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Bladder Matters

Bladder Matters
Bladder Cancer: Increased Risk?

Q. I just read the Spin 2.0 blog that said U.K. singing sensation, actress and paraplegic Kerry McGregor died of bladder cancer. Over the years of reading New Mobility, it seems quite a few people with spinal cord injuries have succumbed to this disease, including former NM editor Barry Corbet and Paralympian and motivational speaker Skip Wilkins. As a T4 complete para, it has be a bit concerned.

The other day I was discussing this with a friend who is also a para. He said he had done a Google search and come across several articles that say people with SCI have a much higher risk of getting bladder cancer than the general population. One study says the risk is 28 times higher.

Does having a spinal cord injury put me at higher risk for bladder cancer? What are the signs or symptoms of bladder cancer? Is there anything I can do to reduce my chances of getting it?

A. John, your questions are timely and important. I’ve received quite a few questions about bladder cancer since Kerry McGregor died — a fitting tribute, as McGregor had become an ambassador for Action on Bladder Cancer, an organization in the U.K. that raises bladder cancer awareness and supports research.

Studies do show that the incidence of bladder cancer is higher in people with SCI than in the general population. It occurs in less than 1 percent of the general population but in about 3 percent of SCI survivors, according to Craig Hospital’s Bladder Cancer web page. The research puts this into perspective, however, noting that the incidence of bladder cancer is still low compared to other SCI complications like pressure sores and kidney failure. And illnesses like heart and respiratory disease result in many more deaths in people with SCI than bladder cancer.

That said, when bladder cancer does occur in people with SCI, it often occurs at an earlier age than in the general population. Bladder Cancer and SCI from from National Rehabilitation Hospital explains that while bladder cancer in the general population is usually associated with people older than 60, it tends to strike people with SCI as early as their 40s and 50s if they’ve had a spinal cord injury for 10 or more years. McGregor was 35 years old and 22 years post-injury when she was diagnosed.

Risk Factors
Bladder cancer usually develops on the inside lining of the walls of the bladder. Like any cancer, the earlier it is diagnosed, the more options there are for treatment and the better the prognosis is for a cure.

Researchers have concluded that long-term irritation is one factor that increases the risk of bladder cancer — culprits include repeated urinary tract infections, repeated bladder stones, and irritation by catheters, especially long-term indwelling Foley catheters or suprapubic catheters.

Paula Wagner, a urology nurse practitioner from UC Davis Medical Center in Sacramento, Calif., says that anybody that has had an indwelling catheter for more than five years should have an annual cystoscopy — a simple outpatient procedure in which a catheter with a tiny camera on the end goes through the urethra and into the bladder to look around for stones and any unusual areas of the bladder walls. If doctors see something unusual, they can take a biopsy of the area through the cystoscope. 

Wagner says it is important for people with indwelling Foley catheters to move their legbags from one leg to the other every day so the Foley balloon isn’t resting on and irritating the same place on the bladder.

But indwelling catheters are not the only culprits when it comes to SCI and bladder cancer. A 2009 study done by UC Irvine’s department of urology looked at 32 people with SCI diagnosed with bladder cancer between 1983 and 2007 and found more than 50 percent of those with bladder cancer did not use an indwelling catheter. This is another reason to have a yearly urology check-up, including an ultrasound and kidney-ureters-bladder (KUB) X-ray to check for kidney and bladder stones — some of the irritants that raise the risk of bladder cancer.

Symptoms, Prevention
The most common symptom of bladder cancer is blood in the urine. Anytime there is chronic blood in the urine — blood that recurs again and again, not to be confused with blood related to a UTI — you should consult with your urologist. A sudden increase in UTIs is another possible bladder cancer symptom. Wagner says anybody with these symptoms should see their urologist for a workup.

Screening for bladder cancer involves ruling out other possibilities, explains Wagner. A person with blood in the urine or an increase in UTIs should have a cystoscopy and CT scan of the kidneys and abdomen to rule out kidney and bladder stones. Additional tests include a urinalysis to look for abnormalities in the urine.

Federally-funded educational materials on bladder cancer and SCI say the most effective way to reduce your odds of bladder cancer is by following proper bladder management guidelines:

• Eat a healthy diet high in fruits and vegetables. 

• Drink plenty of water, enough to keep your urine in the clear or straw-colored range. Drinking water helps flush out irritants and bacteria that can cause UTIs and helps prevent bladder stones. 

• If you are doing intermittent catheterization, be sure to catheterize often enough to keep bladder volumes less than 400 cc  (about 1.5 cups). When a bladder is overfilled, it gets stretched and irritated, and can be damaged and scarred.

• Use plenty of lube to avoid irritation to the urethra and urethral sphincter from catheterization. If you are having difficulty inserting a catheter, speak with your urologist about trying a different type, such as a hydrophilic catheter or coudé.

• If you use an indwelling Foley, switch your legbag side every day.  

• If you are prescribed anticholinergic drugs, such as Ditropan, to quiet your bladder, be sure to use them. Bladder spasms irritate the bladder and can cause permanent scarring.

• Get a urological checkup, including a screening for kidney and bladder stones, on a yearly basis.

Although it should go without saying, do not smoke or use any type of tobacco product. Every information site concerned with bladder cancer says smoking increases bladder cancer risk. This includes cigars, as well as chewing tobacco. An August 16, 2011, article in Science News cites a recent study done by the National Institutes of Health that shows smokers’ risk of bladder cancer is four times higher than that of non-smokers.

Action on Bladder Cancer
• Bladder Matters: How Often Should You Have a Urology Check-Up?
• Bladder Matters: Catheter Options, Fine Tuning the System
• Bladder Matters: Suprapubic Revisited
• Craig Hospital, Bladder Cancer
• National Rehabilitation Hospital, Bladder Cancer and SCI
• Spin 2.0 Blog: Paralyzed Scottish Songstress Dies
• UC Irvine Study, Bladder Cancer in Spinal Cord Injury Patients