Online Health Chat with Dr. J. Stephen Jones
June 8, 2011
Each year, more than 70,000 Americans are diagnosed with bladder cancer, and the number continues to increase.
Bladder cancer is more common in men, and most people who get this cancer are older than 55. The most common and strongest risk factor for bladder cancer is smoking. Smokers are more than twice as likely as non-smokers to develop bladder cancer, according to the American Cancer Society. Other possible risk factors include being exposed to certain substances at work (for example, rubber production, certain dyes and textiles, paint and hairdressing supplies), eating a diet high in fried meats and fat, suffering from chronic bladder inflammation, having external beam radiation to the pelvic area, and taking Aristolochia fangchi (an herb used in some weight loss formulas).
Bladder cancer is highly treatable, especially when detected early. Approaches to bladder cancer treatment include chemotherapy, biological therapy, radiation therapy, and surgery. The best treatment is determined by the individual and the nature of his or her cancer. New advances in technology now available allow surgeons better visualization of bladder tumors for improved surgical accuracy.
Through a multidisciplinary approach, Cleveland Clinic urologists in the Glickman Urological & Kidney Institute work with specialists in the Taussig Cancer Institute to explore all medical and surgical options to ensure that our bladder cancer treatment program will result in a successful outcome for each patient
J. Stephen Jones, MD, is Chair of the Department of Regional Urology in the Glickman Urological & Kidney Institute at Cleveland Clinic, and is Professor of Surgery (Urology) at Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.
Dr. Jones joined Cleveland Clinic in 2000 and holds an appointment in the Section of Urologic Oncology. He also serves on Cleveland Clinic's Foundation’s Board of Governors.
If you would like to make an appointment with Dr. Jones or any of the urologists in the Glickman Urological & Kidney Institute, please call 800.223.2273, ext. 45600, or request an appointment online by visiting www.clevelandclinic.org/appointments.
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. J. Stephen Jones. We are thrilled to have him here today for this chat. Let’s begin with some of your questions.
Grannyscott: What are the symptoms of bladder cancer?
Dr__J_Stephen_Jones: Blood in the urine (hematuria) is #1, #2, #3, etc. In other words, this is far and away the most serious concern, so I can't emphasize enough how important it is that you address this condition with a urologist if it occurs, EVEN if it stops. Occasionally, urinary irritation -- such as urgency and frequency or an inability to make it to the restroom when you feel the urge -- can also be signs of bladder cancer, but this is uncommon, and most people with these symptoms don't have bladder cancer. Nevertheless, these symptoms should be investigated, because they can often be successfully treated.
Sheilamay: I am a 55-year-old woman with bladder cancer diagnosed two years ago. I didn’t have any of the risk factors for bladder cancer listed in the introduction to this web event. Are there other risk factors being studied?
Dr__J_Stephen_Jones: Smoking, smoking, smoking, smoking.
having_fun: Can second-hand smoke contribute to the onset of bladder cancer?
Dr__J_Stephen_Jones: Probably so, but this is not well-documented.
Plavos: Is there any evidence that intense exposure to amino compound fumes can cause bladder cancer. This exposure lasted for about two years.
Dr__J_Stephen_Jones: Not that I am aware of.
IndianaPouch: We know that bladder cancer is the fifth most common cancer, and Cleveland Clinic is rated fourth in urology. Why do we not see Cleveland Clinic advertise the symptoms and risk factors of bladder cancer?
Dr__J_Stephen_Jones: Actually, Cleveland Clinic is rated #2 in urology. Information on symptoms and risk factors is available on our Web site and in our bladder cancer treatment guide, which is downloadable off www.clevelandclinic.org.
ralphallen: Last November, I had a low-grade tumor stage 1 removed. How long for cystoscopy treatment? Every three months for three years and then six months for two more?
Dr__J_Stephen_Jones: Doctors individualize this decision. Most common is every three months for two years, then every six months for two years, then once a year, probably for life. For patients with solitary low-grade tumors, this is probably excessive and moving to once a year appears safe for most situations, especially if the FISH test is negative.
dbart: Regarding the early detection of bladder cancer, do you recommend any other approach other than responding to blood in the urine.
