Bladder Cancer
Bladder cancer affects approximately 55,000 adults each year — about twice as many men as women, and almost all are over 40 years of age. By Rear Adm. Joyce Johnson, D.O

The bladder is the “holding tank” for urine. The kidneys filter waste products from the blood. These products, dissolved in water, form urine. Urine flows from each kidney through each ureter to the bladder, located in the lower abdomen. It leaves the body through the urethra.

Any time you see blood in your urine (i.e., the urine is red or brownish-orange), see your doctor immediately. This could be a sign of a common urinary tract infection, but it also could be a symptom of bladder cancer. Frequent or painful urination also can accompany bladder cancer.

If your health practitioner suspects bladder cancer, he or she will take a complete history and do a physical examination, including tests on the urine. You probably will be referred to a urologist for a cystoscopy, which involves inserting a small fiber optic tube into the urethra to see the inside of the bladder. During the cystoscopy, biopsies may be taken so a pathologist can determine whether the cells are cancerous. Your doctor also could order an intravenous pyelogram, which involves injecting a dye into the veins that, on x-rays, will highlight the outline of the urinary tract and help identify any masses. If bladder cancer is diagnosed, other tests might be necessary to determine how advanced (what “stage”) it is. The stage is a major factor in determining a treatment plan.

Treatment generally involves surgical removal of the cancer. If it is small and superficial, it can easily be removed, leaving the bladder intact; sometimes all or part of the bladder must be removed. If all of the bladder is removed, the surgeon will create a pouch to hold the urine and a tube through which it can exit the body. Even if the cancer is so advanced it is not possible to surgically remove the entire tumor, additional treatments are available. For some patients, additional treatments are recommended after surgery.

Radiation therapy could involve inserting radioactive material directly into the bladder (which must take place in the hospital) or exposing the patient to radiation from a machine similar to an x-ray machine (which requires nearly daily out-patient treatments for a month or two). Occasionally, radiation therapy is done before surgery to shrink the tumor. Chemotherapy and biological therapies also are frequently used, with some medications inserted directly into the bladder and others injected intravenously. Surgery, radiation, chemotherapy, and biological therapy often are combined in a treatment plan tailored to an individual patient.

Bladder cancer can run in some families. Smoking more than doubles your chances of getting bladder cancer. Exposure to some occupational chemicals or to arsenic also increases your risk.

— Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources online at www.moaa.org/wellness.