Dr. Benjamin L. Dehner

The statistics are indisputable. Bladder tumors are three times more common in men than in women, and they’re most common in white men over 50 years old. According to the American Cancer Society, nearly 90 percent of people with bladder cancer are over the age of 55.

“In the past, men were smokers more prevalently than women were, and smoking is the No. 1 reason why this cancer develops. It’s not the kind of thing that typically pops up after one or two cigarettes or even just a year of smoking. It’s the kind of thing that pops up over a lifetime of using the substance,” explained Benjamin L. Dehner, MD, a urologist with Saint Thomas Hospital.

That’s actually encouraging, because fewer people are smoking today than 20 or 30 years ago. “I see less people smoking today than I did when I first started training, which was six years ago, and even as a medical student,” said Dehner, who believes that laws limiting public smoking have been an important impetus  for people to cut back. When cigarette smoke is inhaled, many of the toxins are absorbed into the bloodstream, filtered by the kidneys and then excreted into the urine. Thus, the bladder lining is subject to prolonged contact with carcinogens.

“The best thing I tell patients is that they need to stop smoking, and it’s never too late to stop. Data show that there’s an improvement within a matter of hours,” Dehner said, and that covers urologic, cardiac and pulmonary functions.

A secondary cause of bladder cancer, Dehner said, is exposure to chemicals, such as those prevalent in industrial operations. A vast majority of workers in textiles, dyes and rubber, for example, were … and still are … men. While factory safety has certainly improved, today’s retirees are suffering bladder cancer as result of their former jobs.

While the cellular structure of the bladder lining is the same in men and women, Dehner said hormones and genetics are both areas of research when it comes to bladder cancer. “What it really boils down to is that environmental factors cause it, yet there’s a genetic component that makes some people more susceptible,” he said. Diet and physical activity are two other areas for additional research, Dehner noted.

In fact, a 2010 study implicated processed red meats such as hot dogs, pepperoni and deli cold cuts as bladder-cancer factors. A team of researchers led by the National Cancer Institute followed 300,933 men and women aged 50 to 71 for more than seven years.

Those whose diets contained the highest amounts of the preservatives nitrate and nitrite from processed red meats had an almost 30 percent increased risk for bladder cancer compared to those who consumed the smallest amounts of these compounds. Researchers suspect that when these meats are eaten regularly over time and in large quantities, the preservatives may affect the bladder’s lining when they are passed through the urine. Yet another 2010 study from the University of Texas M.D. Anderson Cancer Center in Houston linked bladder-cancer risk with red meat and fried meat.

Dehner noted that there are variations in bladder cancers. “You can get some odd, different types of bladder cancer from exposure to certain parasites in the Middle East and Egypt,” he said. “I have seen that more in patients who have immigrated here, rather than patients who visit over there.” In addition, chronic infections also irritate the bladder, and that can cause cancer.

Dehner said that painless blood in the urine is the first sign of a problem in 80 percent of cases. Other symptoms include burning while urinating, increased frequency of urination or a sudden need to void. Back or abdominal pain, appetite loss and weight loss are other less common symptoms.

When a patient presents with one or more of these symptoms, urologists conduct a physical and a digital rectal exam, and urine is tested for blood and/or infection. The urine also is sent for cytology to look at the cells themselves. Finally, and usually in the office, urologists perform a cystoscopy, passing a small camera into the bladder through the urethra.

“Many of these things are 5 millimeters or less. They’re quite small, or they’re just flat and not the kind of thing that you can see on a CT scan,” Dehner said. A CT scan is warranted, however, to ensure there’s no bleeding coming from the kidneys, which happens about 3 percent of the time.

Should treatment be necessary, surgery is typically the first step to remove the tumor as well as some adjacent tissue. Surgery alone and in conjunction with other treatments like chemotherapy or radiation are used in more than nine out of 10 cases, according to the ACS.

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