Warning Signs of Bladder Cancer

As the sixth most common cancer in the U.S., bladder cancer affects about 80,000 Americans each year. And because men are at higher risk than women, it’s the #4 cancer risk for them.

Bladder cancer can grow and spread very quickly. The good news is that it is treatable—but like most cancers, the earlier it’s discovered, the more successful that treatment can be. The five-year survival rate for cancer that has not spread beyond the bladder is as high as 96 percent. But when that cancer begins to spread, that number can drop below 10 percent.

So, it’s essential to understand potential risk factors, and to take action if you see any warning signs, particularly blood in the urine.

Bladder Cancer Risk Factors

Let’s first consider some risks for bladder cancer.

Perhaps the most significant is smoking. Smokers are three times as likely as non-smokers to develop this disease. Age can also be a factor: Bladder cancer tends to appear after age 55, and the average age at onset is 75.

Men have about a 30 percent greater chance of developing it than women, and white people are twice as likely to contract it as Blacks or Hispanics.

A family history may also increase the risk, as well as the patient’s own prior history of bladder cancer, bladder infections, or repeated catheterizations. Certain medications and herbal supplements may add risk, including the diabetes medicine pioglitazone (Actos) and herbs in the aristolochia family, such as birthwort and snakeroot. Arsenic in drinking water, as well as some workplace chemicals—specifically aniline dye compounds—may also contribute.

Our kidneys are continually at work, extracting waste products from the blood and excreting them in the form of urine. The bladder is the temporary holding tank, storing the urine until it’s expelled.

Because the kidneys are very efficient at removing toxins from the blood, the resulting urine may contain elements that are potentially hazardous to the bladder. For example, in smokers, those elements are absorbed within the lungs and enter the bloodstream. The kidneys release some toxins via urine, which makes contact with the inner wall of the bladder. These toxins can potentially alter DNA and cause cancer.

Bladder Cancer Symptoms

Bladder cancer can develop and grow quite aggressively, although in its early stages, it seldom causes pain. Blood in the urine is the most prevalent warning sign that something is amiss with the bladder, particularly for people over 50. If you see blood even once, schedule a visit with your doctor.

In later stages of bladder cancer, the patient might experience an increase in urinary incontinence or frequency, a burning sensation, or a feeling that the bladder is not fully emptied. The feet and kidneys may also swell, and the patient may have back pain or bone pain.

Diagnosing Bladder Cancer

In order to determine the extent of bladder disease, I complete a full medical history with the patient and typically order a CT scan of the abdomen, with and without contrast. Occasionally, we conduct specific tests on the urine.

We also schedule a cystoscopy to obtain a direct view of the inside of the patient’s bladder, using a tiny camera and lights mounted on a thin, flexible tube passed through the urethra. With this same scope, we are able to biopsy small samples of bladder tissue for lab analysis.

The procedure, which typically takes about 30 minutes, can be done in the office with numbing anesthesia. Most of my patients do fine afterwards, with only minor irritation and more frequent urination, both of which go away quickly.

Bladder Cancer Treatment

If one or more tumors is found, surgical removal of the tumor tissue is typically the recommended approach.

When disease is present only on the inner lining of the bladder, it can be removed endoscopically without incisions, via a procedure known as transurethral removal of bladder tumors, or TURBT. In most cases, these tumors are completely removed with small instruments passed into the bladder. TURBT surgery leaves the bladder and urinary function intact, and the patient has a very good chance of no recurrence.

Although many cancers are visible to the trained eye under regular, white light, we frequently deploy blue light technology as well. We fill the bladder with a special dye, about an hour before surgery. Rapidly dividing cancer cells absorb the dye more quickly than healthy cells; under blue light, those abnormal cells glow pink.

Blue light technology helps define the edge of the tumor and can sometimes reveal lesions too small to see under white light. It is particularly helpful in diagnosing cancer that may have returned following a traditional procedure. At MedStar Washington Hospital Center, we perform up to 10 blue light procedures per month—more than any other medical center in Washington, D.C.,

After a TURBT procedure, we can introduce any necessary chemotherapy or immunotherapy agents directly into the bladder, where they can do their work without impacting other parts of the body.

When Tumors Go Deeper

If a tumor has invaded the walls and muscular structure of the bladder, we may need to remove the bladder completely, which calls for a plan for the storage and elimination of urine.

Depending on each patient’s unique situation and preferences, we have a few options:

• The most common approach is to use a short section of small intestine to create an ileal conduit, a pathway for urine to exit the body through the abdomen, where it collects into a urostomy bag. My conduit patients do very well with the procedure and with adapting to life with the bag. Most of my patients are able to resume normal activities, including golf, tennis, and other forms of exercise.
• In a neobladder surgery, we create a new bladder from a longer segment of small intestine, which is grafted to the kidneys and urethra to function similarly to the original bladder. The patient must learn to use abdominal muscles to empty the new bladder, which has no muscle mass of its own. This surgery is more complex; however, in cases where we can perform it robotically, we reduce blood loss and risk of complications for the patient.
• Continent cutaneous diversion is a hybrid of the previous two options. We create a new bladder pouch from a portion of small intestine, with a pathway through the abdomen to the outside. The pouch remains inside the body but is not connected to the urethra. It is emptied periodically via a tube inserted into the new abdominal port. This procedure also eliminates the need for the urostomy bag.

In the most serious instances, when cancer escapes the bladder and is found in other areas of the body, we use trimodal therapy, combining surgery, chemotherapy, and radiation. With today’s effective therapies, we are sometimes able to spare the bladder and help the patient maintain normal bathroom function.

An exciting development is the current research on immune checkpoint inhibitor therapy. Cancer cells are very clever; they can cloak themselves with normal-looking proteins to hide from the body’s immune system—wolves in sheep’s clothing. But these new agents remove the disguise, allowing the immune system to spot and eliminate the cancer cells. When these therapies receive FDA approval, we expect them to be game-changers in the treatment of bladder cancer.

Prostate-Friendly Bladder Surgery

MedStar Washington Hospital Center is one of just a few hospitals performing prostate capsule-sparing bladder cancer surgery.

When bladder removal is required, the prostate has traditionally been removed along with it, impairing erectile function. But by means of this surgery, a portion of the prostate is left behind, significantly reducing that risk, as well as the chances of post-surgical leakage or urinary incontinence.

Thanks to prostate capsule-sparing bladder surgery and neobladder surgery, we have the very real prospect of men surviving bladder cancer with sexual function intact and no need for a urostomy bag or absorbent pads or undergarments. This is a huge advance compared to just a decade ago—and particularly important for younger, sexually active patients.

Our Multidisciplinary Approach to Care

Our urologic oncologists team closely with the medical oncology and radiation oncology units to manage disease in our patients closely. Our physician assistants and nurse practitioners are specially trained to help surgery patients adapt to any new bathroom routines that may be required following their surgery.

Bladder cancer is serious and it can spread aggressively. Tumors may bleed for a short time, then stop. So if you notice blood in your urine even once, be sure to schedule a visit with a medical professional.

Delaying treatment for even a month may spell the difference between an early diagnosis with a very good prognosis and a more challenging outcome. It’s never a mistake to heed the warning and protect your health.