‘I was on holiday in France when I urinated blood’

Everyone knows someone who has been affected by cancer, either directly or indirectly. And while some forms of the disease are quite common, others are less so and the early 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 that something wasn't right and immediately sought medical advice. "I was on holiday in France when I urinated blood which was quite thick," says the retired teacher. "I went to A&E the following day and staff were quite reassuring, setting me up with a urologist who arranged a scan, which incidentally showed up nothing [out of the ordinary].

“But before I returned to Ireland, she also did a cystoscopy with local anaesthetic which revealed some sinister-looking inflammation, so she urged me to get it investigated further when I got back to Dublin.”

Crispin, who is married and has one son, went to see an expert when he returned to Ireland and was shocked to discover that he had cancer. “I saw a urologist on my return who had me in for a biopsy fairly rapidly given the cystoscopy results from France,” says the 67-year-old. “I was in for about four days and two or three weeks later I got the results which revealed I had muscle invasive bladder cancer, which was at a fairly advanced stage, but was treatable.

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Biopsy

“My wife had been with me when I went for the biopsy, but she lives and works in France, so I was on my own for the results and knew there was bad news when I was asked if I had brought someone with me. I was initially shocked by the results but to be honest, I had been fearing the worst. So I decided to focus on the fact that there was a way forward and that it was treatable, even if I would have to have my bladder removed.”

The Dublin man was started on a course of chemotherapy in order to reduce the size of the tumour before he would undergo surgery. And although it was an arduous ordeal, he was determined to continue life as normal. “Chemo began about two weeks after diagnosis and comprised of eight full day sessions over 10 weeks, which took me to the beginning of February 2018,” he says.

"I tried to live as normal a life as possible – I'm a very keen follower of horse racing, attending about 70 meetings a year [pre-pandemic] so I maintained this 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, also my son came from London and my wife came at Christmas.

“It turned out that the chemo had gone well and there was the possibility that I could keep the bladder but would require radiotherapy and maybe more chemo. But it was explained that, in order to reach the bladder, the radiotherapy would need to be fairly aggressive, might not work, and could damage the bladder resulting in leakage. I did not fancy this option which would have necessitated frequent [three monthly] check-ups after the heavy treatment.

"So I opted for bladder removal which happened on April 16th, 2018. It apparently took six hours since they needed to remove part of the colon to create the conduit for the urine which exits my body 7-8cm to the right of the belly button. A urostomy bag is then attached and emptied via a tap at the bottom of the bag. In effect I have a 'bladder', but it is outside my body. The operation was fairly heavy-duty, but I was out of hospital within two weeks, at the Stones concert in Croke Park on May 17th and back on my bike by end of June."

Although he made a remarkable recovery, Crispin is still being monitored and has been left with some lasting side effects. “I had been having six monthly CT scans and now the time interval has been extended to a year,” he says. “I still have the urostomy bag, but it has become second nature – changing it [every other day] takes a couple of 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 surrounding area, I am no longer sexually active. I was warned about this and I guess at 65 it’s less of a concern than, say, at 45. But one upside is that I can clip a larger night bag on to the normal urostomy bag, so I no longer have to get up at 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 fairly advanced. So, looking back, I was getting up frequently at night to pee and sometimes there was a burning sensation when peeing. So I think men, particularly when they get to a certain age, just think this is a natural part of growing old, but clearly in my case, it wasn’t.

Red flag

“So the advice I would give would be to consult your doctor when your pee patterns change to greater frequency and/or soreness. It may just be something like an enlarged prostate but follow it through and eliminate the sinister possibilities and obviously, any blood is an immediate red flag. I am grateful for the treatment and care I received, and I can say that life without a bladder can be lived to the full – but try not to get that far.”

Prof Ray McDermott, consultant medical oncologist, Tallaght Hospital and St Vincent’s Hospital, 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.

“That is why knowing the signs and risk factors are so important – and anyone with concerns should speak to their doctor immediately,” says Prof McDermott.

"Over the past year, we have seen cancer services, screening and diagnosis disrupted across the board due to the pandemic," says Liz Yeats, CEO, Marie Keating Foundation, which runs 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 get help if needed.

“Bladder cancer rates have steadily increased year on year and we want anyone with a family history of bladder cancer or who might be experiencing symptoms to be more aware of these changes in their bodies and to seek help. Taking action is key as bladder cancer can be treatable when caught early.”

Bladder cancer: the facts 

• 490 people are diagnosed with bladder cancer in Ireland each year.
• Three times more men than woman are diagnosed with bladder cancer.
• Over three-quarters (78 per cent) of those diagnosed are over the age of 65.
• Five counties in Ireland (Donegal, Sligo, Leitrim, Meath, and Louth) had 15 per cent higher average number of bladder cancer cases than national figure.
• Smoking increases the risk of bladder cancer.
• The most common warning sign is blood in urine, so the Marie Keating Foundation recommends a colour code for bladder health; if you see red (blood), in yellow (urine), go (green) to your doctor immediately.

Warning signs include:

• Blood in urine
• Recurrent urinary tract infections
• Needing to urinate suddenly and more frequently
• Pain when passing urine
• Pain in the lower back or abdomen