Bladder cancer is a disease in which malignant (cancer) cells form in the tissues of the bladder.
The rates of new cancers and of cancer deaths and have been dropping slightly in women in recent years.
In men, incidence rates have been decreasing and death rates have been stable.
Specialists at City of Hope are internationally recognized experts in the treatment of bladder cancer.
As one of a handful of institutes to attain the elite designation of Comprehensive Cancer Center by the National Cancer Institute, City of Hope is acknowledged as a leader in cancer research and treatment.
City of Hope also offers numerous bladder cancer clinical trials and is constantly working to develop and deliver the latest treatment strategies for any stage of bladder cancer.
Bertram Yuh, MD is here to discuss bladder cancer, how you can lower your risk and what types of developments have been made in bladder cancer treatment in the past few years?
Selected Podcast
New Trends and Developments in Bladder Cancer
Featured Speaker:
Bertram Yuh, MD
Bertram Yuh, M.D, M.S.H.C.P.M., M.I.S.M., is a urological cancers surgical expert who joined City of Hope following the completion of a robotic surgery fellowship within City of Hope's Division of Urology and Urologic Oncology Surgery. Dr. Yuh received his medical degree from Case Western Reserve University and holds master degrees in Information Systems Management and Health Care Policy and Management from Carnegie Mellon University. He completed a urology residency at State University of New York in Buffalo, N.Y. Conditions which he is experienced in treating include urologic cancer (robotics) as well as benign prostatic disease, stone disease, prostatitis, urinary infections, incontinence, bladder overactivity, and hypogonadism. Transcription:
New Trends and Developments in Bladder Cancer
Melanie Cole (Host): Specialists at City of Hope are internationally recognized experts in the treatment of bladder cancer. As one of a handful of institutes to attain the elite designation of comprehensive cancer center by the National Cancer Institute, City of Hope is acknowledged as a leader in cancer research and treatment. City of Hope also offers numerous bladder cancer clinical trials and is constantly working to develop and deliver the latest treatment strategies for any stage of bladder cancer. My guest today is Dr. Bertram Yuh. He's a urological cancer surgical expert who joined City of Hope following the completion of a robotic surgery fellowship within City of Hope's Division of Urology and Urologic Oncology Surgery. Welcome to the show, Dr. Yuh. Tell us a little bit about the state of bladder cancer today. How common is this? This could be quite a scary diagnosis, yes?
Dr. Bertram Yuh (Guest): Absolutely. Thank you for having me here today. We have the privilege of treating a lot of patients with bladder cancer here. It is definitely a difficult diagnosis and disease for patients to deal with. It is a disease that's on the rise. We see that, in general, it is about the fifth most common cancer that we see in patients. It tends to be a disease that we see in the elderly. The estimated number of new cases was about 75,000 in 2015. The cancer patients that we see with bladder cancer typically are in their 60s and 70s. However, we also see patients who are younger or older.
Melanie: So, with these patients what might they notice? What are some of the first signs that something is wrong that would get them to a urologist--to a doctor--to get tested?
Dr. Yuh: The most common signs that we see are visible blood in the urine. Another sign that we can see is when patients come to their primary doctors and see microscopic blood in the urine on routine urine tests. Therefore when patients have blood in the urine and don't have any other signs of urinary tract infection or any other problem, we really recommend that they seek expert treatment and evaluation in order to determine whether this blood is from something serious like bladder cancer.
Melanie: Are there certain risk factors, lifestyle behaviors that contribute to bladder cancer?
Dr. Yuh: Absolutely. This is a great question and something I hope will continue to be explored in the research that we are doing at City of Hope. What we are seeing though, is that smoking remains the biggest risk factor for bladder cancer. It's not common that we'll actually see patients with bladder cancer who don't have a history of smoking or second-hand exposure to smoking. Especially, interestingly in the female population, we notice that the rate of bladder cancer is rising due to an increase in smoking in certain populations. We also note that genetics can play a role in certain patients who have a history of bladder cancer inside the family that they can be at increased risk. Additionally, occupational exposures to certain chemicals such as benzenes or chemicals that are in other professions may also cause a rate of increase in bladder cancer.
