Did you guys know that bladder cancer is the fifth most common cancer in the united states? Well,
I'm Dr. Rena Malik, urologist and pelvic surgeon, and today we're going to be talking
all about bladder cancer. If you're new here, I make content weekly on urologic conditions,
bladder health, sexual health, and much much more make sure. if you like
what you see that you subscribe and share this channel with your friends
bladder cancer is a cancer that is developed in the lining of the bladder or the urothelium
and the most common cause of bladder cancer is something called urothelial carcinoma which
is actually from the cells that are lining the bladder as i mentioned before it is the
fifth most common cancer and it's actually more common in men than women with a ratio of four to
one most people who develop bladder cancer are above the age of 55 with an average age of 73.
in 2002 in the united states we expect about 81 000 new cases of bladder cancer and 17
000 deaths from it so how do you know if you might have bladder cancer well the number one symptom
that people will complain of is blood in the urine and that can be gross meaning that you see it in
the toilet after urinating or microscopic meaning that when you give a urine sample at the doctor
they see red blood cells on a microscope this is different from having blood on a dipstick of
urine it's actually when they take your urine sample and look at it under a microscope but
when you look at people who have these findings not everyone develops bladder cancer fortunately
about 13 to 35 percent of people with blood in the urine that they see develop bladder cancer
and less than 10 of people with microscopic blood have bladder cancer other symptoms that
sometimes people notice are what we call storage urinary tract symptoms things like urgency gotta
go gotta go frequency going to the bathroom very often and sometimes pain with urination or waking
up at night to urinate sometimes these things can be misdiagnosed as recurrent bladder infections or
really bad overactive bladder so if you're suffering from either of those problems and
haven't had a cystoscopy please talk to your urologist about getting one ultimately when you
get bladder cancer it's what we called a field change defect and what that means is that the
cells in one area that might have a tumor the changes in the genetics of those cells causing
the cancer cells to proliferate or grow and keep growing growing growing which is essentially
the definition of cancer actually affects all the cells in the bladder even if there's only a tumor
in one section so what causes cancer well the number one thing is smoking so we know that people
who currently smoke are four times more likely to have bladder cancer than someone who doesn't
and people who used to smoke have it's still a two times higher risk of getting bladder cancer about
fifty to sixty percent of bladder cancers are due to smoking certain occupations are at higher risk
for getting bladder cancer because of exposures to certain things like aromatic hydrocarbons
which are found in certain types of industrial chemicals like metal processing plants and
truck drivers or those involved in oil and coal production could be at higher risk people who work
with certain types of dyes that have aromatic amines such as people who are hairdressers
work in textiles or work with paint like chemical paint those people can be at higher risk
and then n nitrosamines which are found in smoke or in rubber and latex manufacturing so bottom
line the kind of work you do plus smoking may put you at a higher risk for getting bladder cancer
there's also a list of genetic disorders where people who have those disorders are at a higher
risk of getting bladder cancer and those you can see listed right over here so how do you diagnose
bladder cancer well the first thing that we do to diagnose bladder cancer is called a cystoscopy
a cystoscopy is a procedure where we go in through the urethra or the pee hole with a camera and
with that camera we look inside the bladder to make sure there's no bladder tumors or areas
of redness that might be concerning for cancer the reason that we have to look with a camera
is because things like ct scans and ultrasounds don't do a good job of seeing very small tumors
that can still be potentially cancerous also if we find a tumor in the bladder we then go on to
do a resection of that tumor and typically that requires a trip to the operating room where we
go in with a specialized camera with something we call a receptoscope and the receptoscope then goes
in and scrapes out that bladder tumor so we can then send it to the pathologist who will look at
it under a microscope also as part of the workup you will need some sort of imaging to look at
the kidneys and the tubes that drain the kidneys because sometimes cancers can spread up into the
ureters or the kidneys and so that's usually done with what's called a ct scan or a ct urogram which
looks at both the kidneys and the ureters as they drain the kidney so that you can see if there's
any what we call filling defects or areas where there might be concern for tumor or blockage so
what happens when you get bladder cancer well once you've found to have bladder cancer the
most important differentiation that we urologists make is if it's invading into the muscle or not
and about 20 to 40 percent of people who get bladder cancer will either have invasion into
the muscle or will progress to get that invasion and so the treatment for both of these types of
bladder cancer is very very different so once you look at the invasion you also look at the grade
of the tumor is it a low-grade appearing tumor on the pathology or is it a high-grade appearing
