Understanding your risk of bladder cancer

Zhentao (Richard) Zhang, MD, PHD, Medical Oncology/Hematology, Parkview Cancer Institute, helps us observe Bladder Cancer Awareness Month with an overview of the disease, including risk factors, prevention and treatment.
How prevalent is bladder cancer?

Bladder cancer is the 7th most commonly diagnosed cancer in the United States. According to the American Cancer Society, it is estimated that, in 2018, about 81,190 new cases of bladder cancer will be diagnosed and about 17,240 patients will die from it.

Who is at the greatest risk?

Environmental exposures account for most cases of bladder cancer. The most common risk factor is tobacco smoking followed by aging, occupational carcinogen exposure and parasites (schistosomiasis). Men are about three times more likely to have bladder cancer than women. This may or may not be related to the environmental factors mentioned above.

What are the symptoms?

The most common symptom of bladder cancer is bloody urine (hematuria). It may or may not be accompanied by abdominal or pelvic pain. Patients may also have voiding symptoms such as urinary frequency, urgency, painful urination or incontinence. If bladder cancer blocks the urinary tract, it may cause obstructive voiding symptoms and possible water retention in the kidney(s) (hydronephrosis). Late stage cancer may cause constitutional symptoms such as fatigue, weight loss, lack of appetite, bone pain and failure to thrive.

Are there routine screening recommendations?

Unfortunately, there is no consensus on routine screening guidelines for bladder cancer currently.

What are some steps for prevention?

Reducing your exposure to environmental risk factors is always recommended. Quit smoking, and avoid carcinogens. Increasing total fluid intake may dilute excreted urinary carcinogens and reduce bladder cancer risk as well.

Are there any dietary behaviors that contribute to bladder cancer?

A lot of environmental carcinogens may exist in drinking water or foods. For example, studies showed that byproducts (Trihalomethanes, THMs) from chlorination found in drinking water may be associated with increased risk for bladder cancer in men. Increased concentration of arsenic in drinking water or foods in certain areas of the world have been associated with increased bladder cancer risk. Removal of arsenic may drop the risk. As mentioned above, drinking plenty of water may help reduce bladder cancer risk.

What is the treatment plan for bladder cancer?

Early stage bladder cancer is primarily managed by urologists. Patients often need to have cystoscopy, biopsy, resection and possible subsequent management with either observation or intravesical injection of BCG (a substance similar to that of the tuberculosis vaccination). 

Treatment for advanced stage or late stage bladder cancer is usually a multi-team approach.  Urologists, medical oncologists and radiation oncologists work together. Patients may need chemotherapy, surgery to remove the bladder with or without lymph nodes dissection or radiation.

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