Dr__J_Stephen_Jones: Usually not, but for patients with bothersome urinary symptoms, a urological evaluation will occasionally identify a bladder cancer in a patient that did not have blood in the urine.
lmgaiso: Urine cytology is often criticized as having low sensitivity. Studies show an incredibly broad range of sensitivity (from 11 percent to as high as 90 percent). In your view, what do you think is a realistic sensitivity percentage from G1, G2, G3, and CIS for cytology? I realize this is a difficult question, but a ballpark is appreciated.
Dr__J_Stephen_Jones: I am one of the critics of cytology. Although it performed well in the past, most recent studies have shown that it is very poor (certainly <20 percent) sensitivity. Nevertheless, the specificity of cytology is very high. So, if it is truly positive (not "atypical," which means little), then it is highly likely that cancer is present.
ralphallen: If I had a transurethral low-grade stage 1 in November, would you recommend an MRI now, six months later, to see if other organs are affected?
Dr__J_Stephen_Jones: Imaging (MRI, etc.) offers very little value in this setting.
ralphallen: What tells my doctor if there are cancer cells elsewhere in my urinary tract or other organs if I had a low-grade stage 1 tumor in November? Is the cystoscopy every three months and urine sample the only course of action?
Dr__J_Stephen_Jones: Many urologists use FISH and/or cytology for this situation, but I have found little benefit to adding them for this low-risk situation. By contrast, if the physician is suspicious or if the cytology is atypical, then there may be value.
go_for_it: What testing is available to check for bladder cancer?
Dr__J_Stephen_Jones: Cystoscopy (placing a small scope into the bladder) is the mainstay of diagnosis. Everyone with visible blood in the urine should have this done.
ralphallen: In November, I had transurethral tumor removal of a low-grade stage 1 papillary urethral carcinoma. Does that mean it never penetrated lamina or muscle? I get a cystoscopy every three months. Shouldn't I be getting an MRI? What tells my doctor if there are cancer cells anywhere else?
Dr__J_Stephen_Jones: Stage 1 is a little difficult to interpret because it might be in the lamina propria (the first layer below the top, which we call urothelium). However, it is extremely rare for low-grade cancer to penetrate or invade, so you almost surely can be reassured of that. A cytology or FISH test could suggest cancer cells elsewhere, but this is highly unlikely with what you have described. The key is to keep up with the cystoscopy examinations to make sure that any possible recurrence can be detected early.
marley05: My daughter was diagnosed with bladder cancer at the age of 20. She had surgery to remove the tumor and nothing more was done except cystoscopy every three months to look for recurrence. She has had intermittent symptoms of a urinary tract infection (UTI), such as burning, frequency, and pain. No infection has been cultured, and cytology has been negative. Cystoscopy is clear. My question is, can bladder cancer recur and cause UTI-like symptoms without being able to be seen on cystoscopy? If so, are there better tests available to determine what's causing her symptoms?
Dr__J_Stephen_Jones: This is a complex situation and it is probably not related to the cancer, but one cannot be sure. Sometimes, a test called UroVysion® can suggest there might be underlying invisible malignancy. If it is positive, I would consider a bladder biopsy. If it is negative, then the likelihood of cancer is very low. Of course, it should be followed carefully, including cystoscopy.
camimor: The pathology following my second transurethral resection came back showing necrosis, etc., no tumor (original was TAG3). I had the slides sent for a second opinion, which found "atypical cells." Is this something that should be followed up?
Dr__J_Stephen_Jones: Atypical cells usually don't mean very much, and it is especially reassuring that this is even after a pathology second opinion. I would not react to these, but you do need careful surveillance and probably BCG, based on the high-grade tumor originally.
barbinal_1: What is the protocol for follow-ups after two years of clear PET scans following radical cystectomy (RC)?
Dr__J_Stephen_Jones: This is highly individualized, but for most patients an annual CT scan with chest X-ray is sufficient. This should be discussed with the treating physician
ralphallen: When I give a urine sample before cystoscopy is that for cytology?
