From Risk to Research
Bladder cancer is the fourth most common cancer in men. Yet, scientists are still working to understand more about its genetic markers and how genetic testing can lead to better treatment options.
“I think for many years it was an orphan cancer because certain types of bladder cancer are rare. But that means there’s the biggest opportunity looking ahead, and there is great potential,” says Joshua J. Meeks, MD, PhD, Northwestern Medicine urologic oncologist; assistant professor of Urology and of Biochemistry and Molecular Genetics at Northwestern University Feinberg School of Medicine; and a member of Robert H. Lurie Comprehensive Cancer Center of Northwestern University. At Polsky Urologic Cancer Institute of Lurie Cancer Center at Northwestern Memorial Hospital, a multidisciplinary access point for innovative research and treatment of genitourinary cancers, Dr. Meeks is researching the underlying genetics of bladder cancer to help develop new treatments for the disease.
A Deeper Look at Bladder Cancer
Urothelial carcinoma, the most common bladder cancer, occurs in the innermost layer of the bladder in the urothelial cells. And though there are other types, such as squamous cell carcinoma (located inside the bladder) and adenocarcinoma (located in the lining of the bladder), these are more rare. Treatment approaches depend on the cancer's location as well as its stage of development.
Risk factors for bladder cancer that you cannot change include:
- Your genetics and family history
- Personal history of bladder cancer
Though bladder cancer can impact anyone, it occurs more frequently in men. Dr. Meeks says scientists are beginning to understand the importance of differences in men's and women's bladders. “There are also differences in when they become diagnosed,” he adds. For example, women with blood in their urine may associate it with a urinary tract infection or menstruation, delaying diagnosis.
One risk factor you can change? Smoking. “We attribute 50 percent to 60 percent of cases to smoking,” says Dr. Meeks. Other additional risk factors include occupational exposures, particularly those with exposure to certain chemicals and water with carcinogens.
Diagnosis and Prognosis of Bladder Cancer
The first sign of bladder cancer is often blood in the urine, which may or may not be accompanied by any other symptoms. This bleeding may occur irregularly, but it’s unlikely to occur just once. That said, blood in the urine can occur for a number of reasons, including infection, kidney stones or other kidney diseases. Regardless, Dr. Meeks suggest seeking medical attention any time you have blood in your urine to investigate the cause.
Other symptoms can include:
- Difficulty with urination, including a slow, weak or interrupted flow
- Decreased urination
- Frequent urination
- Erectile dysfunction
- Weight loss or weakness
- Loss of bladder or bowel control
Individuals with blood in their urine are evaluated in two ways ― a cystoscopy and imaging. If an abnormality is found, a biopsy or resection should be performed.
“We tend to classify the cancer as one of two types,” says Dr. Meeks. “A vast majority will have early-stage, non-muscle invasive cancer. And although it has a high risk of coming back, we can offer treatment that can decrease the risk of recurrence. Progression, meaning recurrence at a higher stage, is quite rare.” By controlling recurrence and progression, non-muscle-invasive bladder cancer, which accounts for about 80 percent of cases, becomes a chronic disease rather than a life-threatening condition. Invasive bladder cancer accounts for the other 20 percent of bladder cancers. This type of cancer is more aggressive and harder to identify. In invasive bladder cancer, the disease invades the muscle, or the deep part of the bladder. It may require aggressive treatment and even removal of the bladder.
Better Research, Better Outcomes
The treatment for bladder cancer is dependent on the grade and stage of cancer, and can include chemotherapy, radiation therapy and surgery. Trials in immunotherapy, which uses patients’ own immune system to fight cancer, have also shown promise. “Immunotherapy may be a good choice for you if you’ve had surgery to remove cancer from your bladder or the cancer has returned,” says Dr. Meeks. “We have patients alive because of this opportunity.”
As a clinical investigator at Polsky Urologic Cancer Institute, Dr. Meeks says many avenues of research are being conducted on this complex disease. “We are conducting research to better understand the expression of certain genes and genetic changes that occur in a bladder tumor,” he explains. “This is the most fundamental cancer question. We also have a clinical trial to better understand the tumor mechanisms.”
Dr. Meeks says he hopes his work leads to the development of new therapies, including intravesical therapies, to improve survival of patients with bladder cancer. He says patients have been generous in participating in research to advance the field.
“We’re learning a lot from these new trials and therapies,” he says. “The future looks bright.”