Bladder cancer in young person

[Gary-J-L]

  I ignored the symptoms of bladder cancer for 4 years.  This was made easier by the fact that the symptoms came and went.
  Also, since I had recurrent chlamydia infections - I believed that the symptoms were the result of the chlamydia.
  In the fourth year of my symptoms - there was much blood (nearly every day), chronic pain on urinating and difficulty in voiding.
  I also experienced greater urgency.
  Bladder cancer was found - the doc said that he is 99% sure that it is all out and that it is low grade superficial - though I am
  still awaiting the biopsy.  What I am concerned about is my age compared to what the websites and my doctor say is normal (average)
  for this cancer.  60+.  Yet I am only 29.  The Doctor said that there is a strong possibility of it coming back - maybe more than superficial
  at some point in the future, thus I am to undergo 3 monthly cystoscopies for the next ten years and less frequently from then on after.
  I have had chemo (myto').  What should be my concerns?  What do I need to be aware of?
  What are my chances of getting invasive cancer?
  Am I worried over nothing?
  Could it have been caused by my abuse (whilst an athlete) of caffeine and ephedrine?

[hfhs M.D.-AK]

_-
Dear Gary,
The bladder is the most common site of malignancy in the urinary tract..  In 1997, 54,500 new cases were identified and 11,700 died secondary to bladder cancer.  It occurs in a 3 to 1 male to female relationship and is twice as common in white men as black men.  It is the fourth most common cause of cancer in men.  Fortunately, superficial bladder cancer is the most common subtype of bladder cancer and represents more than 75% of cases.  From your description, it sound like you also have superficial  bladder cancer.
Some of the associated carcinogens that increase ones risk for developing bladder cancer are: Smoking(2to 5 times increase), coffee (weakly linked), artificial sweeteners (only in animal models),occupational hazards(dye workers,automobile workers, chemical,leather,rubber, and painters to name a few).  There are also a multitude of proposed inherited chromosomal deficiencies which I won’t go into.
You are right to say that you are very young for this disease.  I believe that you will need close follow-up for the rest of your life to make sure you catch any recurrence immediately to prevent possible muscle invasion.  You state in your question that you will have cystoscopy every 3 months for the next ten years, I think this might be a little over zealous.  Usually we follow a patient closely(every 3 month cystoscopy) for about two years.  If you have not had a recurrence, then we might drop down to every six months for a period of time.  After that if recurrence has not occurred, every year or so.  Don’t get me wrong you need to be followed closely, but cytology and other bladder cancer tests can follow well enough once you are a few years out.  Also, if you ever have blood in the urine again, you need to consult your urologist immediately.
It is hard to answer your question about chances of invasive cancer developing without the grade and stage of the tumor.  You have been given Mitomycin C an antibiotic chemotherapeutic agent that inhibits DNA synthesis.  Dosages range from 20 to 40 mg weekly for 6-8 weeks.  Complete response(cure) has been noted upto 40% of the time.  Side effects include contact dermatitis, and rash of the palms and genitalia.  Its biggest concern is myelosuppresion, meaning that the cell making capacity of the body is diminished.  There are other types of chemotherapeutic agents that can be used if the Mitomycin C is unsuccessful.
Overall you are very young and probably need to follow your condition closely.  I don’t think that the caffeine or ephedrine had much to do with your disease.Try to use these substances in moderation but there is no need to eliminate there use.  You used the term worried in your last sentence I would go ahead and live your life but change that term to aware of your disease.  Good Luck!  If we can be of any help at Henry Ford Hospital, call the number below.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Bladder Cancer