Melanie: Because the kidney and the bladder are linked in filtering and storing urine and waste and such, is there a link between kidney issues, whether someone has had past kidney problems or anything along those lines?
Dr. Yuh: That's a great question. There, generally speaking, is not a direct link between kidney and the bladder cancer issues. Though we do know that in certain patients, bladder cancer can actually originate in the kidney and in other patients, tends to be in the minority, 10-20% of patients. But some patients with bladder cancer can then also develop the same tumors which grow inside the kidney.
Melanie: So, what's the standard course of treatment? Obviously, if it's diagnosed and you stage it, that's going to depend on the type of treatments, but what is the standard course of treatment? Do they have to have their bladder removed?
Dr. Yuh: So, patients with bladder cancer present to us at all different stages, at all different time points in their disease. Most commonly, we'll see patients in earlier stages of disease when the tumors are more superficial in the bladder. When the tumor has not penetrated through the muscle lining in the bladder, these tumors are fairly easily and effectively treated with local treatments. What that would involve would be scraping of the bladder tumors to remove the tumors and may also involve placement of medications into the bladder such as immunotherapies or chemotherapies to try to get rid of these superficial tumors and reduce the risk of recurrence and progression. We also know, however, that patients can present with more aggressive disease. These are tumors that tend to grow deeper into the bladder and have a much worse prognosis. These tumors are much more likely to grow outside the bladder, penetrate the bladder, spread to surrounding lymph nodes as well as other parts of the body. So, whenever we see a tumor that’s growing into the muscle lining of the bladder or has potentially caused blockage of a kidney, we become more concerned. This is an aggressive tumor. These are types of tumors, however, that we have distinct specialty in treating at City of Hope. We have one of the largest experiences in the world in terms of doing robotic operations to remove the bladder. Along with removal of the bladder comes a urinary reconstruction which allows urine to exit the body once the bladder has been removed. We also have extensive experience with these types of operations and trying to improve upon outcomes for these patients.
Melanie: Do you just rewire the system, Dr. Yuh? Or do you use an artificial bladder--something to hold that? Or do you just rewire the system so it comes directly out?
Dr. Yuh: It depends on what the patients decide, along with the doctors. Essentially, we are continuing to explore whether there are artificial substitutes for the bladder but presently the standard of care remains reworking the small intestine to build a means for urine to exit the body. At City of Hope, our most commonly performed procedures are what we call 'continent diversions' which allow for the patients to maintain the urine within the body still, as normally is, and not to have to wear a bag. There are other means that can help with urinary reconstructions. The simplest is a conduit which is basically just a tube which helps the urine to exit the body, which drains into the bag but other forms of diversion, which are more complex and which we perform more of, allow for the urine to be stored within the body.
Melanie: So, what are we looking at in terms of developments that have been made in bladder cancer treatment in the past few years? And what advancements can we look to in the future?
Dr. Yuh: Certainly, this is a disease that we have made significant strides in treating but we want to continue to find ways to better treat this disease, to get a better handle of it, to improve detection methods and to prevent the tumors from coming back. We know that bladder cancer is actually the most expensive cancer to treat per patient in the United States and a lot of this comes from the fact that these tumors often recur. Even when they are superficial and not very dangerous, they have a very high rate of coming back and requiring local treatment. We are quite experienced in the treatment of invasive disease and a part of this has also been the development in terms of chemotherapies to treat aggressive bladder cancers. These days the most commonly given form of treatment for aggressive bladder cancer tends to be chemotherapy followed by removal of the bladder. New chemotherapy regimens that have been developed over the past few years are better tolerated by patients and can provide what seems to be equal efficacy in terms of treating the bladder cancer. Additional developments that we are continuing to explore are ways to improve surgical treatment. We know that surgical treatment is very invasive, it's associated with a high complication rate and significant effects to the patient's quality of life. We know that these treatments are the most effective for getting rid of cancer and helping patients to survive and conquer this disease. However, the effects on their body are tremendous. Therefore, we are continuing to explore ways to improve upon patients' quality of life afterwards as well as to technically improve the operation, make the operation simpler, more straightforward and less complicated as well as explore ways to improve the recovery of patients. There has been a big movement over the last couple of years in terms of enhanced pathways to help patients through this arduous process. We know that it's not only the cancer and the surgery that has a big impact on patients’ outcomes. A lot of it has to do with the patients themselves. And here we, at City of Hope, really want to help the patients with that. Therefore, that involves teaching them, instructing them, optimizing their medical health before surgery and really just getting them prepared in the best way possible. We have an extensive database that we are tapping into here at City of Hope which really is helping us to examine our outcomes and to study from the data level, from the information systems level, how we can improve care for these patients.
