Bladder cancer, says the Mayo Clinic, “is one of the most common cancers, affecting approximately 68,000 adults in the United States each year,” and apparently it’s even more common here in Vero Beach.
As Indian River Medical Center urologist Dr. Carrington Mason puts it, “I have seen more bladder cancer in the last five months here than I did practicing in an urban hospital in Dallas [Texas] probably in the last 15 years.”
Orlando’s Florida Hospital adds that the most jarring sign of bladder cancer (technically called urothelial carcinoma or transitional cell carcinoma) is hard to miss: blood in the urine.
That, along with anemia, high blood pressure, frequent and painful urination, and persistent fatigue are among the signs the American Cancer Society says should send you scurrying to your physician.
That’s actually a good thing in the eyes of the Mayo Clinic. It says “about seven out of every 10 bladder cancers diagnosed start out at an early stage when bladder cancer is highly treatable.”
That said, Mayo points out that even early-stage bladder cancers frequently recur so, typically, patients tend to need follow-up tests for years after initial treatment and those treatments are no walk in the park.
As Mason puts it, “I always tell people it’s not Disney World, but the ride’s a little shorter.”
A type of rigid tube called a resectoscope is placed into the bladder through the urethra (in men, that’s through the penis). The resectoscope has a camera and a wire loop at its end and is used to remove any abnormal-looking tissue.
“So, typically,” Mason continues, “what we’ll do is we’ll look in the bladder, we’ll identify a tumor, and then we go do an outpatient procedure called a transurethral resection of a bladder tumor, where, with the patient asleep, we go in and scrape down the tumor and send it off to the pathologist. And we’re looking mainly for two things. One is the level of aggressiveness of the bladder cancer, and then No. 2 is the depth of penetration through the bladder wall.
“Those two bits of information give us much of the guidance as to what sort of therapeutic options we have. For many patients who have a low-grade superficial tumor, we’ll just look in the bladder every three months to six months to a year.”
Shockingly, Mason says there are even cases when your physician might treat your bladder cancer by giving you tuberculosis – sort of.
“If you have a more aggressive tumor,” says Mason, “we may use … BCG [which is] an inactivated tuberculosis that creates an immune response within the bladder so that the recurrence of tumor is significantly decreased.”
Not scary enough? The Mayo Clinic adds “any remaining cancer may be treated by fulguration or burning the base of the tumor while looking at it with the cystoscope or by using a high-energy laser through the cystoscope.”
And the root cause for all this scraping and burning? Mason and the American Cancer Society point the finger squarely at cigarette smoking.
Even if the patient quit smoking years ago, residual toxins that have built up inside the bladder can still trigger this disease and – aside from death – the worst possible result from all those Marlboros might be needing a radical cystectomy or the total removal of the bladder.
Surgery to remove the bladder (and any lymph nodes or nearby organs that contain cancer) is incredibly complex; in men, nearby organs that are likely to be removed are the prostate and the seminal vesicles, while in women it’s the uterus, the ovaries and part of the vagina.
Moreover, when the bladder is removed, another way for urine to leave the body must be created. As Mason explains, “the most common thing is, we create what’s called an ileal loop, where a small, 6-inch segment of intestine is disconnected from the intestinal segment. And we attach the kidneys to this, and then bring the end of it up to the skin where a bag will collect the urine on the skin.”
Mason sums up by simply calling bladder cancer “a crummy disease” and urges anyone with any of the above symptoms to immediately seek medical help.
Dr. Carrington Mason is with the Indian River Medical Center. His office is at 3450 11th Court, Suite 303. The phone number is 772-794-9771.