Healthy Outlook Blog

Bladder cancer only tends to hit the headlines when a celebrity goes public with their diagnoses, like Patti Hansen (Rolling Stones’ Keith Richards’ wife) who was diagnosed 2 years ago, or basketball great Maurice Lucas “the Enforcer” died from bladder cancer recently at age 58. The National Cancer Institute estimates that it will strike 70,530 Americans this year, and kill 14,680. What makes this especially tragic is at least half of these cases could potentially have been prevented by one simple precaution: avoiding smoking or exposure to second-hand smoke.

I am a 63-year-old woman who lives without a bladder. I lost it in an operating room at Memorial Sloan Kettering Cancer Center after I was diagnosed with bladder cancer 10 years ago. I had the usual first symptom, blood in the toilet. Like most women, I brought it to the attention of my gynecologist, who thought the blood was coming from my uterus. After a uterine biopsy, followed by antibiotics for a possible kidney infection, I was finally referred to an urologist who scoped me in the office, saw the tumors and referred me to a surgeon.

Of all the diseases I’d ever worried about, bladder cancer wasn’t even on the list. I thought it was something a 80-year-old man might get. And I didn’t have any of the usual risk factors: I worked out in gym five days a week and ate a healthy diet. And as a psychologist, I hadn’t been exposed to hazardous chemicals. I’d never smoked, but I had been exposed to second-hand smoke for years at home and work. The cancer had already spread to my lymph nodes. That meant I had stage 4 cancer, the most advanced stage. Knowing that my chances of surviving the next 5 years were less than 60 percent, I put all of my energy into getting well.

To save my life, I had to lose my bladder. I now have a new urine reservoir in my abdomen constructed out of a piece of my colon. I void by inserting a catheter through a stoma on my belly. With all the recycled body parts, I felt like a Home Depot plumbing project, but I am fine and fully back in my life and work. I just can’t leave home without a wallet-sized catheterization kit. My plumbing alteration is one of the treatment options. There has been considerable progress in the surgical options if the bladder has to be removed. The oldest is the ileal conduit, where the ureters from the kidneys are brought to the surface of the abdomen, a stoma is created, and the patient wears an external bag into which urine drains. I have the Indiana pouch. The newest option is the replacement of the bladder with a reservoir also constructed of bowel tissue, but the neobladder is attached to the existing urethra, so the patient can void without any equipment. Another possibility still in the research phase is regenerating bladder tissue, using stem cells harvested from the patient’s own bone marrow or in some cases, from the original bladder.

Like me, women typically are diagnosed as much as a year later than men with the same symptom of blood in the urine. Other symptoms include frequent or painful urination. This delay means that women are typically diagnosed at a later stage of the illness. As a result, even though four times more men than women get bladder cancer, women have a 30 percent to 50 percent higher risk of dying from it. Part of the problem is that women and their doctors are so used to women’s bleeding that it does not raise alarms the same way it does for men.

Quitting smoking—or never starting–is the best prevention. A recent study found that smoking-related bladder cancer is on the rise, with smokers in New Hampshire today having nearly four times the risk of bladder cancer than those living in the mid-1990s, possibly due to changes in cigarette design. The researchers also found that among people who smoked the same number of cigarettes in their lifetime, those who smoked fewer per day over a longer period were at higher risk. But here’s the encouraging news: Four years after quitting, the risk of bladder cancer drops by up to 40 percent. Snuffing out the habit is good for your heart, lungs—and bladder.

CONNECT THE DOTS

To learn more, visit the websites of the Memorial Sloan Kettering Cancer Center, American Cancer Society, or Bladder Cancer WebCafe, which offers valuable information for all stages of diagnosis and treatment, with a helpful listserv. Bladder Cancer Advocacy Network provides education and support. For help with quitting smoking, check out Smokefree.gov.