THE CANCER YOU NEVER HEAR ABOUT

Being a bladder cancer patient/survivor, I would like to share a little about this cancer that, for the most part, receives little or no public attention. Many assume this is a cancer that only affects older males. Actually bladder cancer is fourth most common cancer in men and the eighth in women although the mortality rate in women is much higher because it is often diagnosed incorrectly and/or too late meaning that by the time it is diagnosed in many women, it is already second or third stage disease. Somewhere around 70,000 people in this country are diagnosed every year with almost a quarter of those experiencing a less than  good outcome. Smoking is thought to be the major cause. Currently some advocacy groups are pushing to have a bladder cancer warning placed on packs of cigarettes. To be fair, some bladder cancer patients have never smoked. The recurrence rate is anywhere from 50 to 90% making bladder cancer one of the most expensive cancers to treat from time of diagnosis until...Probably the most common symptom is blood in the urine but in 20% of the cases, there are no outward symptoms. In my opinion, anyone over 50 years of age with a history of smoking should be checked by their physician at some time. A simple urine test will show if there is any blood, especially microscopic blood that would not be seen by the naked eye. Should there be an abnormal result, a scope of the inside of the bladder would be in order as would an x-ray and scan of the entire urinary tract. The scope, while no fun, takes little time and is probably no worse than listening to the Puffman Show on a bad day. The discomfort is probably more of a mental than a physical nature. While the outcome is generally good if caught earlier enough, the recurrence rate is high and probably the thing that is most concerning is whether or not the patient will retain their bladder or have the bladder  removed in what is call a radical cystectomy. This will all depend on the stage, grade, and recurrence rate of the cancer. Unfortunately, in my opinion, this cancer receives very little funding/research in comparison to the other cancers and there is "little new under the sun" as far as treatment. BCG therapy is the most common type of treatment.BCG while not exactly chemo therapy is immune therapy.  BCG is a weakened strain of the TB virus and when instilled into the bladder, causes the body to have an "immune reaction", become inflamed, and kill the cancer cells. There are two schools of thought on whether or not BCG is the right answer". Some feel that it is a "cure" while others are of the belief that it is merely a "retardant" and only prolongs what is going to happen anyway. It depends who you talk to. It has been successful in my case but I understand that Sloan Kettering has come up with a graph that compares bladder cancer patients who have had BCG with the ones who have not. My understanding is that when the graph begins, the BCG patients fare much better but as the months and years go along, the graph narrows and the end result is much the same. Some physicians are adding interferon to the mix and claiming better results. The usual course of treatment is six weekly treatments of BCG and then retesting. It is rather interesting that EVERYONE gets the initial six treatments and this is because (true story) that BCG is manufactured by the pharmaceutical company in six packs...packages of six BCG vials. Some physicians believe in a "maintenance" program lasting as long as three years. The most famous protocol, developed by BCG pioneer/physician Dr. Donald Lamm, calls for a maintenance program of 10 years. Other medical people claim there is no benefit to going beyond the initial six week phase. As a bladder cancer patient, I have learned that there is no one answer or opinion. Even the top guys, Doctors O'Donnell in Iowa, Lamm in Arizona, Herr at Sloan Kettering, Kamut at MD Anderson in Texas, and Steinberg in Chicago don't agree. Even the urology association says "no one is quite sure when it is time to surgically remove the bladder though admittedly many bladders are removed too late and the patient succumbs to the cancer. I guess the bottom line is don't smoke, stay away from toxic paints, chemicals, second hand smoke, and don't assume that you are too young to contract this disease. Hopefully there will be more funding, research, and public awareness in the future.