Melanie: Wow. That is absolutely fascinating and such great information. Thank you so much, Dr. Yuh. To find out more you can go to cityofhope.org. That’s cityofhope.org. You're listening to City of Hope Radio. This is Melanie Cole. Thanks so much for listening.
New Trends and Developments in Bladder Cancer
Melanie Cole (Host): Specialists at City of Hope are internationally recognized experts in the treatment of bladder cancer. As one of a handful of institutes to attain the elite designation of comprehensive cancer center by the National Cancer Institute, City of Hope is acknowledged as a leader in cancer research and treatment. City of Hope also offers numerous bladder cancer clinical trials and is constantly working to develop and deliver the latest treatment strategies for any stage of bladder cancer. My guest today is Dr. Bertram Yuh. He's a urological cancer surgical expert who joined City of Hope following the completion of a robotic surgery fellowship within City of Hope's Division of Urology and Urologic Oncology Surgery. Welcome to the show, Dr. Yuh. Tell us a little bit about the state of bladder cancer today. How common is this? This could be quite a scary diagnosis, yes?
Dr. Bertram Yuh (Guest): Absolutely. Thank you for having me here today. We have the privilege of treating a lot of patients with bladder cancer here. It is definitely a difficult diagnosis and disease for patients to deal with. It is a disease that's on the rise. We see that, in general, it is about the fifth most common cancer that we see in patients. It tends to be a disease that we see in the elderly. The estimated number of new cases was about 75,000 in 2015. The cancer patients that we see with bladder cancer typically are in their 60s and 70s. However, we also see patients who are younger or older.
Melanie: So, with these patients what might they notice? What are some of the first signs that something is wrong that would get them to a urologist--to a doctor--to get tested?
Dr. Yuh: The most common signs that we see are visible blood in the urine. Another sign that we can see is when patients come to their primary doctors and see microscopic blood in the urine on routine urine tests. Therefore when patients have blood in the urine and don't have any other signs of urinary tract infection or any other problem, we really recommend that they seek expert treatment and evaluation in order to determine whether this blood is from something serious like bladder cancer.
Melanie: Are there certain risk factors, lifestyle behaviors that contribute to bladder cancer?
Dr. Yuh: Absolutely. This is a great question and something I hope will continue to be explored in the research that we are doing at City of Hope. What we are seeing though, is that smoking remains the biggest risk factor for bladder cancer. It's not common that we'll actually see patients with bladder cancer who don't have a history of smoking or second-hand exposure to smoking. Especially, interestingly in the female population, we notice that the rate of bladder cancer is rising due to an increase in smoking in certain populations. We also note that genetics can play a role in certain patients who have a history of bladder cancer inside the family that they can be at increased risk. Additionally, occupational exposures to certain chemicals such as benzenes or chemicals that are in other professions may also cause a rate of increase in bladder cancer.
Melanie: Because the kidney and the bladder are linked in filtering and storing urine and waste and such, is there a link between kidney issues, whether someone has had past kidney problems or anything along those lines?
Dr. Yuh: That's a great question. There, generally speaking, is not a direct link between kidney and the bladder cancer issues. Though we do know that in certain patients, bladder cancer can actually originate in the kidney and in other patients, tends to be in the minority, 10-20% of patients. But some patients with bladder cancer can then also develop the same tumors which grow inside the kidney.
Melanie: So, what's the standard course of treatment? Obviously, if it's diagnosed and you stage it, that's going to depend on the type of treatments, but what is the standard course of treatment? Do they have to have their bladder removed?