Dr__J_Stephen_Jones: It might be, but it also might be to check for infection before you undergo the procedure. Feel free to ask your caregiver what it is for, and they will surely be happy to discuss it with you.
IndianaPouch: How would you find carcinoma in situ (CIS) in a ureter?
Dr__J_Stephen_Jones: Sometimes this is done with urinary cytology collected from the ureters (usually has to be done under anesthesia) and sometimes through biopsy of the ureters (always requires being placed under anesthesia), which involves placing a scope into the ureters and kidneys. Most patients are at low risk for this cancer, and these tests are not necessary.
RonnieB9: I hear a lot about the FISH. Is this the test that is performed each time I submit urine before BCG and cystoscopies?
Dr__J_Stephen_Jones: FISH stands for fluorescence in situ hybridization. It detects DNA abnormalities in the cells shed into the urine from the bladder. If there is significant DNA damage of certain types, then it can lead to bladder cancer. Often it does not, and false positive readings are an issue with the use of the FISH test. This is the reason I do not recommend the test for most low risk situations (low-grade), other than to establish that low risk early on and when I'm considering spreading out the surveillance interval.
Plavos: I have had two small benign tumors removed from my bladder. A follow-up FISH test was positive. I am scheduled for another cystoscopy, including an attempt to do FISH in the ureters. What other steps do you recommend?
Dr__J_Stephen_Jones: I would not recommend FISH from the ureters based on limited information on its use. Simply getting X-rays (retrograde pyelogram or CT urogram--different doctors utilize each) and cystoscopy is the standard recommendation.
lmgaiso: I am under surveillance for detection of urological cancer. At month zero I had a CT urogram, cystoscopy, and cytology. At month 6 and 12, I had a cystoscopy and cytology. All have been negative. The plan going forward is to have cystoscopy and cytology every six months. PSA is low and is checked every year. Would there be a benefit to adding a FISH test as well?
Dr__J_Stephen_Jones: The FISH test is controversial; but if all looks well, it offers limited value. The one place where it would play a role in most patients, such as you, would be when considering spreading out surveillance, for example to once a year. If the FISH is negative, the likelihood that anything could occur during that time is very low.
RonnieB9: I was T1G3. Should I be getting regular FISH tests?
Dr__J_Stephen_Jones: This should be discussed with your physician to determine how he or she integrates the FISH test into practice.
Ginger12: How many reoccurrences might one experience before chemotherapy is suggested?
Dr__J_Stephen_Jones: It is highly variable, but if the tumor is high-grade, than BCG or occasionally chemotherapy is definitely indicated.
berty6: Is chemotherapy successful with bladder cancer once it has penetrated the muscle wall? Does it get rid of the cancer or just slow down the progression of the cancer?
Dr__J_Stephen_Jones: The intent would be for chemotherapy to actually cure the cancer, i.e., end it for good. When the cancer is outside the bladder, this becomes a bigger challenge; but this is typically the best situation in which to give chemotherapy because the possibility of cancer recurrence is higher if the cancer was outside the bladder at the time of treatment
tprovder: I have had bladder cancer for almost three years. My Cleveland Clinic doctor has generated progress with a six-course treatment of Mitomycin-C. I have to get up about every two hours during the night when I’m sleeping to urinate. He knows about this but hasn't prescribed medication, such as Flomax®, to help with this problem. Is there some reason the doctor doesn't want to prescribe such medication? Does it have to do with having bladder cancer?
Dr__J_Stephen_Jones: Flomax® (tamsulosin) is a medication for obstruction and not for these types of symptoms.
IndianaPouch: What would you advise patients who have had a radical cystectomy to do to prevent a recurrence of cancer? Do you suggest any supplements?
Dr__J_Stephen_Jones: The only thing to consider, other than smoking cessation, is chemotherapy. The risks and side effects must be weighed against the risk of recurrence, and this is best judged in discussion with your physician.
