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Bladder cancer, recognizing the early warning signs

Bladder cancer occurs about three times more often in men than women. It’s also more likely to strike older adults.
Environmental factors such as tobacco and industrial chemicals can increase the risk of bladder cancer as well.
Chemicals such as industrial solvents, paints and paint thinners have been linked to a higher rate of bladder cancer, and the risk is even higher for smokers exposed to these chemicals.

“ It’s very important for patients to pay attention to the symptoms that they may experience. For example, if someone has blood in the urine, they may have the tendency to dismiss that or ignore that. I cannot emphasize enough that it is very important for patients with that symptom to be evaluated by a physician. Blood in the urine is never normal and should always be evaluated,” says Cheryl Lee, director of the Bladder Cancer Program at the University of Michigan Comprehensive Cancer Center.

About 13,000 people die of bladder cancer each year.

Blood in the urine is the most common and most likely early symptom of bladder cancer. By the time other symptoms, such as pain in the mid-section or bones, emerge it’s a sign of advanced disease that has spread beyond the bladder.

Treatment is most successful in the early stages of bladder cancer, when the tumor is smaller and on the surface of the bladder, rather than invading the bladder wall.

“If a patient unfortunately has had a delay in diagnosis, or has not responded to some of the signs such as blood in the urine, the tumor has the opportunity to grow, to invade the wall of the bladder and even to extend beyond the bladder, or metastasize, to other organs. In that scenario, we’re looking at much more aggressive and radical treatment plans,” Lee says.

Early stage tumors that have not invaded the bladder wall can be removed in an outpatient setting. Treatment would also include drugs that reduce the risk of tumors coming back. After five years, 85 percent of patients or more with this stage of bladder cancer survive.

For more advanced cancer that has invaded the bladder wall but remains confined to the bladder, treatment involves surgery to remove the bladder or a combination of chemotherapy and radiation therapy. Survival is 60 percent to 75 percent after five years.

“ We’re using new research techniques to study whether we can look at the genes and the genetic profile of a tumor to determine whether a patient is going to respond to a particular type of chemotherapy,” Lee says.

Tests to diagnose bladder cancer include:

• A urine sample, where doctors look for cancer cells under a microscope.

• X-rays of the kidney and urinary system, including the bladder.

• Cystoscopy, in which a small flexible tube with a camera on the end is placed into the bladder. This is similar to a colonoscopy but for the bladder.

Symptoms of bladder cancer

• Blood in the urine. This occurs in the vast majority of people with bladder cancer.

• Urgency to urinate.

• Frequent urination in small amounts.

• Back or abdominal pain.

• Painful urination.

• Loss of appetite and weight.

Source: University of Michigan Health System, 2005