Everyone knows someone who has been touched by cancer, directly or indirectly. And while some forms of the disease are quite common, others are less so and the warning signs may not be so well known.
There are fewer than 500 cases of bladder cancer diagnosed in Ireland each year, but when Crispin Wall noticed blood in his urine in 2017, he knew something was wrong and immediately sought medical advice. “I was on vacation in France when I urinated blood that was quite thick,” says the retired teacher. “I went to A&E the next day and the staff were quite reassuring, put me in touch with a urologist who arranged for a scan, which incidentally did not reveal anything. [out of the ordinary].
“But before I returned to Ireland, she also had a cystoscopy with a local anesthetic which revealed a sinister-looking inflammation, so she urged me to do further investigation when I returned to Dublin. “
Crispin, who is married and has a son, went to an expert on his return to Ireland and was shocked to find out he had cancer. “On my return, I saw a urologist who had me do a biopsy fairly quickly given the results of the cystoscopy in France,” says the 67-year-old man. “I was there for about four days and two or three weeks later got the results which revealed that I had muscle invasive bladder cancer, which was at a fairly advanced stage, but could be treaty.
“My wife was with me when I went to do the biopsy, but she lives and works in France, so I was alone for the results and I knew there was bad news when I was asked if I had brought someone with me. At first I was shocked by the results but to be honest I feared the worst. So I decided to focus on the fact that there was a way forward and that it was treatable, even if I had to have my bladder removed.
The Dublin man began chemotherapy to reduce the size of the tumor before undergoing surgery. And although it was a tough test, he was determined to continue living normally. “The chemo started about two weeks after the diagnosis and consisted of eight full-day sessions over 10 weeks, which took me to early February 2018,” he says.
“I’ve tried to lead as normal a life as possible – I’m a big fan of horse racing, I attend about 70 meetings a year. [pre-pandemic] So I maintained that attendance rate during the chemo, and it was a fantastic distraction. I also had a few visits – a friend from Denmark stayed for a few days, my son also came from London, and my wife came over Christmas.
“It turned out that the chemo had gone well and I might be able to keep the bladder on but I would need radiation therapy and maybe more chemo. But it was explained that in order to reach the bladder, radiation therapy would have to be quite aggressive, might not work, and might damage the bladder leading to leakage. I did not like this option which would have required frequent [three monthly] check-ups after heavy treatment.
“So I opted for the bladder removal that happened on April 16, 2018. It apparently took six hours because they had to remove part of the colon to create the conduit for the urine to come out of my. body 7-8 cm to the right of the navel. . A urostomy bag is then attached and emptied via a tap at the bottom of the bag. Indeed I have a ‘bladder’, but it is outside my body. The operation was quite heavy, but I was out of the hospital in less than two weeks, at the Stones concert in Croke Park on May 17th and back on my bike at the end of June.
Although he has made a remarkable recovery, Crispin is still being watched and has suffered lasting side effects. “I had had six CT scans every month and now the time interval has been extended to one year,” he says. “I still have the urostomy bag, but it became second nature – change it [every other day] takes a few minutes after my shower and I can lead a perfectly normal life with it – running, cycling, swimming etc.
“As the surgery also involved the prostate and its surroundings, I am no longer sexually active. I’ve been warned about this and I guess at 65 it’s less of a concern than, say, 45. night to go to the bathroom and I get a full night’s sleep.
“In my case, the blood [in the urine] was the first visible indication that something was wrong, and it turned out that by then my cancer was quite advanced. So in hindsight, I would get up frequently at night to pee, and sometimes I would have a burning sensation when we pee. So I think men, especially when they reach a certain age, just think it’s a natural part of aging, but clearly in my case it wasn’t.
“So my advice would be to see your doctor when your peeing habits change and become more frequent and / or painful. It may be just something like an enlarged prostate, but follow it and rule out the grim possibilities and obviously any blood is an immediate red flag. I am grateful for the treatment and care I received, and can say that life without a bladder can be lived to the fullest – but try not to go that far.
Professor Ray McDermott, a consulting medical oncologist at Tallaght Hospital and St Vincent’s Hospital in Dublin, agrees and says early detection is key. “There are different types of bladder cancer and different ways to treat or manage it,” he says. “The key is to diagnose bladder cancer as early as possible, giving patients the best chance of survival and quality of life with less invasive treatments.
“This is why knowing the signs and risk factors is so important – and anyone with concerns should speak to their doctor immediately,” says Professor McDermott.
“Over the past year, we have seen cancer services, screening and diagnostics disrupted in all areas due to the pandemic,” said Liz Yeats, CEO of the Marie Keating Foundation, who heads the Give bladder cancer the red card campaign, which aims to encourage men – who are three times more likely to be diagnosed than women – to know the signs of bladder cancer and to get help if needed.
“Bladder cancer rates have been increasing year after year and we want anyone with a family history of bladder cancer or who may be showing symptoms to be more aware of these changes in their body and looking for help. Action is essential because bladder cancer can be treated if caught early. “
Bladder Cancer: The Facts
- 490 people are diagnosed with bladder cancer in Ireland each year.
- Three times more men than women are diagnosed with bladder cancer.
- More than three-quarters (78%) of those diagnosed are over 65 years old.
- Five counties in Ireland (Donegal, Sligo, Leitrim, Meath and Louth) have recorded an average number of bladder cancer cases 15% higher than the national figure.
- Smoking increases the risk of bladder cancer.
- The most common warning sign is blood in the urine, which is why the Marie Keating Foundation recommends color coding for bladder health; if you see red (blood), yellow (urine), go (green) to your doctor immediately.
Warning signs include:
- Blood in the urine
- Recurrent urinary tract infections
- Need to urinate suddenly and more frequently
- Pain when urinating
- Pain in the lower back or abdomen