Watch the full interview with Dr. Vignesh Packiam:
You are listening to ABC Radio, WWTR, 1170 AM, Bridgewater. Your choice. Good afternoon, friends. You are listening to ABC Radio, 1170 AM, Apki Choice. And I’m your host, Alka. And you know, whenever Alka comes on the radio, she brings you a very, very special guest. And again, we have a very renowned person on the radio. We will be talking to him a little later. Thank you.
So today, this is a health education series, which is brought to you by Robert Wood Johnson Barnabas Health. And this is very, very close to my heart, this segment. I believe health is wealth. And if your health is good, you are wealthy.
To talk today, we have a topic: bladder cancer. And to talk on the topic, we have Dr. Vignesh Packiam. Dr. Vignesh Packiam is a urologic surgeon-oncologist at Rutgers Cancer Institute and Jack and Cheryl Morris Cancer Center, specializing in the treatment of urologic cancers with a specialization in bladder cancer.
He earned his medical degree at the University of Pittsburgh and completed a urology residency at the University of Chicago, followed by a fellowship in urological oncology at the Mayo Clinic. Prior to joining Rutgers Cancer Institute, he built a busy clinical practice and research program at the University of Iowa, performing more than 100 bladder removals each year and gaining extensive experience with advanced intravesical therapies for non-muscle invasive bladder cancer.
His research is centered on developing and implementing several new treatments for bladder cancer. He has received funding from the American Cancer Society to improve the safety and effectiveness of therapies for non-muscle invasive bladder cancer. His research also explores biomarkers and precision medicine, finding ways to match each patient with the treatment most likely to help them. In addition, he leads studies on quality of life and novel therapeutics with the goal of restoring patients’ bladder function and well-being after treatment. Dr. Packiam has co-authored more than 150 peer-reviewed articles and book chapters.
Wow, doctor, such a great bio you have and what an achievement you have achieved in your time here. So a very warm welcome, Dr. Vignesh Packiam, on ABC Radio. How are you doing?
Dr. Packiam: Thank you. I’m doing great and appreciate you having me on here. I’m really excited to be able to talk to you and your audience today about bladder cancer.
Alka: Yes. As we are talking about bladder cancer, the topic is bladder cancer. So can you discuss some of the symptoms of bladder cancer?
Dr. Packiam: Yes, absolutely. One of the troubles with bladder cancer is that a lot of the time it doesn’t show many symptoms. It can be subtle, especially in the beginning. The most common symptom, or way that bladder cancer presents, is painless blood in the urine. So anytime someone has blood in the urine, they should immediately go to the physician. It’s really important to make sure that there is nothing going on beyond just a urinary tract infection. Oftentimes, some men and women will have a delay in diagnosis of bladder cancer if the blood in the urine is thought to be from a urinary tract infection. So it’s always important to see a urologist in addition to the primary care doctor to take a closer look and make sure there’s nothing else going on.
The other symptoms that can sometimes happen, especially if bladder cancers get very large or fill up most of the bladder, are pain with urination, irritative peeing symptoms like feeling the urge to rush to the bathroom, leaking, or sometimes burning with urination. But really, the most common thing is visible blood in the urine.
Alka: So, doctor, as you said, leaking or going more often for urination. Many times people see that when they are diabetic. So they do feel those kinds of symptoms. How do they differentiate between that?
Dr. Packiam: I would say the vast majority of the time, if patients are just having voiding symptoms, it’s not from bladder cancer. It’s really when those symptoms are unexplained that we have to look a little further to see if it’s bladder cancer or not.
Another test that can sometimes be useful is to check for microscopic blood in the urine. We can check for that just by doing a urinalysis and looking for blood there. If there’s no blood inside the urine microscopically, there’s a very low chance of there being bladder cancer. And most of the time, that’s one of the tests that’s ordered when people have troubles with urination.
Alka: From my side, doctor, I would like to ask this question: is this test part of your physical checkup, or does it need to be ordered if there are any symptoms?
Dr. Packiam: That’s a good question. It’s not a standard part of the workup. It just depends on your primary care doctor’s philosophy and how aggressive they want to be with testing. Some primary care doctors order very few tests; others like to order a lot of tests. So this one isn’t mandatory, but it’s usually a good idea if there are any symptoms.
Alka: Okay, great. So how does bladder cancer get diagnosed?
Dr. Packiam: Once there’s a concern for the possibility of bladder cancer or if we want to work up a situation where there’s visible or microscopic blood in the urine, there are really two main steps for diagnosing bladder cancer.
The first step is a special type of CAT scan called a CT urogram that has three phases. One phase is without contrast, which looks for kidney stones. The second phase is the enhancing phase with contrast, which helps us look for masses in the kidney or tumors in the urinary tract. The third phase is a delayed phase, where the contrast goes into the urine, helping us see areas in the bladder that may be suspicious for cancer. This is a very useful test and is usually the first step in diagnosing bladder cancer.
