With 7000 new patients per year, bladder cancer is number 5 in the top 10 most common cancers
Check your urine regularly for the presence of blood. This is what urologists Joost Boormans and Tahlita Zuiverloon of the Erasmus MC Cancer Institute advise all over-50s in the Netherlands who smoke or have smoked.
And they urge all Dutch people to stop smoking. The urologists hope that fewer people will develop bladder cancer in the long term. Or that it will at least be discovered sooner.
May is bladder cancer month, and Boormans and Zuiverloon want more attention for this disease. With 7,000 new patients per year, bladder cancer is number 5 in the top 10 most common cancers. But relatively little attention is paid to bladder cancer. There is no population screening, such as for breast, cervical and colon cancer, and there are no large collection campaigns, such as for pancreatic cancer.
Yet it is important to bring bladder cancer to the fore, say Zuiverloon and Boormans. ‘Many people know that smoking causes lung cancer, but hardly anyone realizes that it can also cause bladder cancer.’
Blood
An important first symptom of bladder cancer is blood in the urine without painful urination. Therefore check the urine regularly, the urologists encourage smokers and ex-smokers. ‘Peate your blood, that’s never good’, warns Boormans. “A quarter of people who pee blood have cancer of the urinary tract.”
Urologists Boormans and Zuiverloon: ‘Urine of a bladder cancer patient resembles rosacea or red wine’
Zuiverloon adds: ‘At my consultation hours, I often see women between the ages of 60 and 70 who urinate blood and have been treated with antibiotics for a while because the first thought was a bladder infection. Valuable time is lost as a result: the tumor is more often in an advanced stage in women, which makes treatment more difficult and the chance of a cure is smaller.’
But how do you check that? ‘Men who pee standing up can see it directly from the color of the spray. Usually the beam is bright yellow. But if there’s blood in it, it looks like you’re peeing roosvicee or even red wine. I realize that it is more difficult for women to check their urine because they pee sitting down. But women can also watch the stream or look into the toilet bowl while urinating.’
If there is indeed blood in the urine, a visit to the doctor is always necessary. For bladder cancer, the earlier it is detected, the better it can be treated. In 70 percent of patients, bladder cancer is found at a superficial stage. More than 90 percent of them are still alive after five years.
In about 25 percent of patients, the tumor has already grown into the muscle layer of the bladder wall at diagnosis. In the other patients, the tumor has progressed even further: ingrown into the abdominal wall, or spread to elsewhere in the body.
If the tumor has already grown into the muscle layer of the bladder wall, or has progressed further, the bladder must be removed or irradiated in its entirety. The prognosis is bleak: less than half of the patients are still alive after 5 years, despite surgery or radiation. With even more advanced bladder cancer, only 12 percent are alive after 5 years. ‘It is therefore important that people pay close attention to the signals, of which blood in the urine is the most important’, emphasize Zuiverloon and Boormans.
‘At my office hours I often see women between the ages of 60 and 70 who urinate blood and who have been treated with antibiotics for a long time because the first thought was a bladder infection’
Stop smoking
It is even better to prevent bladder cancer as much as possible. Not starting smoking or quitting smoking is the most important step. Smokers are three times more likely to develop bladder cancer than non-smokers. ‘Tobacco contains toxic substances that end up in the urine via the bloodstream,’ explains Boormans. ‘The bladder is a reservoir, which urine usually stays in there for 3 to 4 hours. The toxic substances then act on the bladder wall and can eventually cause bladder cancer.’
Boormans and Zuiverloon work in the Bladder Cancer Center, which was founded a few years ago by the Erasmus MC Cancer Institute. ‘Bladder cancer is a spearhead of the Cancer Institute. We treat patients with advanced, aggressive tumors here as an expert centre.’
The Bladder Cancer Center also conducts a lot of research, because bladder cancer is a capricious disease, about which much is still unclear. ‘Treatments do not work for every patient and the disease is difficult to predict,’ says Boormans.
“I had a patient that we treated successfully. At least we thought so. But the cancer came back after two years, and in an aggressive form. That does something to you, as a doctor. We want to use research to gain a better understanding of tumors and their molecular characteristics.’
The research is funded by the Make Cancer Kansloos campaign of the Erasmus MC Foundation – Daniel den Hoed Fund. Through www.maakkankerkansloos.nl you can register for Run4Daniel (5 or 10 KM running or walking) on Saturday 2 July in the Kralingse Bos and/or the Swim4Daniel on Sunday 3 July in the Wijnhaven near Plein 1940 in Rotterdam. By participating, you support the research of Zuiverloon and Mahmoudi.
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