Dr. Yuh: So, patients with bladder cancer present to us at all different stages, at all different time points in their disease. Most commonly, we'll see patients in earlier stages of disease when the tumors are more superficial in the bladder. When the tumor has not penetrated through the muscle lining in the bladder, these tumors are fairly easily and effectively treated with local treatments. What that would involve would be scraping of the bladder tumors to remove the tumors and may also involve placement of medications into the bladder such as immunotherapies or chemotherapies to try to get rid of these superficial tumors and reduce the risk of recurrence and progression. We also know, however, that patients can present with more aggressive disease. These are tumors that tend to grow deeper into the bladder and have a much worse prognosis. These tumors are much more likely to grow outside the bladder, penetrate the bladder, spread to surrounding lymph nodes as well as other parts of the body. So, whenever we see a tumor that’s growing into the muscle lining of the bladder or has potentially caused blockage of a kidney, we become more concerned. This is an aggressive tumor. These are types of tumors, however, that we have distinct specialty in treating at City of Hope. We have one of the largest experiences in the world in terms of doing robotic operations to remove the bladder. Along with removal of the bladder comes a urinary reconstruction which allows urine to exit the body once the bladder has been removed. We also have extensive experience with these types of operations and trying to improve upon outcomes for these patients.
Melanie: Do you just rewire the system, Dr. Yuh? Or do you use an artificial bladder--something to hold that? Or do you just rewire the system so it comes directly out?
Dr. Yuh: It depends on what the patients decide, along with the doctors. Essentially, we are continuing to explore whether there are artificial substitutes for the bladder but presently the standard of care remains reworking the small intestine to build a means for urine to exit the body. At City of Hope, our most commonly performed procedures are what we call 'continent diversions' which allow for the patients to maintain the urine within the body still, as normally is, and not to have to wear a bag. There are other means that can help with urinary reconstructions. The simplest is a conduit which is basically just a tube which helps the urine to exit the body, which drains into the bag but other forms of diversion, which are more complex and which we perform more of, allow for the urine to be stored within the body.
Melanie: So, what are we looking at in terms of developments that have been made in bladder cancer treatment in the past few years? And what advancements can we look to in the future?
Dr. Yuh: Certainly, this is a disease that we have made significant strides in treating but we want to continue to find ways to better treat this disease, to get a better handle of it, to improve detection methods and to prevent the tumors from coming back. We know that bladder cancer is actually the most expensive cancer to treat per patient in the United States and a lot of this comes from the fact that these tumors often recur. Even when they are superficial and not very dangerous, they have a very high rate of coming back and requiring local treatment. We are quite experienced in the treatment of invasive disease and a part of this has also been the development in terms of chemotherapies to treat aggressive bladder cancers. These days the most commonly given form of treatment for aggressive bladder cancer tends to be chemotherapy followed by removal of the bladder. New chemotherapy regimens that have been developed over the past few years are better tolerated by patients and can provide what seems to be equal efficacy in terms of treating the bladder cancer. Additional developments that we are continuing to explore are ways to improve surgical treatment. We know that surgical treatment is very invasive, it's associated with a high complication rate and significant effects to the patient's quality of life. We know that these treatments are the most effective for getting rid of cancer and helping patients to survive and conquer this disease. However, the effects on their body are tremendous. Therefore, we are continuing to explore ways to improve upon patients' quality of life afterwards as well as to technically improve the operation, make the operation simpler, more straightforward and less complicated as well as explore ways to improve the recovery of patients. There has been a big movement over the last couple of years in terms of enhanced pathways to help patients through this arduous process. We know that it's not only the cancer and the surgery that has a big impact on patients’ outcomes. A lot of it has to do with the patients themselves. And here we, at City of Hope, really want to help the patients with that. Therefore, that involves teaching them, instructing them, optimizing their medical health before surgery and really just getting them prepared in the best way possible. We have an extensive database that we are tapping into here at City of Hope which really is helping us to examine our outcomes and to study from the data level, from the information systems level, how we can improve care for these patients.
Melanie: Wow. That is absolutely fascinating and such great information. Thank you so much, Dr. Yuh. To find out more you can go to cityofhope.org. That’s cityofhope.org. You're listening to City of Hope Radio. This is Melanie Cole. Thanks so much for listening.