What you should know about bladder cancer

This year, nearly 75,000 people will be diagnosed with bladder cancer, according to the American Cancer Society. The vast majority of people diagnosed with this disease are white men over age 55, but bladder cancer can -- and does -- affect men and women of all ages and races.

For many, blood in the urine will be the first tell-tale bladder cancer symptom. But many patients don't come to MD Anderson until their disease is late-stage and the bladder cancer has spread. And that, says, Arlene Siefker-Radtke, M.D., associate professor in Genitourinary Medical Oncology, can make it harder to treat.

Here's what Dr. Siefker-Radtke wants bladder cancer patients and caregivers to know so they can get the best treatment possible and boost their chances of beating this disease.

What factors make someone more likely to develop bladder cancer?

Tobacco use is one of the biggest risk factors for bladder cancer. That includes smoking, as well as every other kind of tobacco use, including snuff, dip and chew.

Chemical exposure also can increase a person's risk of bladder cancer. People who work around a lot of chemicals are more likely to develop bladder cancer.

Chronic urinary tract infections and kidney stones also can put you at increased risk for bladder cancer.

What are the most common bladder cancer symptoms?

The most common bladder cancer symptom is blood in the urine.

Other bladder cancer symptoms may include needing to urinate more frequently or experiencing pain while urinating.

Although other conditions -- such as an enlarged prostate, urinary tract infections or kidney stones -- can cause similar symptoms, it's important to see an urologist immediately so you can get the correct diagnosis and start treatment right away if you do in fact have bladder cancer.

How is bladder cancer typically diagnosed?

Bladder cancer is typically diagnosed when the urologist looks inside the bladder by doing a cystoscopy and sees an abnormality.

For many patients it's a small, easily removed, low-grade tumor that could be compared to a wart or colon polyp.

But a small number of bladder cancer patients have a more aggressive tumor, which can invade and spread more rapidly to other areas, requiring more aggressive treatment.

What are the typical bladder cancer treatment options?

Transurethral resection, surgery to remove the tumor, is the standard bladder cancer treatment, but many patients also need another type of treatment as well.

Patients with superficial tumors can be treated with surgery andintravesical therapy, where doctors inserts a tube across the urethra and instill the chemo across the tube through the patient's urine. Chemotherapy is instilled directly into bladder with a catheter.

Patients who have more aggressive (either recurrent high-grade or muscle-invasive) tumors typically need to have the bladder completely removed.

What is some of the most promising new bladder cancer research being conducted here at MD Anderson?

We identify patients at highest risk who definitely need chemo before surgery and those who don't need chemo. This is important because chemo can have adverse side-effects and be hard on the heart, nerves, hearing, and kidneys. It may not help everyone, so we want to make sure we're only giving chemo to patients who really need it. Other hospitals can't really do this because it requires a team of urologists, oncologists and others who work closely together to identify the factors contributing to the most aggressive cancers.

We've also been focusing on immunotherapy, which activates the patient's immune system to help fight the cancer. Several studies use immunotherapy to improve patients' responses to chemo to keep the bladder cancer from progressing as quickly. Additional work includes developing proteasome inhibitors in combination with chemo, especially for patients who can't tolerate the chemotherapy drug cisplatin. It appears to make the chemo more effective. I've had some patients who've had longer-lasting responses.

We've also done a clinic trial that's showed that gene therapy can get to the cancer and kill tumor cells.

What questions should a newly diagnosed bladder cancer patient ask his or her doctor?

First, find out if your tumor is high-grade or low-grade, superficial or muscle-invasive because that will affect your bladder cancer treatment.

If it's high-grade and you need to have your bladder removed, ask to speak to an oncologist to see if you need chemo before surgery. Here at MD Anderson, we have a multidisciplinary clinic where oncologists work with urologists to determine when a patient needs chemo.

If you need chemo, also ask your doctor if you're a candidate for cisplatin, the most successful bladder cancer chemo drug to date.

Any other advice for someone who's just been diagnosed with bladder cancer?

Go to a multidisciplinary cancer center like MD Anderson, so you have a team of medical, surgical and radiation oncologists working closely together to develop the best bladder cancer treatment for you and your tumor, and so that you can take advantage of the latest bladder cancer research and clinical trials.

And, don't wait to do that. What you do first in terms of treatment makes the biggest impact in your cancer. So, go get a second opinion early, rather than when the cancer has spread and may no longer be treatable.