Dr. Nimira Alimohamed
Medical Oncologist, Tom Baker Cancer Centre
Bladder cancer is the fourth most common cancer in men. It’s important to know the early signs and talk to your doctor.
Many men notice urinary symptoms as they age, such as needing to go to the bathroom more often or feeling like their bladder doesn’t completely empty. While these symptoms may indicate an enlarged prostate, a common condition for men as they age, they can also be a sign of bladder cancer.
“Men may assume that these symptoms are a normal part of aging and just live with them, but it’s always important to talk to your doctor about any new symptoms and advocate for yourself. Men should ask about their bladder health and prostate health,” says Dr. Nimira Alimohamed, a medical oncologist at the Tom Baker Cancer Centre in Calgary.
Knowing the risk factors
In Canada, bladder cancer is the fourth most common cancer among men and the eighth most common cancer among women.i It most commonly occurs in men in their 70s. Dr. Alimohamed says that it’s not known why bladder cancer is more common in men, but it’s likely due to hormonal factors. Other risk factors include smoking and exposure to certain chemicals that are commonly used in the textiles and paint industries.ii
The most common early sign of bladder cancer is blood in the urine. Other signs include urinating more frequently, urinating small amounts often, not emptying the bladder, and feeling a burning sensation when urinating. Signs that could indicate that bladder cancer has spread to other parts of the body include back pain, pelvic pain, loss of appetite, unexplained weight loss, and fatigue.iii
Knowing the treatment options
“Treatment for bladder cancer depends on the type and stage,” says Dr. Alimohamed. “Early-stage bladder cancer, which has not gone beyond the first layer of the bladder wall, is treated with Bacillus Calmette-Guerin (BCG), which is an immunotherapy injected into the bladder. In advanced disease, where the cancer has gone into the bladder muscle, the patient’s bladder is removed, or they’re treated with chemotherapy and radiation.”
Dr. Alimohamed says that patients who stabilize after chemotherapy are treated with maintenance immunotherapy. Patients who aren’t responding to chemotherapy may also be treated with a different immunotherapy.
Cancer grows by evading the body’s own immune system and figuring out how to hide from it. Dr. Alimohamed explains that immunotherapy unlocks that hiding mechanism. Your body can then recognize the cancer as being foreign and work to find and attack the cancer cells.
A growing understanding of the disease
“We’ve come a long way in the options that we have to treat bladder cancer in all stages, but also in our understanding of the disease. There are a lot of research studies and clinical trials happening in this area. So, hopefully, we’ll have even better treatments in the future. That’s really encouraging,” says Dr. Alimohamed. “Immunotherapy has helped patients live a lot longer. In some patients, we’re seeing a complete response, where we can’t see any evidence of cancer that’s active on imaging and the patients are doing very well. We’re seeing long-term survivors — it was rare to see that a few years ago. Immunotherapy is providing a lot of hope and optimism.”
Q&A with Bladder Cancer Advocate, Jacques Spilka
Jacques Spilka has been a pivotal supporter for many patients — including those newly diagnosed with bladder cancer — and has volunteered with Bladder Cancer Canada for years.
Tell us a little bit about yourself, your health journey, and your diagnosis.
Well, my problem started in my early 50s, and I was diagnosed with cancer when I was 56. I’ll be 69 next week, so it’s been 13 years. At first, I was waking up two to three times a night which is typical for a man of my age at that time. When I saw the doctor, he put me on medication for enlarged prostate, and that seemed to help, but three years later, I was waking up every 45 minutes to go to the bathroom. My life revolved around being close to a toilet because of the frequency and pain. After two years of this, I changed urologists, and he did a cystoscopy and found carcinoma in situ — which was the beginning of my cancer journey.
I had my bladder removed when I was 56, and then my left kidney and four lymph nodes when I was 63. That was followed by chemotherapy and then radiation treatment. I’ve been in remission ever since. That’s my journey. My doctor recruited me for Bladder Cancer Canada, and I took over the convening of the bladder cancer support meeting for the Hope and Cope group of the Jewish General Hospital in Montreal. But from there, I went on to doing peer support for Bladder Cancer Canada, which I’ve been doing ever since.
What’s a common misconception about bladder cancer?
I’d say the biggest misconception is that your life is over. After my first surgery, my doctor told me I could go scuba diving, so I did. I’ve travelled quite a bit pre-COVID, going to Japan, Sri Lanka, and other places — sometimes up to 24 hours of travel time to reach my destination. So go ahead and make the arrangements. There’s nothing that’s going to slow you down. I was able to live again. I was able to eat again.
What brought you hope during the cancer journey?
I’m a firm believer that your attitude defines your reality. You can choose to be miserable, or you can choose to be happy. I retired because it was work that was killing me. I tried to get back to work, but the two times I had cancer were the two times I was under intense work pressure. So, I retired. Because what’s the point of saving for the future if you don’t have one?
I did all my travelling at this positive bend. I don’t need to get sick to do the things I want or not do the things I don’t want. Now, believe it or not, since I had chemo, which is now going up to seven years, I’ve not been sick once.
What advice would you give to Canadians who’ve recently been diagnosed with bladder cancer?
I think the biggest thing is the fear of the unknown. I was really scared. The most comforting thing is to speak to someone like me. Reach out to Bladder Cancer Canada or any cancer organization, and do your research. When I started, there was no real peer support, per se, aside from this group. Now we have a lot more accessibility. I do this both in English and French. It’s always talking to a frightened person, and by the end of the call, they’ve calmed down, and they’re able to handle what’s coming because they understand that it’s not the end of the world.
Any additional thoughts that you’d like to share?
It’s crucial to tell people not to let the medical system push them around. And when the time comes, get a second opinion. At least that worked for me 13 years ago. But, of course, I know the medical system has changed quite a bit since then.
This article was made possible with support from research-based pharmaceutical companies.
i Bladder Cancer Canada, https://bladdercancercanada.org/en/bladder-cancer-facts/
ii Canadian Cancer Society, https://cancer.ca/en/cancerinformation/cancer-types/bladder/risks
iii Canadian Cancer Society, https://cancer.ca/en/cancerinformation/cancer-types/bladder/signs-and-symptoms