8 questions and answers about bladder cancer

March 7, 2014 | by

Bladder cancer incidence rates have not increased over the past few years — which is a good thing. But unlike cancers of the colon, prostate and lung, they haven’t declined either.

Bladder, shown with kidneys

Bladder cancer rates remain stubbornly unchanged. City of Hope's Sumanta Pal explores the reasons. Here, the bladder is shown with the kidneys; all part of the renal system.

With more than 74,690 new cases of bladder cancer diagnosed in the United States each year and approximately 15, 580 deaths from the disease, it's imperative to find the underlying causes of bladder cancer and why the incidence rate remains stubbornly unchanged.

Here Sumanta Kumar Pal, M.D., co-director of the Kidney Cancer Program at City of Hope, explores both the factors behind the stagnant incidence rates and the disease’s current and future treatments.

What is the current trend for bladder cancer incidence rates?

When reviewing the most recent American Cancer Society statistics, it appears as though bladder cancer incidences have flat-lined to some extent. This is disappointing because there are several other cancers indicated in the same annual report that appear to be on the decline. For instance, the incidence rates on prostate cancer in broad terms seem to be falling.

Furthermore, incidence rates of lung cancer and colorectal cancer also appear to be falling. This may potentially reflect little change in terms of bladder cancer screening; whereas for colorectal cancer and prostate cancer, there’s been a great extent of literature on cancer screening. We just don’t have the same in the context of bladder cancer.

How is bladder cancer detected?

Typically when patients present a diagnosis of bladder cancer, they have symptoms such as blood in the urine or they may demonstrate pain with urination. The first evaluation for bladder cancer is typically by a urologist. They may perform CT scans and potentially a procedure called a cystoscopy, where they directly visualize the bladder. These procedures aid in determining whether or not a bladder tumor is present.

What are some of the risk factors for bladder cancer?

One of the major risk factors for bladder cancer includes smoking, which is not exclusive to bladder cancer, of course. It’s also a risk factor for diseases such as lung cancer and kidney cancer. We also have found, quite interestingly, that there are certain dyes — specifically dyes called aniline — that can potentially be associated with bladder cancer incidence. These dyes are actually used in clothing manufacturing facilities, so you may find that certain individuals with work exposure to these types of dyes may develop bladder cancer at a higher rate.

Like kidney cancer, bladder occurs more in men than women and in the elderly. Why is that?

Sumanta Pal

Sumanta Kumar Pal explains the risk factors and symptoms for bladder cancer.

We typically find that bladder cancer affects males to females in a 3 to 1 ratio. The rationale for this is not completely understood, but this may be potentially tied in with some of the risk factors like smoking. We also do find that bladder cancer tends to be a disease that occurs in an older age group — median age diagnosis is in the range of 60 to 65 — this may be due to an accumulation over one’s lifetime and damage to the bladder. So for instance, long-term bladder irritation can be one of the deciding factors for bladder cancer. And as you can imagine, these sorts of things might be exacerbated over a lifetime.

How can someone lower his or her risk of bladder cancer?

Unfortunately, beyond limiting chemical exposures such as smoking and exposures to certain dyes, there’s not a lot one can do to prevent bladder cancer from developing. Having said that, in order to most effectually treat bladder cancer, we’d like it to be at a limited stage. So when you do develop symptoms consistent with bladder cancer, such as blood in the urine or pain with urination, it would be great to see a urologist as soon as possible, as this may broaden the scope of available treatment options.

What questions should patients ask their doctors when they are first diagnosed with bladder cancer?

When someone is diagnosed with bladder cancer, there are several questions they can ask their doctor to stay on track in terms of treatment. Perhaps the most important question is understanding how far the bladder cancer has spread. This is a loaded question. First, we’d like to know whether or not the tumor has actually escaped the boundaries of the bladder and moved to the lymph nodes or lungs, as these are common sites where bladder cancer may potentially spread.

The second question we may want to know from the urologist is that, if the disease has not spread to that extent, is whether or not the bladder cancer penetrated some of the deeper muscular layers of the bladder. This is a major treatment distinction in the management of bladder cancer. Typically, if a bladder tumor has invaded into those muscular layers, removal of the bladder constitutes one of the ways we would treat the disease.

What types of developments have been made in bladder cancer treatment in the past few years?

I treat three types of cancer: prostate cancer, kidney cancer and bladder cancer. Over the past five years, we’ve had five drugs approved for prostate cancer. In the setting of kidney cancer, we’ve actually had seven drugs approved over the past decade. In the case of bladder cancer, there unfortunately have been no drugs approved.

However, there are a number of clinical trials underway. We are participating in many here at City of Hope. I think that you’ll find that many of the treatments for bladder cancer are moving away from chemotherapy and toward immune-based treatments. These are drugs that actually might stimulate one’s own body to respond and react against the bladder cancer. We have clinical trials that are ongoing at City of Hope that explore these types of therapies. So certainly when you’re having conversations with your physician, it would be important to ask whether or not they have ties to an academic center that can provide further clinical trials.

What type of advancements should we expect see in the next five to 10 years?

Over the next 10 years, what I hope we’ll see in regard to bladder cancer is a better understanding of the molecular profile of the disease. Right now at this moment we don’t really have a good sense of what the underlying drivers are for bladder cancer.

In the case of prostate cancer we know testosterone is one of the key drivers of cancer growth and cell division. In the setting of kidney cancer, we have identified specific mutations that drive the disease. The key there is that we actually can recognize drugs that target those molecular pathways by virtue of that. So for bladder cancer, if we have a deeper understanding of the molecular nature of the disease, then we may potentially be able to devise better treatments to tackle the disease itself.

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Learn more about bladder cancer treatment at City of Hope.

Learn more about clinical trials at City of Hope.