tumor on the pathology based on those two things you undergo what's called a risk stratification
so we look at these things plus what the tumor looks like or how many tumors there are
and that will help us determine what risk category you belong to for the purposes of
this video i'm just going to talk about treatment for non-muscle invasive bladder cancer and muscle
invasive bladder cancer very generally if you want to learn more specifics about any of these things
comment below and let me know so if you don't have muscle invasion the first thing that will
happen is that you may undergo a second resection of the tumor that's typically done for a number of
different reasons but most often if you have high grade disease or if it was incompletely resected
you'll go back about six weeks later for another resection to make sure that there's no new growth
and to make sure that you've gotten all the cancer out of the bladder interestingly when they look
at studies about 15 of people who undergo this second stage look either get upgraded in their
depth of invasion to a deeper level but not to muscle invasion and about 20 to 30 percent will be
upstaged to being muscle invasive bladder cancer and again this is important because a treatment
for both of these is very different for non-muscle invasive bladder cancer the treatment most often
is undergoing intravesical treatment so what that means is that usually you'll undergo a treatment
where a catheter is placed into the bladder and a medication is instilled into the bladder
to help prevent both recurrence of the tumor and progression of the tumor so it doesn't get worse
depending on the grade of your tumor the chance of recurrence can be quite high up to 75 percent of
people can have a recurrence of bladder tumor and this makes sense because we described it
as a field change defect meaning that the tumor cells actually change the genetics of the cells
in the bladder throughout the entire structure but progression can vary if it's low grade
progression rates are quite low less than five percent when you're looking at high grade tumors
the progression rate can be up to 25 percent because of this if you have low grade tumor
you don't really need to have any intravesicle treatment but you will have to have recurrent
and repeated cystoscopies to make sure you don't have a recurrence in high grade tumors however
typically the treatment as i mentioned earlier is intravesical treatment with what we call bcg
and typically you undergo an induction phase where you get this treatment once a week for six weeks
where they instill this agent into your bladder and then after that you undergo another cystoscopy
to make sure there's no recurrence of the tumor or new tumors that have arisen after that you
then go on to induction therapy and induction therapy is typically every three months for up
to two to three years depending on your tumor type and periodically through this time you will keep
getting cystoscopies to ensure that there's no recurrence or progression of the disease
for people who are unresponsive to bcg there's a new immunotherapy called pembrolizumab which
is also available now let's move on to muscle invasive bladder cancer these cancers are lethal
and they are very very aggressive at presentation 33 of people will already have advancement of the
cancer itself so that it's spreading through the bladder into the adjacent organs and five percent
will have metastatic disease the standard of care treatment for muscle invasive bladder cancer is
a radical cystectomy with a lymph node dissection and for men that will also
include a prostatectomy and for women that will usually include removal of all the female
organs the uterus the cervix the fallopian tubes and sometimes even the anterior part of the vagina
after removal there are options to recreate a new option to eliminate your urine and the most
common one is what's called an allele conduit that's where you make a stoma which the tubes
that drain urine from the kidneys drain into and that comes out into a bag on the skin there's also
options to have a neo bladder which is essentially taking intestine and making a brand new bladder
that sits in the same place as your bladder used to be that functions similarly but not exactly
like your old bladder and lastly sometimes people opt to have what's called a continent
catheterizable channel where they make a pouch on the inside of the abdomen which holds urine and
then has a channel that goes out to the abdomen that you can then catheterize to empty your
bladder i'm not going to go into the specifics about the benefits or the risks for any of these
urinary diversions but certainly if you're interested in learning more about them please
comment below and i'd be happy to talk about them in addition to surgery very often depending on the
stage of the cancer you may be offered neoadjuvant or adjuvant chemotherapy and what does that mean
it means either you'll get chemotherapy before surgery or chemotherapy after surgery so what's
the risk of spread and mortality or death when you have muscle invasive bladder cancer well about
20 percent of people with muscle invasion will eventually develop metastases or spread outside of
the bladder five-year survival rate for people who have organ confined disease meaning that's only in
the bladder and hasn't spread is about 60 to 85 percent however once it spread beyond the bladder
that survival drops to about 50 percent so this is a very serious condition and bottom line if
you're seeing blood in your urine do not delay go see your urologist immediately to get evaluated i
hope you all found this helpful as always remember to take care of yourself because you're worth it