BCG (Bacillus Calmette-Guerrin)*
camimor: Are there statistics on how many cases originally diagnosed as papillary noninvasive high-grade cancer treated with BCG eventually resulted in bladder removal? Is there a reason to try BCG for high-grade rather than moving to bladder removal? It seemed that I am in better shape for serious surgery now than I will be after long term BCG treatment. I have only had one and it is already rough. If the BCG works for a while then stops working, will I not be in worse shape than if I had just had my bladder removed from the start? Thank you.
Dr__J_Stephen_Jones: This situation is the one that requires the most meticulous management. High-grade bladder cancer, even if noninvasive at the time, will often progress. We would individualize this decision. For some patients who prioritize cure above all else, bladder removal (cystectomy) may be chosen. Most patients will give at least one attempt at BCG, but if they do not tolerate it due to side effects (which may be the case for you), or if the cancer does not respond to the first six-week set of treatments, then most patients should proceed to bladder removal. This is a very complex decision and certainly should involve a specialist in bladder cancer removal.
RonnieB9: After a 102 degree fever from BCG, I was reduced to 1/10 strength. How effective has 1/10 strength BCG proven to be?
Dr__J_Stephen_Jones: Studies suggest it actually might be as effective as full dose BCG. However, it is very important to recognize that very rare cases of "BCG sepsis" can occur in patients who have fever with BCG. This risk should be discussed with your physician, who may feel that the risk of BCG has become too high for you to continue to take it
New_Orleans: Some protocols suggest BCG treatments every three months for the duration of the procedures. Other protocols jump to every six months after you have had three series at three month intervals. Which is best?
Dr__J_Stephen_Jones: The SWOG (Southwest Oncology Group) protocol is the most well-defined and the one we use. It would be every six months for two to three years (depending on the case) and occasionally longer.
over_the_top: Is BCG painful? If yes, how do I manage the pain?
Dr__J_Stephen_Jones: BCG treatment is usually very well tolerated, but occasionally irritation or mild pain occurs. If the pain is very bad, you should discuss it with your physician. You may be having a reaction to it.
camimor: Are long-term results better for non-invasive high-grade (Ta or T1) cancer treated with BCG or with early cystectomy?
Dr__J_Stephen_Jones: Certainly the chance of cure is higher with early cystectomy, but this comes at the trade-off of having to undergo major surgery and reconstruction.
Jeanjack: I am a 48-year-old woman who has had two rounds of BCG therapy. I don't think it is working. Are there any new kinds of treatments?
Dr__J_Stephen_Jones: If the cancer is high-grade or CIS, then considerations should be made for bladder removal. If it is low-grade than other agents might be tried, but this may well mean that the tumors just don't respond to intravesical therapy, and removing them when they occur may be best. It is critical to note the cancer grade for this situation.
* BCG (Bacillus Calmette-Guerrin) is a type of therapy called immunotherapy or biological therapy, which uses your body’s own immune system to fight disease. BCG is a bacterium that triggers your immune system to attack bladder cancer cells.
erenne: When would you recommend an RC after a PC and follow-up with chemotherapy stopped working?
Dr__J_Stephen_Jones: Patients with recurrences of high-grade cancer usually require radical cystectomy (RC), so if this occurs after PC (partial cystectomy) then this should be seriously considered.
erenne: Can a radical cystectomy be performed after a partial cystectomy has been?
Dr__J_Stephen_Jones: Absolutely. There is some scarring from the first operation but it can definitely be performed.
camimor: Is a robotic RC as comprehensive as an open one?
Dr__J_Stephen_Jones: That has been a subject of debate, but we know that it is if the surgeon is highly experienced with robotic surgery.
barbinal: I have developed hand tremors since my RC in Feb 2009. Is this something that may be a result of that robotic surgery?
Dr__J_Stephen_Jones: The robot per se should not lead to this. I recommend you see a neurologist to check for nerve damage or other cause of tremors
RonnieB9: Can the mesh used in hernia surgery cause difficulties for an RC, particularly robotic?
Dr__J_Stephen_Jones: At one point, it was believed that this mesh might be a contraindication to bladder removal, but I published a couple of cases six or seven years ago in which we found that the surgery was more challenging, but certainly not contraindicated.
barbinal_1: What would surgical correction involve for a blocked ureter after RC, a stent perhaps?