The second step is a cystoscopy, where we take a small flexible camera and look inside the bladder. Most of the time, we do this in the office. It’s a little invasive because it’s about the width of a pencil, but usually not painful and very quick, taking about 30 seconds. We look around the bladder to make sure there’s nothing going on. Sometimes bladder tumors are too small to be detected on a CAT scan, but the camera allows us to see them easily. Early detection is very important so that we can treat bladder cancer more effectively and reduce the chance of recurrence.
Alka: All right. So, doctor, what are some treatment options for bladder cancer, and are there new approaches for managing it?
Dr. Packiam: It’s a very exciting time for bladder cancer treatment. Before 10 years ago, there weren’t many new advances, but in the last decade, we’ve seen a lot of progress, both in surgery and treatments.
Usually, the first step is to remove the tumor endoscopically. We use a special instrument to look inside the bladder while the patient is asleep and use a loop to remove all of the tumor from the inside. There are no skin incisions, and once removed, the pathologist examines the tissue under a microscope to confirm the diagnosis and determine the type of cancer. Endoscopic removal is therapeutic by itself.
At Rutgers, we use blue light cystoscopy, where a special chemical taken up by bladder cancer cells makes tumors glow bright pink under a certain wavelength of light. Studies show this finds 30–40% more tumors than standard white light, reducing recurrence.
After removal, medicines can be placed inside the bladder to prevent recurrence. For a long time, we only had one or two decent therapies. In the last five years, we’ve had FDA approval of four or five new treatments and new drug delivery devices, making treatments more effective.
Alka: That is fantastic, doctor. I hear that bladder cancer often comes back. With the new treatments, can you really target most of the cancer cells in the bladder?
Dr. Packiam: Yes. This cancer is prone to recurrence, but newer treatments are increasingly effective at both preventing recurrence and treating it if it comes back. Previously, if the first treatment failed, we often had to remove the entire bladder. Now, that’s less common, especially for non-invasive cancers.
Alka: Friends, if you have just tuned in, we are talking to Dr. Vignesh Packiam about bladder cancer. This segment is a health education series brought to you by Robert Wood Johnson Barnabas Health.
Alka: Doctor, how does bladder cancer impact the South Asian community?
Dr. Packiam: That’s a great question. We don’t fully understand how different populations are affected. Most U.S. research focuses on white patients, but bladder cancer does affect South Asians. The recommendations I mentioned earlier—monitoring closely for blood in the urine—are very applicable to South Asians.
Alka: Personally, I notice when you first see a doctor, forms usually don’t allow you to specify South Asian or Indian ethnicity.
Dr. Packiam: That’s true. Many forms just say “Asian” and don’t let us specify. If that data isn’t collected, South Asians aren’t fully counted in research studies.
Alka: Why should listeners seek cancer care at NCI-designated comprehensive cancer centers like Rutgers Cancer Institute and Robert Wood Johnson Barnabas Health?
Dr. Packiam: I’m proud to work at Rutgers. Our cutting-edge research informs our clinical program. Patients benefit from the best surgical and pharmaceutical treatments, research programs, and clinical trials. Specialists like us dedicate their time and energy to one problem, and our expertise helps patients get the best care.
The Jack and Cheryl Morris Cancer Center, next to Rutgers, is a beautiful, patient-centered hospital. It’s designed to be calming and peaceful, which helps patients recover.
Alka: Doctor, before we let you go, how can listeners prevent bladder cancer, or if they have it, how can they get timely diagnosis and treatment?
Dr. Packiam: By far, the number one preventable cause of bladder cancer is smoking. Stopping or never starting smoking is the best prevention. The longer someone has quit, the lower their risk.
Other exposures, like processed foods and microplastics, are being studied. Even though smoking rates have gone down, bladder cancer diagnoses remain stable, so research continues.
The most important step for early detection is to see a doctor immediately if there’s blood in the urine and advocate for more in-depth testing beyond ruling out a urinary tract infection.
Alka: So microscopic blood in the urine—how is that detected?
Dr. Packiam: There are two types of blood: visible (gross hematuria) and microscopic. Microscopic blood is found via urinalysis, where urine is examined under a microscope. If a certain threshold is met, further evaluation with a CAT scan and cystoscopy is recommended. Most peeing symptoms alone are not due to bladder cancer, but urinalysis is a cheap and non-invasive test to check for microscopic blood.
Alka: Thank you so much, doctor. I also want to thank Robert Wood Johnson Barnabas Health for sponsoring this health education series and bringing great doctors to ABC Radio to educate listeners. Life is busy, and this helps people know what to do and avoid. I look forward to speaking with you again, doctor, and happy Navratri to you. Stay well.
Dr. Packiam: Thank you so much. Great to chat with you, and we’ll be in touch.
