Bladder CancerL: Symptoms & Treatment
- New York Mets radio announcer Howie Rose, 68, has opened up about his struggle with bladder cancer which he’s been battling since 2021.
- Bladder cancer develops when cells that make up the urinary bladder start to grow and eventually develop into tumors. It is highly treatable when caught in the early stages of the disease.
- Blood in the urine, or hematuria, is the most common symptom of bladder cancer, but there are other signs of the disease. One of our experts says the best way to avoid bladder cancer is to "hydrate well, don't smoke and make sure that you get in to see your physician if you have symptoms that concern you."
- A radical cystectomy, like the one Howie Rose underwent, is a common treatment option for bladder cancer patients when the cancerous tumors become muscle invasive, or spread into deeper layers of the bladder wall. This procedures involves the removal of the bladder along with nearby lymph nodes, other organs in the pelvis and potentially other nearby organs as well.
The long-time MLB announcer opened up about his diagnosis last weekend at the Baseball Writers’ Association of America dinner in hopes to spread awareness for the disease.
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Recounting what his doctors told him before the surgery, he told The Post, “They said, 'Look, here's the deal: We can give you more medication and a higher dosage or a different type of medication that will probably involve chemo, but this is a cancer that has a high recurrence rate.’ So I said, 'Look, are we prolonging the inevitable?' Because the surgery was not going to be a pretty one. And my urologist said, 'We probably are,' so then I was left really with no choice but to have a procedure."
He ultimately underwent a radical cystoprostatectomy, a surgery to remove the bladder as well as nearby lymph nodes in the pelvis.
“The bottom line, after the pathology came back after the surgery, the doctor basically said, ‘You’re good to go,’ Rose continued. “‘The surgeon, he says, ‘You have no restrictions, do whatever you want.'”
Rose, who previously worked as the play-by-play announcer for the two NHL teams, the New York Rangers and New York Islanders, continued, “And it’s managing the situation where my life is more complicated than it used to be. It’s not insurmountable. Obviously. It certainly hasn’t helped my golf game, that’s for sure.”
“But the beauty of it is I can go out and play golf. I can ride my bike. I can play pickleball if I want or tennis and do whatever I want. I’m thankful for that,” he added.
His surgery was performed with the use of robotics under Mount Sinai's Dr. Reza Mehrazin’s supervision, a procedure Rose described as “miraculous.” Despite the surgery going well, Rose still needed a second surgery after suffering from a hernia last winter.
Rose, who will have Keith Raad and Patrick McCarthy as his new partners next season, has revealed he will only work 125 games instead of 162.
The Brooklyn-born sportscaster, who praised his wife Barbara as “Wonder Woman” when he was honored as a co-recipient of the Arthur & Milton Richman “You Gotta Have Heart” Award last weekend, took to Twitter once The Post published his story.
He tweeted, “Thank you â¦@AndrewMarchand for telling the story so well and for hitting just the right chord. If I can help someone going through this, I'm happy to do so.”
Thank you @AndrewMarchand for telling the story so well and for hitting just the right chord. If I can help someone going through this, I’m happy to do so. https://t.co/5fXB7KaSrU
— Howie Rose (@HowieRose) February 1, 2023
Bladder Cancer Overview
Bladder cancer is the sixth most common type of cancer overall in the United States, though it is the fourth most common for men. Your bladder is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. The bladder is an essential part of your urinary system, which also includes two kidneys, two ureters and the urethra.
Bladder cancer develops when cells that make up the urinary bladder start to grow and eventually develop into tumors. Smoking is a leading risk factor for this disease with smokers being three times more likely to be diagnosed with bladder cancer than non-smokers.
Bladder cancer occurs mainly in older people. About 9 out of 10 people with this cancer are over the age of 55. The average age of people when they are diagnosed is 73. Fortunately, many diagnoses are caught at an early stage, when the cancer is highly treatable. However, it is common for new occurrences or recurrences to occur even after successful treatments. Patients typically need follow-up tests done years after treatment.
Types Of Bladder Cancer
Urothelial carcinoma: The most common type of bladder cancer is called urothelial carcinoma. This type occurs when urothelial cells cells that line the inside of the bladder or other parts of the urinary tract become cancerous.
