One of the questions I put on a test when I taught genitourinary nursing eons ago was, “You come home from nursing school and your father tells you, ‘On Wednesday my urine came out red.’ What do you tell him?” I gave extra points to the students who could go beyond, “See a doctor” as the answer.

Bladder cancer occurs in 38 out of 100,000 men and 10 out of every 100,000 women. There are several risk factors for bladder cancer; the most common one is cigarette smoking. People who have been exposed to chemicals in the dye and rubber industries are also at risk. Dry cleaners, clothing manufacturers, and coal handlers are also at risk. (1) You increase your risk of bladder cancer by eating large amounts of fried meats and animal fats.
Blood in the urine is the most common sign of bladder cancer. Some people have pain or burning during urination and a change in bladder habits, such as feeling the need to urinate more frequently. Other conditions may cause these same symptoms, making bladder cancer difficult to diagnose. Bladder cancer may be present without symptoms for a long time. (2)

Bladder cancer is diagnosed by examining the urine for blood, examining the urine for cells (urine cytology), and performing a cystoscopy and an abdominal CT scan or ultrasound. A cystoscopy is performed under anesthesia, and involves inserting a lighted instrument into the urethra to examine the bladder. The balder is filled with fluid to enlarge it. The addition of a blue or white light makes it easier to see abnormalities of the inside of the bladder. The urologist biopsies any abnormal–appearing areas.

The most common type of bladder tumor is called urothelial. It tends to be superficial and not invade the walls of the bladder. It makes up 90% of all bladder tumors. The bladder may also have squamous cell or adenocarcinoma, more aggressive types of tumors. High grade tumors are also more aggressive, as are poorly differentiated ones.

If the urologist sees a tumor, the first step is to remove it and send it for pathology. It may be difficult to cut tumors out of the bladder because of the risk of perforating the bladder wall. Uncontrolled bleeding and perforation occur in less than 5% of cases. (3)

Bladder cancer is the sixth leading cause of cancer death among Americans (4). Complete removal of the tumor is not always possible, and therefore some patients have to undergo radical surgery consisting of removal of the bladder. An artificial bladder is created with a loop of bowel. This surgery has significant quality of life issues. It is accompanied by removal of the uterus and ovaries and part of the vagina or the prostate and seminal vesicles. Urine may drain into a bag attached the abdomen or be removed several times a day with a catheter. Surgery may be used along with chemotherapy or radiation therapy to reduce spread of cancer through the lymph nodes.

Liability issues surrounding bladder cancer include:
• Delay in diagnosis of bladder cancer
• Failure to correctly interpret ultrasounds or CT scans
• Damage to the bladder and surrounding structures during biopsy or bladder tumor removal
• Delay in recognizing hemorrhage or perforation of the bladder
• Failure to correctly read pathology slides
• Treatment – related complications such as extravasation (leaking into tissues) of chemotherapy

Bladder cancer is a nasty disease. Reduce your risks by not smoking, reducing your consumption of meat, and by promptly seeking medical attention if you have any of the symptoms of bladder cancer.

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(1) Malignant Neoplasms, Rakel: Textbook of Family Medicine, 8th Edition
(2) Bladder cancer, Dr. Melissa Stopper, emedicinehealth
(3) Endoscopic surgical management, Wein: Campbell-Walsh Urology, 10th edition
(4) Surgery for bladder cancer, Wein: Campbell-Walsh Urology, 10th edition