Knowing whether your cancer is low-risk or high-risk can help you better understand your treatment options and next steps. Dr. Ashish Kamat, a bladder cancer specialist, explains how bladder cancer is diagnosed and classified, why an accurate diagnosis matters, and how getting a second opinion may be worth considering when choosing therapy.
Dr. Ashish Kamat is a Urologic Oncologist and the Director of the Bladder Cancer Support Program at University of Texas MD Anderson Cancer Center in Houston, Texas. Dr. Kamat also serves as the founding President of the International Bladder Cancer Group (IBCG). Learn more about Dr. Kamat.
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Transcript
Katherine Banwell:
Well, let’s turn to the types of bladder cancer. Can you give us some information about that?
Dr. Ashish Kamat:
Sure. And that’s a very complicated situation. So, the way for a patient to think about types of bladder cancer is any cancer that arises in the lining of the bladder, which also includes the lining of the prostate in men, and the lining of the uterus and the kidney in both sexes; it is called bladder cancer just locally because it arises from the lining of the bladder, which is the largest lining. So, you have a tumor that arises from the bladder; all this lining is called urothelial cancer or bladder cancer. And once you have bladder cancer, what I tell patients is that it can come in two wide varieties.
You can have the low-risk cancer, and you can have the high-risk cancer. The low-risk cancer is low risk because it’s low risk to the life of the patient.
That’s the key thing. It’s not necessarily something that’s not going to come back, but it can come back. It’s low risk, it’s low-grade, it’s not the kind of tumor that penetrates the bladder, spreads, metastasizes.
And once you are low risk, it is a nuisance; it needs to be treated, but you don’t have to worry about a threat to life. And then you have the high-risk cancers.
And the high-risk cancers are the ones that are a threat to life. And by threat to life, I don’t mean immediate threat to life. They are a threat to life because they are high grade.
Even if they are noninvasive, and by noninvasive, I mean not invasive in the muscle layer, they still have the tendency to recur and potentially start invading into the bladder’s wall. And once these tumors get a hold of the bladder wall, the true muscle layer of the bladder, that’s when the aggressive treatments really sort of go to the forefront.
Bladder removal is standard, radiotherapy in some patients, because if you don’t do that on time, and the cancer metastasizes, that’s when this high-risk cancer actually is a threat to life, and there’s no cure.
Even with the best treatments we have nowadays, the median survival is around three years. It’s not five years, 10 years, and it’s gone up from about 14 months to about 30 months in the last year. So, it’s gotten better, but it’s by no means a home run.
Katherine Banwell:
Why is an accurate diagnosis essential, and how can a person ensure they’re getting the correct diagnosis?
Dr. Ashish Kamat:
Yeah, very good question because the accurate diagnosis is what sets the stage for everything; understanding the risks that we talked about, understanding the treatment paradigm, understanding what it involves for you as a patient. And an accurate diagnosis involves appropriate tumor biopsy, grade, and stage from the pathologist and other workups such as CAT scans or MRIs that really add to this. I think those are the questions that patients should ask their doctor: Have I undergone all the testing that I need in order to have an accurate diagnosis?
Is there anything else I need to do to get the best diagnosis? And has this tumor, which has been removed or biopsied, been assessed by an expert GU pathologist? And by that, what I mean is, I’m not implying that every patient, especially in rural parts, will have access to an expert GU pathologist because pathology is a broad field, but if there’s any doubt in the physician’s mind that, “Oh, this tumor doesn’t look right,” it’s worth sending it off somewhere else for a second opinion which can easily be done nowadays especially with digitization of slides.
Katherine Banwell:
So, that actually leads to my next question because it’s often advised that newly diagnosed patients seek consultation with a bladder cancer specialist. So, what’s the value of getting a second opinion?
Dr. Ashish Kamat:
It’s huge, Katherine, and the value is twofold: Number one, for peace of mind for the patient because however much the physician in front of them might be the expert, if the patient has any doubt in his or her mind that they would prefer a second opinion, they should get one.
So, even if patients come to see me and I am an expert in bladder cancer, if they would ask me, “Should I get a second opinion?” I would say, “Yes, if it makes you feel better, please do.” Because it is peace of mind. It’s that knowing that, hey, I at least got a second opinion, and the second opinion agrees with what was recommended. So, that’s one. The other one is just asking an honest question because not everybody is a bladder cancer expert. In fact, most patients are diagnosed by a general urologist. Now, we do teach general urologists, and that’s part of the urology training, how to take care of bladder cancer.
So, I’m not saying that a patient needs to make a five-hour journey and go to a major cancer center if their treating physician is comfortable with the diagnosis. But that’s an honest question to ask the physician and say, “Do you think my cancer is such that you are comfortable taking care of this, or do you, as my physician, recommend that we, not just the patient, but the physician together, get a second opinion?”
And most physicians who are taking care of patients are very honest with their information. So, if it’s a low-grade cancer that is extremely easy to treat, extremely low risk, the physician is likely to tell the patient, “You don’t really need a second opinion, but if you want to get one, please do,” or they might say, “Oh, I haven’t seen this cancer before. We definitely need a second opinion.”