Adenocarcinoma: 1 in 100 bladder cancers are adenocarcinomas, which have a higher likelihood of being invasive at diagnosis. This type of bladder cancer develops from glandular (secretory) cells in the lining of the bladder.
Sarcoma: This type of bladder cancer is rare and found in the muscle cells of the bladder. Bladder sarcomas tend to form in the area between the openings of the ureters and the urethra, but they can also develop in the entire bladder area.
Squamous cell carcinoma: About 5 percent of bladder cancer patients have squamous cell carcinoma. The cells in this type have a higher chance of becoming invasive. It is associated with chronic irritation of the bladder which can be caused by things like long-term use of a urinary catheter or an infection.
Small cell carcinoma: This bladder cancer is very rare and starts in neuroendocrine (nerve-like) cells. It is a highly aggressive cancer that tends to be caught at advanced stages of the disease.
Signs and Symptoms of Bladder Cancer
According to National Comprehensive Cancer Network, smoking is the greatest risk factor for bladder cancersmokers are three times more likely to be diagnosed with the disease than non-smokers. Exposure to certain chemicals present in dyes, rubber, printing materials, leather, textiles, and paint products are also associated with an increased risk of bladder cancer.
People who have had bladder cancer or who have a family history of the disease are also at higher risk, as are white people, who are roughly twice as likely to develop bladder cancer than non-white people.
What Are the Signs and Symptoms of Bladder Cancer?
The Main Symptom: Blood in Urine
Bladder cancer can often be detected early because its first signblood in the urineis not easy to overlook. This condition is called hematuria, and the blood can change the urine's color to orange, pink, and in some extreme cases, dark red.
"That is far and away the most common presenting symptom," said Dr. Arjun Balar, the director of the genitourinary medical oncology program at NYU Langone's Perlmutter Cancer Center. In the early stages of bladder cancer, when the tumor is small and cancer cells are confined to the bladder, this bleeding is typically painless.
Two aspects of hematuria that might cause people to put off seeking a medical evaluation are that it is not painful, and the symptoms can be brief and irregular. If there are only small amounts of blood in the urine, sometimes it will not make a visible difference and can only be detected through urinalysis. Patients who catch the disease early can confront it while it is still highly treatable.
RELATED: Exploring the Treatment Options for Metastatic Bladder Cancer
When someone reports blood in their urine, doctors run tests to evaluate the entire urinary system. This encompasses the kidneys, the ureters (tubes that bring the urine from the kidneys to the bladder), the bladder, and the urethra (which empties the urine).
"So for anyone with blood in the urine, we have to do tests to determine what the source of that bleeding might be. And that source of bleeding could be anywhere in the urinary tract," Dr. Jay Shah, a urologic oncologist specializing in the treatment of bladder cancer and other urologic cancers at the Stanford Cancer Center, tells SurvivorNet.
Additional Symptoms
According to Dr. Balar, other bladder cancer symptoms resemble the symptoms of a urinary tract infection. In fact, patients may only learn that they have bladder cancer after "many courses of antibiotics to treat what was thought to be a urinary tract infection that simply did not get better," Dr. Balar says. "Early acknowledgment of symptoms, and not ignoring symptoms is probably one of the other most important things that you can do," he adds.
Besides blood in the urine, other symptoms involve changes in urinary habits or discomfort while urinating. These may include:
- Needing to urinate more frequently than you typically would
- Feeling like you need to urinate urgently even when your bladder isn't full
- Waking up to urinate many times throughout a night
- Having trouble urinating because of pain or a burning sensation
Frequent urination, urgent urination, and uncomfortable urination are all symptoms of bladder cancer. People with advanced bladder cancer may experience additional symptoms, including:
- Inability to urinate
- Pain on one side of the lower back and pelvis
- Loss of appetite
- Unintended weight loss
- Fatigue or weakness
- Bone pain
- Swollen feet
Screening For Bladder Cancer
Screening for bladder cancer is not common, because no screening methods have been shown to reduce the risk of dying from bladder cancer for people with an average level of risk. Doctors may recommend screening for certain high-risk individuals. Dr. Balar's main message for people who want to avoid bladder cancer? "Hydrate well, don't smoke, and make sure that you get in to see your physician if you have symptoms that concern you."
