Jason Gee, MD, a urologist with Emerson Urology Associates, tackles the subject of bladder cancer, including who is at risk, new methods of treatment, and his involvement in studying possible prevention strategies.
How common is bladder cancer?
Overall, bladder cancer represents about 5 percent of new cancer cases in the U.S. each year. However, it is the fourth most common cancer among men, after prostate, lung and colorectal cancer. Men are about four times more likely to develop bladder cancer than women. Smoking puts people at risk for bladder cancer; smokers are three times as likely to develop bladder cancer as non-smokers.
It is a cancer that mainly occurs in older individuals; the average age at diagnosis is 73. Bladder cancer is thought to be related to exposure; the longer you smoke, the more likely you are to develop bladder cancer.
What are the symptoms of bladder cancer, and is there any way to screen for it?
The most common symptoms are blood in the urine and the need to urinate frequently. As with all cancers, early diagnosis is very important. There currently is no way to screen for bladder cancer, but I participated in research on home screening that tests urine. This may have potential use for those who are at high risk due to a history of smoking.
When someone has symptoms, we typically take a CT scan of the abdomen and pelvis and sometimes detect a different condition, such as kidney stones. Performing a cystoscopy — where a tube and light are inserted into the urethra — allows us to look more closely at the bladder. We also perform urine tests to look for abnormal cells.
Is there anything new in the treatment of bladder cancer?
The latest research is focused on identifying molecular markers that will determine whether or not someone has to have their bladder removed, which may be the appropriate treatment when a patient has advanced bladder cancer. In many cases, we can perform organ-sparing surgery to remove the tumor.
When a patient needs to have their bladder removed, they worry about having a urostomy, which was the standard surgery for many years. However, that procedure requires that the patient wear a urinary bag. Many people ask: is there a way to restore my anatomy so that I can avoid having to wear a urinary bag? Fortunately, today the answer is yes, we can offer patients novel surgical options that address this quality of life issue.
What are those surgical options?
We often can perform surgical reconstruction of the "neo-bladder," meaning we create a new bladder. This is done by removing a segment of the patient's small or large intestine, which we use to provide lower urinary tract function. For those who cannot have neo-bladder surgery, we can perform surgery that creates an internal reservoir that functions as a bladder, but with a catheter that opens at the skin surface — another way to avoid wearing a urinary bag.
Not only do we offer these reconstructive surgical procedures at Emerson, we have extensive experience in performing them. Studies have shown that the more experience a surgeon has, the better the outcome. We have everything a patient with urologic cancer needs, including a supportive network of clinicians. In addition to bladder cancer, we also treat patients with prostate, kidney, testicular and adrenal cancer.
Are there strategies to prevent the development of bladder cancer?
Yes. We are working with the National Institutes for Health (NIH) Bladder Chemoprevention Consortium to study neutriceuticals — nutrients that appear to prevent bladder, and perhaps also, prostate cancer. While we cannot yet recommend one nutrient vs. another, there are clinical studies showing favorable molecular changes in patients with bladder tumors.
I am the principal investigator for a National Cancer Institute study looking at the impact of ECGC, a nutrient found in green tea, on bladder cancer. The NIH purified ECGC into pill form, which we evaluated on a molecular level. We identified beneficial changes associated with ECGC when compared with a placebo. This research is slated for publication in the coming months. My hope is that we can use this information to design a larger-scale clinical trial involving patients who are at risk for bladder cancer, and then watch for diagnoses over time.
For more information on urology services at Emerson Hospital, visit the Urology page on our website.