It is estimated that before this year is over, more than 72,000 Americans—most of them over age 55 and two-thirds of them male— will be diagnosed with bladder cancer. When found in its earliest stages—as it is for approximately 75 percent of bladder cancer patients—the cure rate is high. Which makes it all the more important to take heed of possible symptoms and warning signs.
Patients who experience urinary pain, frequency or urgency, especially if they are accompanied by visible signs of blood in the urine (gross hematuria), should consult a physician or urologist. Although these symptoms are commonly associated with a urinary tract infection, they may also be the sign of something more serious, such as precancerous lesions or bladder cancer.
“The most telltale warning sign of bladder cancer is blood in the urine,” says Praneeth Vemulapalli, M.D., of Premier’s Urology Division. “When a patient presents with urinary symptoms, tests will reveal the presence of microscopic hematuria, amounts invisible to the naked eye. If blood is present, the first thing we do is investigate where the bleeding is coming from,” Dr. Vemulapalli says. “We conduct an upper urinary tract imaging study of the kidneys and ureters to rule out such things as kidney stones, infections or other potential sources of upper tract bleeding.”
In order to evaluate the lower urinary tract, cystoscopy is performed, a procedure in which a small camera provides views of the urethra and bladder. Cystoscopy is considered the “gold standard” for evaluating the lower urinary tract. We can also perform narrow band imaging to reveal tumors that might not be visible under white light cystoscopy.
If a tumor is located, the physician will perform an endoscopic transurethral resection, a procedure in which the tumor is scraped off the bladder lining. The pathology department grades the tumor for its severity and to help determine the appropriate course of follow-up care.
In the least aggressive cases, known as papillary carcinomas, removing the tumor from the bladder lining may be the only treatment required. If the cancer appears more aggressive, but is still limited to the bladder lining, intravesical chemotherapy can be used to kill remaining cancer cells in a localized manner. This involves inserting a drug directly into the bladder through a catheter, either as a single dose shortly after the bladder resection, or over the course of six weekly treatments. Such targeted treatment spares the patient many of the unpleasant side effects of systemic chemotherapy, such as nausea and hair loss.
More serious cases may require a combination of chemotherapy and immunotherapy. The most aggressive cases of bladder cancer— in which the cancer has spread to the bladder muscle itself—may require either a partial or a radical cystectomy, removing a portion of the bladder or the entire bladder. In the case of a radical cystectomy, there are several options for accommodating bladder function, including creation of a “neo-bladder” that permits close to normal urinary function or an Ileal conduit to divert urine outside of the body.
“If found early, the success rate for the treatment of bladder cancer is very high and most patients can go on to live full and complete lives without comprising their quality of life in any way,” says Dr. Vemulapalli. It should be noted that bladder cancer has a high recurrence rate, however with close follow-up, patients have a very good chance of beating and surviving the disease.
For this reason, people who have had bladder cancer are advised to commit to lifelong follow-up exams. The American Academy of Urologists calls for assessment every three months in the first two years after diagnosis, every six months for the next two to three years, then annually thereafter.
Many people are surprised to learn smoking is the primary cause of bladder cancer, responsible for about half the cases of the disease in both men and women. Smokers are at least three times as likely to get bladder cancer as nonsmokers.
“The carcinogens in tobacco that are absorbed through the lungs are filtered through the kidneys and ultimately collect in the bladder, where they can stay for long periods of time, until the patient urinates,” Dr. Vemulapalli says. “My advice to patients who want to avoid bladder cancer—and many other health problems—is simple: Stop smoking. Now.”