An NCI-designated Comprehensive Cancer Center
By Veronique de Turenne | March 31, 2017
Mary Soto Bladder cancer patient Mary Soto
Mary Soto was looking forward to her trip to Maui, where she would celebrate her 60th birthday with her daughter. But suddenly the problem that she had been dealing with on and off for the past few months – a bit of blood in her urine – returned full force. This time, though, instead of just a tinge of color, the water in the toilet was bright red.
“This problem had started back in June of 2013 when every now and again my urine had a pinkish color,” Soto said. “But there was no pain and so, when it went away on its own, I ignored it.”
A slight recurrence a few months later led to a diagnosis of a urinary tract infection. After treatment for the UTI, everything went back to normal. But with this latest incident, which occurred just before Thanksgiving, Soto knew something was very wrong.
A visit with a urologist revealed that Soto had a sizable tumor in her bladder. A biopsy performed a few weeks later confirmed her fears – she had bladder cancer.
“I had been a smoker for many years and smoking is one of the risk factors for bladder cancer,” Soto said. “I quit that night.”
Soto’s bladder cancer was Stage 2, which means the tumor had invaded the muscle layer of the bladder wall. Treatment would include chemotherapy and cystectomy, which is the surgical removal of the bladder. After a visit with a surgeon who was so cold and brusque that Soto left his office in tears, she and her husband, Lou, turned to City of Hope.
“It was like night and day,” Soto said. “At City of Hope, everyone we met with and spoke with, from the clerks to the nurses to my doctors, was welcoming and reassuring, and we knew we had made the right decision.”
About 70,000 new cases of bladder cancer are diagnosed each year, 90 percent of them in patients who are over 55 years old. The majority of bladder cancer patients – close to 80 percent – are men. But women account for one-third of all bladder cancer deaths. 
“Bladder cancer – depending on its stage – can require removal of the bladder,” said Kevin Chan, M.D., a urologic surgeon at City of Hope, and associate clinical professor in the Division of Urology and Urologic Oncology.
Kevin Chan Kevin Chan, M.D.
Once the bladder is removed, surgeons must create a new way for urine to exit the body, known as urinary diversion.
“The majority of people with bladder cancer are offered a urinary diversion that requires an external appliance bag. Ninety-five percent of these patients in the United States are given this option.” Chan said. “But at City of Hope, we can offer our patients more options.”
Soto was a candidate for a diversion known as an Indiana pouch, which is an internal reservoir that collects urine. It is created using portions of both the large and the small intestines. The surgeon uses a piece of the small intestine to create a tube with a one-way valve mechanism, to prevent urine leakage. This tube exits the body via a small opening on the skin, known as a stoma.
The patient empties the pouch by inserting a small catheter into the stoma several times each day. The stoma itself is easily hidden with a Band-Aid.
“A high-volume center may perform seven cystectomies a year," said Chan." At City of Hope, we perform over 60 per year, so our patients benefit from a higher level of experience and expertise. Most centers only offer the ileal conduit (external bag) option. Rare centers offer continent urinary diversion such as Indiana pouches or the orthotopic neobladder. The majority of patients at City of Hope receive these continent urinary diversions."
Although the Indiana pouch is a more complex surgery, it offers bladder cancer patients a more normal life. Recovery takes about two months as the kidneys adjust to the internal changes, Chan said.
Chan was careful to explain everything, Soto said. He went over the details of the surgery, outlined the specifics of the recovery process and offered information about possible complications. It was a radically different experience from the first surgeon she saw.
“Dr. Chan was so kind and so patient, I feel like he is my son,” Soto said with a laugh.
She is back to leading a vibrant and active life that she and her husband refer to as “the new normal.”
“It has been three years now and although the surgery and recovery were hard, we got through it,” Soto said. “Now I work out, I go to gym and I can go swimming – I just put a different kind of bandage on my stoma. “
Chan is pleased with Soto’s progress, and says she is now cancer-free.
“Mary Soto is a lovely person and a great success story,” Chan said. “I am very happy to have had the chance to help her.”


Learn more about our bladder cancer program. If you are looking for a second opinion about your diagnosis or consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.




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