Dr__J_Stephen_Jones: A stent is usually just a temporary solution, because it only lasts a few months. If the person is healthy enough for surgical correction, usually this is the better life-long solution.
barbinal: What is the reoccurrence rate for T2 bladder cancer in those who have had a radical cystectomy? I had neoadjuvant chemotherapy.
Dr__J_Stephen_Jones: Less than one third of patients with T2 bladder cancer will have a recurrence. Having undergone neoadjuvant chemotherapy makes this rate lower than having not undergone the treatment.
dbart: Does having a recurrence of stage 1 carcinoma in the urothelium raise the probability of higher-grade cancers?
Dr__J_Stephen_Jones: This is not the case as long as the occurrences so far have been low-grade, and assuming there is no carcinoma in situ. If the latter were present, the physician would have almost surely let you know, so the risk sounds low.
janzey: iDr__J_Stephen_Jones: Age is not the determinant of recurrence. If the tumor was confined to the bladder and if the lymph nodes were all negative, assuming all the nodes in the pelvis were removed, then that seems like a reasonable prediction of recurrence. Careful follow-up is of course in order.
barbinal: I am wondering if any statistics are available from studies done in the U.S. concerning recurrence of bladder cancer after a radical cystectomy has been done. I had T2 invasive cancer, had neoadjuvant chemotherapy and robotic surgery done 2/11/09.
Dr__J_Stephen_Jones: We would expect about 70 percent of patients to be cured with what you described. Even better, now that you are two years out from the operation, the likelihood starts going down a lot. Congratulations on reaching this important milestone!
dbart: Are there any medical/diet interventions for prevention of reoccurrence of bladder cancer. I had a small papillary urothelial cell carcinoma removed last year and another small spot removed last week. Any substances to avoid e.g., unfiltered water, certain herbs, coffee, etc.? Does low-grade cancer mean higher probability of occurrence of higher-grade cancer?
Dr__J_Stephen_Jones: Actually, very few (<10 percent) patients with low-grade cancer will progress to high-grade. Unfortunately, not much has been shown to change this risk other than active treatment (BCG) or smoking cessation. Other things that have been investigated have shown poor response.
dbart: Does benign prostatic hyperplasia (BPH) and moderated to severe lower urinary tract symptoms (LUTS), including incomplete emptying, increase the risk of bladder cancer or recurrence of BC?
Dr__J_Stephen_Jones: There is no information to suggest that this is a risk regarding bladder cancer.
Twig9317: Dr. Jones: Some of us have been lucky so far to be dealing with non-invasive BC with the standard protocol of BCG, other drugs, and periodic cystoscopies. However, since the odds of tumor recurrence are great, what advice do you have for patients in our boat?
Dr__J_Stephen_Jones: One thing that reduces recurrence is intravesical therapy, and one of the effective ways to give it is immediately after tumor resection. The trade-off is possible bladder irritation side effects or sometimes scarring of the bladder, which is relatively uncommon. Another effective method is to undergo the resection using fluorescence cystoscopy (Cysview™). Using this, the doctor can see tumors "light up," and then additional tumors can be removed that were not visible initially. This reduces cancer recurrences by at least 15 percent.
RonnieB9: I was T1G receiving BCG protocol. Three months all clear, six months all clear. Am I more likely than average not to have a recurrence or progression because of the three month and six month all clear? If so, are the nine month and 12 month checks also more predictive of eventual progression?
Dr__J_Stephen_Jones: The longer one goes after cancer treatment, the more the risk goes down, but careful life-long follow-up is mandatory.
Plavos: With benign tumors removed from the bladder, and no recurrence on a second cystoscopy, but a positive FISH test, what would YOU recommend as follow up procedures?
Dr__J_Stephen_Jones: The circumstance you described is why I do not use FISH for low-risk situations. It is often a "false positive" in that setting, and it is very possible that this is the case here. That is not to say that it is never used; quite the contrary. However, I caution against "over investigating" a positive FISH if that is the only finding.
Sheilamay: Do you have any suggestions for women with incontinence issues who have the neobladder?
