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Bladder Cancer is Likely to Come Back

July 24, 2012

Washington Hospital Infusion Center Offers Immunotherapy to Prevent Reoccurrence

Bladder cancer is not one of the cancers you hear about very often. Most cases are caught in the early stages, when bladder cancer is highly treatable. The five-year survival rate for stage-one bladder cancer is nearly 90 percent, according to the American Cancer Society. But the disease does have a high recurrence rate, meaning that ongoing treatment is often needed.

The bladder is a balloon-shaped organ in the pelvic area that stores urine. Bladder cancer usually begins in the cells that line the inside of the bladder.

An estimated 73,510 people in the U.S. will develop bladder cancer this year, according to the American Cancer Society, and more than 14,000 will die from the disease. Men are much more likely to develop bladder cancer than women, although the number of cases seems to be rising in women, according to Dr. Mark Saleh, a local urologist and member of the Washington Hospital medical staff.

"Bladder cancer is most often detected in a routine urinalysis," he said. "Smoking is the biggest risk factor. The same chemicals in the smoke that cause lung cancer get absorbed into the bloodstream and end up in the bladder. Excessive alcohol use can also contribute to bladder cancer."

Saleh said another major risk factor is exposure to industrial chemicals. Just like with tobacco smoke, the kidneys play a major role in filtering harmful chemicals from the bloodstream and moving them into the bladder, he explained. Chemicals linked to bladder cancer include arsenic and those used to manufacture dyes, rubber, leather, textiles, and paint products.

The most common type of bladder cancer is transitional cell carcinoma. Transitional cells line the inside of the bladder and expand when the bladder is full and contract when it is empty. Squamous cell carcinoma happens in response to infection and irritation. This type is rare in the U.S.

With early stage bladder cancer, the cancer sits on the surface of the bladder lining and treatment can often be managed by a urologist like Saleh. The cancer invades the bladder wall and muscle in later stages, making it more difficult to treat. Once it has moved beyond the lining, cancer cells may enter the bloodstream and lymph system, allowing the cancer to spread to other parts of the body.

Even when detected in the early stages, bladder cancer is likely to reoccur, according to Saleh. For that reason, treatment plans are designed not only to get rid of the cancer, but also to prevent it from coming back.

Treatment Options

In the early stages, bladder cancer can be treated by removing it from the lining of the bladder. A small camera, called a cystoscope, is passed into the bladder, allowing direct visualization and treatment of the cancer using laser or electric current, Saleh explained.

He said sometimes surgery is performed to remove the portion of the bladder that contains the cancer cells. For invasive bladder cancer, the entire bladder may be removed and alternative ways to hold and expel urine may need to be surgically created.

"Chemotherapy and immunotherapy are commonly used to treat bladder cancer and keep it from reoccurring," said Dr. Vandana Sharma, a medical oncologist and member of the Washington Hospital medical staff. "The Sandy Amos, R.N. Infusion Center at Washington Hospital offers our patients a state-of-the-art facility where they can receive these treatments in a comfortable setting."

If the cancer hasn't invaded the bladder wall, the chemotherapy drugs can be put directly into the bladder through the urethra, she said. For invasive bladder cancer, the drugs must be injected into the bloodstream so they can reach cancer cells that have moved beyond the bladder.

"We have seen a lot of success preventing reoccurrences with immunotherapy, and it has much fewer side-effects than chemotherapy," Saleh said. "With immunotherapy, we use the body's own immune system to fight the cancer. A small amount of live, weakened bacteria is introduced into the bladder, which stimulates the immune system."

To keep the cancer at bay, these treatments need to continue long after the cancer is gone, according to Sharma. She said that is why it is so important for people to have a comfortable setting where all their care can be coordinated by their physician and oncologist with the help of nurse navigators.

"The nurse navigators at the Infusion Center are invaluable," Sharma said. "They guide patients through their cancer treatments, coordinate appointments and care, and make sure patients get what they need."

For information about cancer prevention and treatment services available at Washington Hospital, visit www.whhs.com. For more details about the Sandy Amos, R.N. Infusion Center, visit www.whhs.com/infusioncenter.