J., Hanley, J. M., Konety, B. R., Saigal, C. S., & Urologic Diseases in America Project (2013). Recurrence of high-risk bladder cancer: a population-based analysis. Cancer, 119(17), 3219–3227. https://pubmed.ncbi.nlm.nih.gov/23737352/
  13. Schroeck, F. R., Smith, N., & Shelton, J. B. (2018). Implementing risk-aligned bladder cancer surveillance care. Urologic oncology, 36(5), 257–264. https://pubmed.ncbi.nlm.nih.gov/29395957/

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