By Jocelyn Selim
Ewing's Last Diagnosis
By Jocelyn Selim
In the spring of 1943, pathologist James Ewing was 76, and although retired as the director of Memorial Hospital in New York City, he was still a frequent presence there. It was at Memorial that a microscopic analysis of his own cells caused him to make what would be his final diagnosis: his own bladder cancer.
“It sounds like it was most likely transitional or squamous cell carcinoma,” says Dean Bajorin, a medical oncologist who specializes in genitourinary oncology at the hospital, now Memorial Sloan-Kettering Cancer Center. Transitional cell carcinoma, caused by the irritation of cells on the inside surface of the bladder, accounts for more than 90 percent of bladder cancers. It usually results from exposure to carcinogenic dyes in the workplace or smoking. “Most people don’t make the connection, but most bladder cancers are caused by smoking,” says Bajorin. “After carcinogens are filtered from the blood, they sit in the bladder for a while, so there’s prolonged exposure.”
It’s unlikely that Ewing, who recognized the link between smoking and lung cancer by the early 1930s, smoked. However, it’s possible that painful bladder stones, which he suffered from for years, played a role. “Squamous cell carcinoma is much more rare than transitional cell carcinoma, but it has been linked to persistent irritations like bladder stones,” Bajorin says.
Ewing likely realized his chances of recovery weren’t good. After he became ill, he suffered a cardiac arrest. Hospital legend has it that, when doctors resuscitated him, his response was, “What the hell did you do that for? Now I’ll have to go through all of this again in a few days! And when I do, just leave me alone.” In those days, Bajorin says, nearly all patients diagnosed with bladder cancer would have died within 12 to 18 months.
These days, thanks to advances in bladder cancer diagnosis and treatment, patient survival is much better. Even though there’s no routine screening tool, almost 75 percent of the 67,000 new cases in the U.S. each year are found before the cancer has spread beyond the inner layers of the bladder—mostly through the detection of small amounts of blood or abnormal cells in urine. And nearly 95 percent of patients whose cancers are detected at this early stage are still alive five years later. “The statistics are good,” says Bajorin. “But I can’t emphasize this enough: Smoking is the single largest contributing factor to bladder cancer. It’s a huge problem.”