1 – Mike Riordan, Charlie Rinehart MD, and Paul Roach MD embark on a full discussion of Bladder Cancer: what it is, how it happens, how it behaves, and how it’s treated.

2 – Guest: Charlie Rinehart, MD, a practicing Urologist and medical officer in the U.S. Navy, (formerly an officer in the USMC), undergraduate at Georgetown, Medical School at Columbia, and Urologic Residency at US Naval Medical Center, San Diego. Currently practices at the Captain James A. Lovell Federal Health Care Center, in North Chicago, Illinois

3 – Timestamps relevant to points within the episode, in this format:

[00:24] – Intro & Charlie Rinehart, MD

A. Disclosure

B. Dr. Rinehart background & training.

[06:22] Overview of Bladder Cancer:

A. Incidence and Epidemiology

B. Clinical Presentation

C. Urinary system

[14:10] Hematuria and how is bladder cancer causing me problems?

A. Hematuria & its workup

B. Male / Female incidence & etiology.

i. Smoking Factors

ii. Occupational factors

iii. Low, Medium, High Risk

[21:06] Initial Workup of Bladder Cancer

A. Cystoscopy & Biopsy

B. CT Scan

[26:45] Tumor Grades and Depth of Invasion

A. Tumor Grades

B. Tumor Depth: Muscle Invasive and Non-Muscle Invasive

[36:00] Treatment & Surveillance of Non-Muscle Invasive Disease

A. Treatment

B. Surveillance

C. Why not bladder screening for everyone?

[40:50] Local Invasion & Metastasis

A. Pelvic organs

B. Lymph Nodes

C. Metastatic Behavior

D. Bladder removal (Cystectomy) and reconstruction

[50:00] Preventing progression from Non- to Muscle-invasive disease


B. Chemotherapies and Radiotherapy

[54:00] Bladder Cancer Endemic to East Africa & Middle East

A. Squamous Cell Cancer: Chronic Inflammation

i. Chronic Indwelling Urinary Catheter

ii. Parasite: Shistosoma

[57:45] Transitional Cell, Squamous Cell, AdenoCarcinoma Cell types

[59:30] Prevention

[1:01:30] Advanced Disease and Clinical Trials

[1:05:00] Closing

4 – Key takeaways in bulleted format:

— Bladder Cancer happens to Men and Women, typically beginning in the more advanced ages.

— Blood in the urine (either visible to naked eye, or only under the microscope) is a common feature.

— Smoking (and some industrial exposures) important factors in its development

— “Transitional Cell” the most common type in USA and Europe; Squamous Cell (caused by a parasite called Shistosoma) also common in East Africa and Middle East

— Non-Muscle Invasive and Muscle Invasive frequently treated quite differently

— Chemotherapy, Radiotherapy, Immunotherapies available for Advanced Disease

— Important to not smoke, or quit smoking, to lower risk of disease.

— In East Africa and Middle East, a type of bladder cancer can occur because of a parasitic infection.

5 – Relevant links mentioned in the episode

6 – Follow us on your favorite Podcast program, and learn more through the homepage at https://paulbryanroach.com/so-its-cancer/

7 – Coming up next month: “What Is Cancer?”