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According to American Cancer Society, 82,290 Americans will be diagnosed with bladder cancer in 2023. About 90% of people diagnosed with bladder cancer are over the age of 55, and 73 is the average age of diagnosis. “The vast majority of bladder cancer patients are diagnosed with cancer that is not imminently life threatening, but tends to be aggressive,” says urologist Mark Tyson, MD, MPH. “So bladder cancers, even though they’re not life-threatening when first diagnosed, tend to recur and sometimes require the patient to go through a lot of procedures and treatments and that sort of thing. There is a subset, probably around 20% of patients, who have an aggressive, invasive form of the disease that requires more aggressive treatments, and in those cases it can be life-threatening.
The 5-year survival rate for people with bladder cancer is 77%, the 10-year survival rate is 70%, and the 15-year survival rate is 65%. Individual factors such as general health and risk factors, such as smoking, have a significant impact on the results.
“The type of bladder cancer most patients are diagnosed with is urothelial carcinoma,” said Dr. Tyson. “There are other types of bladder cancers, such as adenocarcinomas and small cell carcinomas, but urothelial carcinoma is the most common. Some urothelial carcinomas have what is called variant histology, and these can be plasmacytoid, micropapillary, microcystic. These are tumors that generally increase the aggressiveness of urothelial carcinoma. But in addition to the cell type, you also need to know the grade and stage of your tumor. These tumors are usually classified as low grade and high grade, with high grade cancers being more aggressive The grade, stage and type of cancer are all used to determine the type of treatment you will receive.
Here are the most common symptoms of bladder cancer, according to experts.
The most common sign of bladder cancer is blood in the urine (hematuria). “Usually it bleeds,” says Dr. Tyson. “So patients will usually be told they have blood in their urine on a test done by a primary care physician or otherwise, or they will see blood in their urine. And those types of situations require urological evaluation That’s one of the big problems with delays in diagnosis. We think there’s something else causing the bleeding and we’re delaying urologic evaluation, which can lead to delays in care. So, if bleeding occurs, it requires immediate attention.
Other common symptoms are painful urination and constant urination (especially at night). “There are other sorts of things that patients will sometimes notice when first diagnosed, and that could be a change in their urinary symptoms. It’s not a common presentation, but the frequency and the urgency and the nocturia, especially those irritative urination symptoms, are a bit more common with fairly aggressive disease.We’ll see this more frequently with some of the variants, not necessarily the routine urothelial carcinomas, but some of the more esoteric types of the disease. These can sometimes show dramatic changes in voiding function, but usually it bleeds.
A simple urine DNA test could detect mutations up to ten years before clinical diagnosis, according to the World Health Organization’s International Agency for Research on Cancer. “A simple urine test has recently been developed, and these new results are another exciting step towards validating a non-invasive early detection tool,” said Florence Le Calvez-KelmIARC scientist and principal investigator of the study published in The Lancet. “This test could significantly improve and simplify the way bladder cancer is detected.”
“Our results provide the first evidence from a prospective, population-based cohort study of the potential of urinary TERT promoter mutations as promising noninvasive biomarkers for the early detection of bladder cancer,” said co-lead study author, Ismail Hosen. “If the results are validated, large trials in people at high risk of developing bladder cancer should be designed to examine the health benefits and costs of screening for TERT promoter mutations for the global burden of cancer. of the bladder,” says Mahdi Sheikh, postdoctoral researcher. at IARC and co-first author of the study.
“We believe that around 50% of all bladder cancers are caused by smoking, this is most patients as a surprise to learn this because they generally think that smoking is a disease
that affects the lungs, ” said Dr. Tyson. “But indeed the chemicals that are inhaled are excreted into the bladder and retained in the bladder and before they are emptied, and this causes changes in the urothelium, which really occur anywhere along from the urinary tract, from the kidneys to the tip of the urethra.
“And so bladder cancer itself tends to be the most common site of urothelial carcinoma, which is, you know, the urothelium is the inner lining of the bladder. But the urothelium, as I said, is anywhere along that tract, and so you can develop urothelial carcinoma, much like bladder cancer in the kidneys or ureters, which is the tube that drains the kidneys, or the urethra. So smoking is the biggest risk factor, but there are others as well. We think that especially patients who were raised in rural communities where there are pesticides in the groundwater, arsenic pesticides, a lot of people live on wells, they tap those wells, like my parents live on a well in a farming community.”
There are several different methods to treat bladder cancer, depending on the stage of detection. Surgery to remove tumor cells, chemotherapy to destroy cancer cells, immunotherapy to help boost the immune system, and radiation therapy using high-energy waves to kill cancer cells are all typical treatment methods. Promising new research shows that treatment using antibody-drug conjugates and checkpoint inhibitors could be a very effective alternative for people who cannot receive chemotherapy.
“Although bladder cancer cases are decreasing, death rates haven’t changed much,” says Memorial Sloan Kettering Cancer Center (MSK) genitourinary oncologist Jonathan Rosenberg. “The availability of these new treatment options dramatically improves the outlook for many bladder cancer patients. While immunotherapy has garnered more attention in recent years, antibody-drug conjugates may end up having a greater positive impact, at least in the near future.
“The emergence of checkpoint inhibitors has been game-changing for some people with very aggressive and life-threatening bladder cancer. But immunotherapy still doesn’t work in enough patients. We need to find better ways improve response rates and survival Although checkpoint inhibitors and antibody-drug conjugates are not a cure for bladder cancer, anything that might help people live longer or delaying disease progression – in some cases, allowing them to avoid bladder removal or chemotherapy after surgery – will improve their quality of life.”
Certain lifestyle factors can increase the risk of bladder cancer. “Old age is an important risk factor for cancer in general. Repeated exposures to risk factors, including smoking, can lead to an accumulation of genetic changes that can contribute to the development of bladder cancer,” says oncologist Petros Grivas, MD, PhD. “A man has about a 1 in 26 chance of developing bladder cancer in his lifetime, while a woman’s risk is about 1 in 90,” says Dr Grivas, adding that the risk is higher. high for men because they are more likely to smoke tobacco. or be exposed to hazardous chemicals.
“Certain occupations, such as firefighting, machining, and truck driving may increase risk because people in these occupations are more exposed to toxins and chemicals; smoking may further increase this risk. higher level of community awareness and involvement can contribute to more effective research with meaningful new treatments and life-saving medicines.” Dr. Grivas recommends not smoking, staying well hydrated, eating a healthy diet, and protecting yourself from chemical exposure to help prevent bladder cancer.
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