Dr__J_Stephen_Jones: This is very complex and can involve either something not functioning well with the neobladder ("new bladder") or with the urinary sphincter that should hold urine in. Urodynamic testing can sort this out, and often surgery can correct the problem. If the problem is that the neobladder can't hold enough urine, it can be enlarged, and sometimes medications can help. If the sphincter is not working well, an operation called a "sling" can often help.
IndianaPouch: How do you care for an Indiana Pouch? How often should you catheterize? Is it OK to go all night without catheterizing? How often should you irrigate? How many cc's of saline should you use? Should you pull back to suction the saline out or should you allow it to drain? What can be done to prevent infections in the pouch? Do you feel cranberry or D Mannose helps prevent infections? Do you have any other advice for an Indiana pouch?
Dr__J_Stephen_Jones: Surgeons have different protocols. Ideally, irrigate daily and use aspiration to remove any detritus, then allow more to drain under gravity (spontaneously). Many people spread this out later in time, but it depends on how much material builds up in the bladder.
Prognosis & Complications
xyln8arw: What is the prognosis for someone diagnosed with invasive bladder cancer? I believe it is neuroendocrine cancer? What typical symptoms will one experience as the disease progresses?
Dr__J_Stephen_Jones: This is a very common type of tumor and it would be difficult to comment on it without knowing the full details on the case. I would definitely recommend a medical center known for bladder cancer care. U.S. News & World Report rated Cleveland Clinic #2 in urology in 2010.
erenne: I had prostate cancer. In 2005, it was successfully treated with seeds. I was diagnosed with stage 4 bladder cancer in 10/2010, had partial cystectomy and had positive results from systemic chemotherapy. I am now having issues with blockages in my urethra to the point where a cystoscopy can't be performed; the scope won't make it through. What could be the potential causes of the blockages? What are potential treatments to get rid of the blockages?
Dr__J_Stephen_Jones: This is a very complex situation and would be difficult to assess in this format. Clearly, this is a situation where you should be cared for at a center with experience with three issues: bladder cancer, prostate cancer, and urinary reconstruction -- based on the potential that there is scar tissue causing this situation.
marley05: I was told that my ureter was cut during the transurethral resection procedure to remove the bladder tumor. Now I am having symptoms of UTIs but the urine tests are negative. Can the severed ureter be a cause of the symptoms I am having?
Dr__J_Stephen_Jones: This would be highly unlikely to be the cause of UTI symptoms.
stop_it: Have you ever heard of bladder cancer returning to the vaginal wall several years after radical cystectomy?
Dr__J_Stephen_Jones: This is very uncommon, but yes it does occur on occasion. Treatment would be individualized
erenne: Can treatment of prostate cancer with radioactive seeds cause tumors in the bladder?
Dr__J_Stephen_Jones: There is a small risk of "secondary malignancy" with any form of radiation. It is certainly a low risk, and of course there is no way to know if a cancer that occurs in someone with prior radiation was related to that radiation, or was just a spontaneous occurrence, which would be far more likely.
Diet & Supplements
Ginger12: Dr. Oz suggested D-Mannose for people who have frequent UTIs. I was wondering if you thought there was any benefit to taking it for bladder cancer.
Dr__J_Stephen_Jones: To my knowledge, no information exists to support doing this.
Bunga: I read that a high red meat diet may be causative for bladder cancer. I am a gluten-free vegan, a female, with no other risk factors that I am aware of. What role does diet play both before and -- more importantly -- after diagnosis? Are there any foods, supplements, etc. that you feel may help retard or prevent the recurrence etc.?
Dr__J_Stephen_Jones: Lots of things have been investigated but nothing has been identified other than stopping smoking and possibly increasing fluid intake, which dilutes carcinogens that ultimately end up in the bladder.
RonnieB9: Do you recommend any particular foods, supplements, or alternative medicine for fighting bladder cancer?
Dr__J_Stephen_Jones: So far, everything that has been studied has shown disappointing results. Increased fluid intake appears to perhaps dilute toxins that are inevitable in the urine, so it may reduce the risk.