Can Urinary Tract Infections Cause Bladder Cancer?
If you find blood in your urine or a urine test discovers trace amounts of blood, the next step is typically to undergo a cystoscopy. A cystoscopy is a procedure in which a small camera on the end of a long tube is inserted through the urethra into the bladder to look for signs of cancerous tumors. If cancer is detected, there are a variety of imaging tests (CT scan, CT urography, MRI, MR urography, renal ultrasound, retrograde ureteropyelogram) that can be used to determine whether the cancer has spread beyond the bladder to surrounding tissues, organs or lymph nodes.
Bladder Cancer Treatment Options
Surgery for bladder cancer, like the one Howie Rose underwent, often offers the best chance for a cure. There are various surgical options depending on the location of your bladder cancer. You and your doctor will consult on which path is best for your specific bladder cancer case.
RELATED: What Are The Surgical Options To Treat Bladder Cancer?
Transurethral resection of visible bladder tumor (TURBT) is a procedure in which a surgeon inserts a camera into the bladder and removes the visible cancer.
A radical cystectomy is the surgical removal of the bladder as well as nearby lymph nodes in the pelvis.
Understanding A Radical Cystectomy
A partial cystectomy preserves part of the bladder.
Patients may require a urinary diversion procedure following surgery for bladder cancer. During this procedure the surgeon uses one of three options to re-route urine out of the body.
Systemic Treatment Options
Chemotherapy alone or chemotherapy with radiation is recommended for different reasons in muscle-invasive bladder cancer. We review some of the most common scenarios here.
Checkpoint inhibitors are a type of immunotherapy drug that doctors use to treat bladder cancer. Often doctors prescribe them to people who can't take the chemotherapy drug cisplatin. Checkpoints like PD-1 and PD-L1 are proteins on the surface of some cells, including cancer cells. They prevent the immune system from attacking those cells. Immunotherapy drugs turn off the checkpoints.
Targeted therapy is a more precise way to treat cancer than chemotherapy. Chemo attacks many types of quickly dividing cells, including some healthy cells. Targeted therapy focuses on the processes that help cancer cells grow. The FDA has recently approved two targeted therapies for bladder cancer: the FGFR inhibitor erdafitinib and the nectin-4 antibody-drug conjugate enfortumab vedotin.
More On Cystectomy: Radical and Partial
"Radical cystectomy" is the surgical removal of the bladder as well as nearby lymph nodes in the pelvis. Total removal of the bladder is recommended for patients with muscle-invasive bladder cancer, and the goal is to cure the cancer. Imaging and/or biopsies may be needed prior to surgery to evaluate whether the lymph nodes are involved.
For men, radical cystectomy typically includes removal of the prostate and seminal vesicles as well. This can lead to side effects such as erectile dysfunction which should be discussed with your doctor both before and after the procedure. In women, involvement of the reproductive organs is less common, so the ovaries and uterus are not routinely removed, unless there is a concern for cancer involving these areas.
Radical cystectomy requires several days of hospitalization, where you will be monitored, and taught how to care for your catheter or stoma, depending on your specific surgery. Chemotherapy is usually recommended before cystectomy. Giving chemotherapy prior, or "neoadjuvantly" has been shown in large trials to improve survival in bladder cancer.
Partial cystectomy is an option for some patients that have one muscle-invasive tumor located in a lower-risk area of the bladder. Like a radical cystectomy, the surrounding pelvic lymph nodes can be removed. Since the bladder is saved, this option avoids the need to drain the urine through another method, known as urinary diversion. Because the bladder is physically opened during the procedure, (unlike radical cystectomy, where the bladder is removed in its entirety), there is a risk of cancer coming back in the abdominal cavity or near your scar, where it was removed. As with TURBT, whenever the bladder is left in place, there is a risk of the cancer coming back elsewhere in the bladder. Neoadjuvant chemotherapy is usually recommended before having this procedure. Your surgeon will discuss if partial cystectomy is possible in your specific case.
Contributing: SurvivorNet Staff
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