Julian Diaz was concerned when he spotted blood in his urine. The 58-year-old husband and father of three was two years away from retirement. When he mentioned it to his doctor, he was told he must have eaten something weird, but Diaz didn’t think that sounded right. Two doctor’s visits later, he knew for certain what the problem was.
Diaz was diagnosed with bladder cancer, the fifth most common cancer in the United States and one that kills more than 17,000 people every year. It is three times more likely to affect men than women, according to the American Cancer Society.
The reason for the disparity is still unclear, but doctors believe higher rates of smoking among men and exposure to toxic chemicals in their jobs are contributing factors, said Dr. Primo Lara, associate director for translational research at the UC Davis Cancer Center.
Either way, the concentration of carcinogens in the bladder is to blame for cancer, Lara said, and treatment can dramatically change a patient’s way of life.
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“I had no idea it was going to hit me as hard as it did,” Diaz said.
Blood in urine is often a sign leading to early detection, Lara said. The bladder has three layers, and when cancerous cells form in the innermost layer, they can cause other cells to burst, releasing blood into urine.
To determine the best treatment, doctors insert a camera up the urethra into the bladder to check out the cancerous cells. If the cancer is caught early, they can scrape the small tumors off the walls of the bladder and squirt a treatment on the affected areas, Lara said. More advanced stages require surgery.
Two and half years after his diagnosis, Diaz – now 61 years old – has had three surgeries and travels an hour and a half from his home in Oroville to Sacramento every six months for treatment.
His cancer is in stage three, and while it is not life-threatening, it could still become aggressive.
Diaz’s treatment involves having a chemical called BCG, a vaccine to prevent tuberculosis, injected into his bladder. He has to hold it in for two hours, turning every 15 minutes to coat the inside walls. Then he urinates it out and goes home. The treatment does have side effects. Diaz said it takes him anywhere from 36 hours to three days to recover.
“It agitates the prostate so much you have to stick near the bathroom,” Diaz said. “You have to go again every 15 or 20 minutes, and you can’t run to Wal-Mart with that.”
The BCG treatment “can cause significant side effects in patients and a small percentage of patients can become very sick from the treatment,” said Dr. Stanley Alexander Yap, a urologic oncologist and associate professor at UC Davis.
The treatment is supposed to last three years, but most people don’t complete it. In fact, only 20 percent make it all the way through because the treatment can worsen urinary symptoms and cause bleeding and pain, Yap said.
Despite the pain and discomfort, Diaz said he’s going to stick with the treatment. “I don’t want to start all over again. I want this to be gone, that’s why I’m pushing myself through the treatments because I want to be one of those 20 percent that makes it through.”
Patients will always need check-ups to make sure the cancer doesn’t come back, Lara said. And the need for constant monitoring and treatment is what makes bladder cancer the most expensive kind of cancer to treat.
“It’s like a bad penny,” Lara said. “It keeps coming up.”
For patients who develop large tumors, doctors will remove the whole bladder and mold a new one out of a 60-centimeter piece of small intestine, Yap said.
The new bladder will store urine, but the patient will often have to drain it using a catheter or externally through a bag.
“It’s a big surgery and a long recovery, more than (patients) expect,” Yap said. “Regardless of how we put things together, they have to relearn their new plumbing.”
For example, the new bladder is much smaller, which makes patients urinate frequently, usually every one to two hours. It takes a few months for the bladder to stretch to a normal size. In the meantime, the new bladders create a lot of mucous, so patients have to irrigate it with external tubes a couple times a day for the first month. They also have to learn the new sensations of feeling full and how to generate pressure to urinate.
Doctors perform this procedure on patients whose bladders have been badly damaged or when the cancer has the potential to spread. Bladder cancer can become deadly when tumors leach into the outer layers of the bladder. There, cancerous cells gain access to muscle tissue, which can spread to different parts of the body. These cases account for most of the deaths attributed to bladder cancer, Lara said.
Diaz’s cancer has so far stuck to the inner layer of his bladder. And at his last check-up two weeks ago, his doctor said it looked all clear.
Diaz is two years into the three-year treatment. He chose not to tell his mother or his six young grandchildren about his diagnosis. He said he didn’t want them to worry.
“Worrying doesn’t help the situation,” Diaz said.
Even though he had to retire early, he has since been elected to the school board for the Oroville City Elementary School District. He still takes his grandkids to school.
He’s been to Mexico three times in the last year, visiting the pyramids there. He said he hopes to visit family in Jalisco the next time he goes. And the ultimate goal, he said, is to go to Italy and meet the pope.