Dr. Aly-Khan Lalani
Associate Professor, McMaster University & Genitourinary (GU) Medical Oncologist, Juravinski Cancer Centre
Peter Rich
Patient & Peer Support Volunteer, Bladder Cancer Canada
The fifth most common cancer in Canada, bladder cancer strikes more men than women. Being educated and proactive helps ensure positive outcomes.
In the fall of 2017, Peter Rich, then 65 and self-employed in Aurora, Ontario, sought medical atten- tion after noticing blood in his urine. “It was initially diagnosed as a bladder or kidney infection, but it soon became apparent after heavier bleeding and small blood clots began to appear, that further investigation was required,” he says. In June of 2018, he received the diagnosis of stage 4 muscle invasive bladder cancer. “The tumour was so advanced that my only option was surgery to remove the blad- der and undergo multiple rounds of chemotherapy,” says Rich.
Bladder cancer is the fifth most common cancer in Canada and the fourth most common cancer in men. Estimates are that 12,300 Canadians will be diagnosed with bladder cancer in 2024 and about 2,300 are expected to die from the disease. While the majority are diagnosed with non- muscle invasive bladder cancer, where the cancer has not grown into the muscle surrounding the bladder, approximately 10 to 15 per cent of bladder cancer cases are locally advanced or metastatic at diagnosis, as was Rich’s.
New treatment options for advanced bladder cancer show promise for improving quality of life and survival for many patients.
A heavy disease burden and high risk of recurrence
The most common symptom is blood in the urine (hematuria), as Rich experienced. Other symptoms can include bladder spasms, increased frequency, urgency, difficulty urinating, and back, pelvic, or groin pain. Treatment for non-muscle invasive bladder cancer typically involves surgery to remove tumours from inside the bladder and the insertion of drugs into the bladder. Muscle invasive bladder cancer is commonly treated by removing the bladder (cystectomy) and other modalities such as radiation, chemo- therapy, and immunotherapy.
Understandably, patients with advanced bladder cancer carry a heavy disease burden. “Apart from dealing with the shock of their diagnosis, they’re also dealing with uncomfortable and painful symptoms in their pelvic area and the treatment burden,” says Dr. Aly-Khan Lalani, Associate Professor at McMaster University and Genitourinary (GU) Medical Oncologist at the Juravinski Cancer Centre. “These patients also need to be closely followed in specialized clinics because of the high recurrence rate and the potential for it to become advanced metastatic disease. This is unfortunately especially common with muscle invasive bladder cancer,” he says.
New treatment options needed
“New treatment options for advanced bladder cancer show promise for improving quality of life and survival for many patients. We also hope to have these new treatment options available in early stages across the disease spectrum,” says Dr. Lalani.
With more first line options, Dr. Lalani says “I think we need to study novel treatments for patients whose disease grows despite the newer therapies. Because of the aggressiveness of the disease, high risk of recurrence, and poor prognosis once spread, we need to make sure novel drugs and innovative surgical options are available to Canadians.”
Despite being cancer-free, Rich’s life with a urostomy is not without challenges. While Rich is very appreciative of the support and treatment he received, he recognizes that living with a urostomy has required adjustments and accommodations. “I’m beyond grateful for the support and treatment I was given,” Rich says. He credits his medical team for encouraging him to conduct his own research, ask questions, and advocate for himself. Through his own experiences, he discovered valuable resources and support through Bladder Cancer Canada, which he now utilizes to help other patients as a peer support volunteer.
If you notice any unusual bladder symptoms, reach out to your healthcare provider, or learn more at bladdercancercanada.org.
