August 18, 2010
Bladder Cancer Outlook Good If Caught Early
Bladder cancer has a high cure rate when caught early, but knowing the warning signs and risk factors for the disease is especially important because routine screenings are not common, said a Baylor College of Medicine urologic oncologist.
"Bladder cancer is a highly treatable, highly curable disease particularly before it invades the muscle," said Dr. Seth P. Lerner, professor in the Scott Department of Urology and the NCI-designated Dan L. Duncan Cancer Center at BCM and Beth and Dave Swalm Chair in Urologic Oncology.
While bladder cancer is typically a disease of people in their 60s and 70s, Lerner said symptoms can occur in much younger people. Painful urination and/or blood in the urine are the most common presenting symptoms.
"This disease is more common in men than women," said Lerner. "However, women have a tendency to have more advanced forms of the cancer because early warning signs, such as blood in urine, are frequently dismissed as urinary tract infections or voiding dysfunction."
Never ignore blood in the urine, Lerner emphasized. "Get it checked out every single time."
Risk factors for the disease include working in certain occupations and cigarette smoking.
"Cigarette smoking is associated with 50 percent of all bladder cancers, while occupational exposure accounts for another 20 percent."
Research has identified a list of occupations that may include exposure to carcinogens that link to bladder cancer. These occupations include dry cleaning, rubber and aluminum industries, magenta and auramine manufacturing, petroleum refining and petrochemical manufacturers and barbers and/or hair dressers working with permanent dye.
Bladder cancer forms in the lining of the bladder after carcinogens in urine concentrate and sit in the bladder. Over a long period of time, this exposure to the bladder lining causes the changes in the cells that lead to cancer, Lerner said.
Management and treatment
"About 75 percent of cases when first diagnosed have a tumor that is non-muscle invasive and can be managed quite easily," said Lerner. "We can remove the tumor with a cystoscopic procedure using a lighted instrument to scrape out the tumor."
These patients remain at a high risk for developing tumors in the future, Lerner said. They require frequent follow-up cystoscopy tests and urine biomarker tests performed in the outpatient clinic.
"Bladder cancer requires long-term follow-up and surveillance to spot and treat a potential recurrence," Lerner emphasized.
Highest-risk patients may be treated with chemotherapy or immunotherapy delivered into the bladder by a catheter passed through the urethra, a procedure called intravesical therapy.
"The other 25 percent of patients have muscle invasive tumors that may spread to other parts of the body," said Lerner. "These patients typically have their bladders removed or reconstructed or undergo chemotherapy and radiation and are also followed very closely."
Lerner said a major challenge in fighting bladder cancer is the lack of data to support screening for bladder cancer in a broader population. He is currently enrolling patients for a study to test screening in a high-risk population which includes male cigarette smokers 60 years or older with a 40 pack year smoking history (number of cigarettes smoked per day multiplied by the number of years smoked).
"In 2010, an estimated 70,530 adults (52,760 men and 17,770 women) will be diagnosed with bladder cancer in the United States," said Lerner. "It is estimated that 14,680 people (10,410 men and 4,270 women) will die from this disease."
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