The best advice: A healthy diet and no tobacco products, which we know are far and away the most common causes of most cancers, especially bladder cancer.
fairway: Any thoughts on a resveratrol regimen. It has proven very successful in treating my T1 BC. I’ve had no recurring tumors in last 15 months
Dr__J_Stephen_Jones: I presented a review of resveratrol in Capetown, South Africa, a few years ago, and my findings were that it was really unclear how much difference it made in urological oncology. It is very intriguing, but so far studies have not proven whether it is beneficial. A small warning: The most common source of resveratrol for most people is red wine, and you should beware not to take the potential health benefits as license to drink more than about two glasses a day, which appears to be a relatively safe level for most people. Of course ask your own physician about this.
camimor: Do you know if UNC Chapel Hill, where I am being treated, is high enough up on the list of bladder cancer centers to trust "meticulous management" of my high-grade (so far noninvasive) papillary or should I be traveling for treatment?
Dr__J_Stephen_Jones: I don't have personal experience with UNC’s bladder cancer program, so I cannot give you much information.
lmgaiso: What is the amount a radiation that one receives from a CT urogram?
Dr__J_Stephen_Jones: I am not a radiologist, so I do not know the exact amount, but it is enough that we try to limit the urogram to only once a year in most patients. Obviously, the risk of radiation must be weighed against the risk of not having the information it provides; so if recommended, it is usually judged to be worth that small but real risk.
Bunga: I have seen that the Mayo Clinic is using laser ablation under MRI for liver cancer tumors. Can this be applied to bladder tumors? If so, what is your recommendation regarding this procedure? In your opinion what are the best treatments for bladder cancer today? Where do you recommend a female be treated in the Detroit (suburban) Michigan area?
Dr__J_Stephen_Jones: No information exists to support doing this to my knowledge. For treatment, a specialist in bladder cancer, but I do not have personal contacts there to answer that question.
Twig9317: Are you aware of any studies that positively link bladder cancer to Agent Orange exposure? It seems that the VA might be close to adding BC to their list of covered diseases.
Dr__J_Stephen_Jones: I have heard that the VA is considering the issue, but I have not seen the data on this.
Paulina78: If your husband has bladder cancer and is urinating blood and you have sex, can the cancer cells be transmitted to me through sexual intercourse?
Dr__J_Stephen_Jones: No. There is no risk to either partner by sexual activity in people who have cancer.
marley05: My pathology report says "non-invasive papillary and inverted neoplasm, of low malignant potential. Muscularis propria is not present." I've been told this means they did not get a muscle sample when resecting the tumor. Can you know there is no muscle invasion even if you did not get a sample of the muscle?
Dr__J_Stephen_Jones: This condition has been controversial but it is usually effectively benign. The organizations do recommend surveillance for the very low likelihood of recurrence. Also, you are absolutely right that one cannot be sure on muscle invasion unless the muscle is sampled, but it is also known that PUNLMP never invades the muscle so this is safe as long as this is the only thing the biopsy shows.
Ginger12: What correlation, if any, exists with people who have had difficulty with kidney stones and now also have bladder cancer? Is there a link between these two?
Dr__J_Stephen_Jones: I am not aware of a link.
barbinal_1: My kidneys are working at 90 percent on the left and 10 percent on the right following RC. Should this be a concern?
Dr__J_Stephen_Jones: Yes. This is often related to a blockage in a ureter (the tube that drains the kidney). This should be investigated. If a blockage is found, there is a very high risk of kidney damage, so it should be investigated further and probably treated with surgical correction.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. J. Stephen Jones is now over. Thank you again Dr. Jones for taking the time to answer our questions today about bladder cancer.
Dr__J_Stephen_Jones: Thank you all for your questions and for your desire to optimize care for this condition. I hope this was helpful for you and wish you the very best on your journey!
If you would like to make an appointment with Dr. Jones or any of the urologists in the Glickman Urological & Kidney Institute, please call 800.223.2273, ext. 45600, or request an appointment online by visiting www.clevelandclinic.org/appointments.
A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit www.eclevelandclinic.org/myConsult.
This chat occurred on June 8, 2011
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