HJAR Jul/Aug 2023

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2023 49 Brad Houston, MD Arkansas Urology People who smoke are around three times more likely to be diagnosed with bladder cancer than those who don’t. Chemical exposures are also thought to be a major contributor to bladder cancer. One risk factor that may impact patients living in rural areas is naturally occurring arsenic in well water, which contributes to bladder cancer rates worldwide. Working around diesel fumes, rubber, dyes, textiles, paint, or inks is also thought to increase the chance of contracting blad- der cancer. That means those who work in certain professions and industries are at el- evated risk, including painters, truck driv- ers, hairdressers, printers, mechanics, and machinists. Due to exposure to diesel fumes and tox- ins in smoke, firefighters are also considered particularly at risk, with around double the risk of bladder cancer compared to the aver- ageAmerican. Smoking tobacco can further increase the risk for all these groups. Other factors that can increase the risk for bladder cancer include being older, with around 90% of cases occurring in those over 55; having a history of chronic bladder in- fections and irritations, including UTIs, kid- ney/bladder stones, long-term catheter use, etc.; and having a family history of bladder cancer. Treatment options For bladder cancers that are detected early, transurethral resection (TUR) is of- ten a good option. In this procedure, a re- sectoscope is fed up the urethra and into the bladder. The surgeon then removes the tumor from the bladder wall. Another treatment option is intravesical therapy. Used primarily to treat superficial bladder cancer, this option involves scrap- ing tumor cells from the wall of the bladder, which is then filled with fluid containing a bacteria called Bacillus Calmette-Guérin (BCG). This bacteria induces an immune response from the body, which encourages the body to recognize and kill cancer cells in the urothelium. More advanced cases sometimes require cystectomy, followed by bladder reconstruc- tion. In most cases, the entire bladder is re- moved, but certain patients may be candi- dates for partial cystectomy. Lymph nodes close to the bladder are also removed, as is usually the prostate in men. For women, a cystectomy may include removal of the ovaries, uterus, and fallopian tubes. Chemotherapy and radiation are also of- ten part of the treatment plan, with drugs administered directly to the bladder or systemically. By keeping an eye out for the subtle symp- toms that may point to bladder cancer and inquiring after the factors that may put cer- tain people and occupations at risk, you can help keep diagnosis and death rates mov- ing in the right direction. From a urologist who often has to help patients deal with the life-changing aftermath of more advanced cases: Thank you for your diligence and your vigilance. n Brad Houston, MD, obtained a Bachelor of Science in biology at University of Arkansas in Fayetteville. Houston graduated from the University of Arkansas for Medical Sciences with both a Master of Public Health and a Doctor of Medicine.He then completed an internship in general surgery and residency in urology at University of Tennessee Health Science Center in 2018 and 2022 respectively.He practices at Arkansas Urology locations inConway and Russellville. tumors that originate in the bladder can easily spread to these structures. According to data from the National Can- cer Institute, the five-year survival rate for cancer that is localized to the bladder is 71%. That drops to 39% for cancer that has spread to nearby organs or lymph nodes, and just 8% for cancer that has spread to distant or- gans and tissues in the body. Common symptoms The most common symptom of bladder cancer — hematuria — is an asset to early de- tection, as even the most physician-adverse patients will usually get to the doctor’s of- fice after noticing bright red or rusty-brown blood in their urine. Other early symptoms of bladder can- cer include frequent urination, especially at night; burning or pain during urination; and feeling the urge to urinate even when the bladder isn’t full. Certain symptoms may indicate advanced bladder cancer. These symptoms may in- clude inability to urinate, lower back pain on one side, abdominal pain, deep bone aches and pains, general fatigue, swelling of the feet, loss of appetite, and unintended weight loss. Risk factors As the symptoms of bladder cancer are shared with many other conditions, risk fac- tors should also be carefully considered if a patient presents with urinary-related pain or other issues. One of the most important risk factors is smoking, with the American Cancer So- ciety estimating that tobacco use directly causes nearly half of all bladder cancer cases.