Recently, a 70-year-old patient and friend of mine started passing blood in the urine. A pelvic sonogram revealed a mass in the urinary bladder. Further tests revealed it was a malignant cancer. It came like a bolt from the blue. But mobilising the spirit of courage, my gentle pal did everything recommended by his doctor, and is today in frank remission. Cancer is the growth of abnormal cells in the body. Bladder cancer typically begins in the inner lining of the bladder, the organ that stores urine after it passes from the kidneys. Most bladder cancers are detected early, when treatments are highly successful and the disease has not spread beyond the bladder. But bladder cancer tends to come back, so regular check-ups are important.
Blood in the urine can be a sign of bladder cancer, either visible to the eye or picked up by routine testing. Most commonly, blood in the urine is not caused by cancer, but by other causes. These include exercise, trauma, infections, blood or kidney disorders, or drugs, such as blood thinners. Although the exact causes of bladder cancer remain unknown, smoking is the leading risk factor. Smokers are about four times more likely to get bladder cancer than people who have never smoked. Chemicals in tobacco smoke are carried from the lungs to the bloodstream, and then filtered by the kidneys into urine. This concentrates harmful chemicals in the bladder, where they damage cells that can give rise to cancer.
Anyone can get bladder cancer, but some factors put you at greater risk: Men are three times more likely to get bladder cancer. Nine out of 10 cases occur over the age of 55. Other factors at play include a family history of bladder cancer, previous cancer treatment, certain birth defects of the bladder, and chronic bladder irritation.
There’s no routine test for bladder cancer. But if you’re at high risk or have symptoms, your doctor may first order a urine test. If needed, a procedure called cystoscopy lets your doctor see inside the bladder with a slender lighted tube with a camera on the end. The cystoscope can be used to remove small tissue samples (a biopsy) to be examined under a microscope. A biopsy is the best way to diagnose cancer.
If cancer is found, imaging tests can show whether it has spread beyond the bladder. CT and MRI scans give detailed images and can show the lymph nodes nearby. An ultrasound uses sound waves, instead of radiation, to produce images. Additional imaging tests look for cancer that has spread to the lungs and bone.
There are various stages of bladder cancer according to whether it stays in the inner lining or spreads to the pelvic or abdominal wall, lymph nodes, or distant sites such as bones, liver, or lungs. Transurethral surgery is most often done for early-stage cancers. If cancer has invaded more of the bladder, the surgeon will most likely perform either a partial cystectomy, removing a portion of the bladder, or a radical cystectomy, to remove the entire bladder. For men, the prostate and urethra may also be removed. For women, the uterus, fallopian tubes, ovaries, and part of the vagina may also be removed.
Other modalities of treatment include chemotherapy, immunotherapy and radiation. Cancer is a life-changing experience.
And although there’s no sure fire way of preventing a recurrence, you can take steps to feel and stay healthy: eat plenty of fruits, veggies, whole grains, and stick to modest portions of lean meat. If you smoke, stop. Limit alcohol to one or two drinks a day. Daily exercise and regular checkups will also support your health and give you peace of mind.
I remember many of my bosom friends whose cancer sadly led to death and others who mercifully survived. There may be many reasons, some discernible, others unfathomable. No doubt we will all die one day. “Death is not the greatest loss in life. The greatest loss is what dies inside us while we live,” Norman Cousins wrote. As for me, I must confess, I don’t fear death as much as I fear its prologues: loneliness, decrepitude, pain, debilitation, depression, senility. After a few years of those, I would say death would present itself like a holiday at the beach.
Knowing how vulnerable we are, we must use our time to get to know ourselves better. It takes courage because it is far easier to hide behind a mask than to see ourselves as we really are. There are many who think they are perfect and need not change. They feel they are at the centre of the universe and their only ambition is that their barns must be filled to overflowing.
As we age, we must endeavour to know ourselves and change for the better; we need to accept our inadequacies, fears, weaknesses, mistakes, and more; we need to spend some time being totally alone and see how we feel. If we are comfortable, then we are in the process of knowing ourselves and the Source of Life. “Once we can do that,” said Bernie Siegel, “the frantic search for distraction and escape will stop ruling our life and we will choose to fill it with the things that bring joy”. And our journey will be tolerable until in tranquillity, death lets us fly into eternity.
(Dr Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa, column writer, singer/songwriter/music aficionado and past president of the state IMA)
