7 Essential Facts to Know About Bladder Cancer

Bladder cancer is the fifth most frequent, behind those of the colon and rectum, breast, lung and prostate. This year, in Spain some 21,700 new cases, with an overwhelming majority of men (17,731). However, in the coming years a decrease in the number of people affected is expected among men and an increase among women, a Change of trend relevant due to the fact that men smoke less and less, while smoking is increasing among women, points out the report Cancer figures in Spain 2023of the Spanish Society of Medical Oncology (SEOM).

More than 3,500 men and 905 women will die in 2023 as a result of bladder cancer

The survival long term of this sickness it is long, and even so, more than 3,500 men and 905 women will die in 2023 as a result of it.

Despite being one of the most frequent tumors, it is not so well known among the population such as colon, lung or breast. For this reason, El Confidencial has asked one of the specialists who knows the most, Dr. Enrique Grande, chief of the Medical Oncology Service at the MD Anderson Cancer Center Hospitalfrom Madrid, and member of the multidisciplinary research consortium GUARD (GenitoUrinary Research And Development), which involves different specialists involved in the management of gastrointestinal tumors, such as oncologists, radiotherapists, urologists, nuclear medicine doctors and researchers.

Is there more and more bladder cancer?

Every time I diagnose more casesbut this data is a good thing and reflects, on the one hand, that “it is increasingly easier to access specialized care that is capable of performing that initial diagnosis as quickly and efficiently as possible”. On the other hand, the fact that there are many people with this disease shows that survival is increasing in our country. Fortunately, most of the cases –70%, approximately – are diagnosed when the tumor is still confined in the bladder and, therefore, the chances of us being able to cure it are very high.

What factors favor its appearance?

tobacco is the main risk factor associated with the development of this tumor, which is why it is more common in men over 50 years of age, although in recent years there has been a trend towards higher incidence in women.

However, other factors that also contribute are exposure to certain chemical agents, such as old Lacasse which were used in the hairdressers.

In some cases, the cause is inheritance of certain genes that predispose to developing bladder cancer.

As usual, a habit of sedentary life and obesity It is associated with the development of different tumors, although a direct relationship with bladder cancer is not clear, since several of these factors often come together, along with smoking and alcohol intake.

What are the warning signs?

To address a tumor as soon as possible, it is essential to know how to recognize the symptoms. It is true that there are cancers that show up when they are already advanced (pancreas), but bladder cancer is one of the tumors that is most often diagnosed, even in very early stages, because a single drop of blood he is able to dye urine and “the patient gets scared and goes to his doctor, health center or emergency room”.

The diagnosis is made in a relatively simple way, by means of a cistoscopiaa technique that consists of introducing a camera through the urethra and seeing the contents inside the bladder.

It can also be set via a urine cytologywhich consists of observing tumor cells desquamated in it.

What prognosis do you have?

He degree in which the tumor is located at the time of diagnosis informs the prognosis. If the disease is diagnosed when the tumor only occupies and penetrates the most superficial layer of the bladderit is possible to resect (excise) locally and reach heals in the range of 80%. If, on the other hand, the tumor has already infiltrated the muscle layer that makes up the inner wall of the bladder, the cure rate drops to 50%. When the tumor has spread at a distance and has metastasized to other organs – liver, lungs or bones – “unfortunately cures are very rare.”

What are the treatment options?

Local treatments available are transurethral resection, surgery and radiotherapy, and the general treatments are, fundamentally, chemotherapy and immunotherapy. The choice of one or the other depends on the advanced that the disease is.

when the tumor is superficial and does not infiltrate the muscle layer, it is usually controlled by resections through the urethra followed, depending on the risk of local relapse, by instillations into the bladder with BCG, which is nothing other than the tuberculosis bacillus attenuated which produces an inflammation inside the bladder that prevents, in most cases, the re-development of the tumor.

When the bladder is removed, a new one can be created with the intestinal loops. If not, a hole is made in the abdomen and a bag is placed

If the tumor has infiltrated the muscle, intravenous chemotherapy should first be given to reduce the size of the tumor and then the bladder is removed and a new bladder is created with the patient’s bowel loops. If this solution is not feasible, a hole must be opened in the patient’s abdomen in which a bag is attached to collect the urine.

Is the treatment forever?

Some tumors require a therapy of maintenance for avoid relapse, this is the case with some breast tumors. In those of the bladder, it is also necessary to maintain the treatment continuously in cases in which the tumor has disseminated at a distance.

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Doctor Grande stresses that there are increasingly “more and better therapeutic weapons that have joined classical chemotherapy.” Among them, the immunotherapy, which “has changed the natural history and the perspective of patients with advanced bladder cancer. What used to be synonymous with death in a few months now translates into the fact that there is a percentage of those affected, ranging between 20 and 30%, who will become long survivorswho can be alive for years despite the terrible initial diagnosis ”.

Precisely, know in advance who are the patients who will respond to immunotherapy “It is one of the main challenges we face in the daily clinic”.

The oncologist also highlights a new treatment alternative, the new drug-conjugated antibodieswhich are antibodies that bind to the tumor cell and are directly introduced into the chemotherapy: “They would act in a similar way to that of a Trojan horse but with the tumor cells.”

Are short treatments effective?

The head of medical oncology at MD Anderson in Madrid combines healthcare work with research, which is why he is currently coordinating the DISCUS studya joint study between the United Kingdom, Spain and France, which will recruit 210 patients with metastatic bladder tumors: “The objective is to see if reducing the number of chemotherapy cycles that are administered before immunotherapy, the patient arrives less exhausted to immunotherapy, thus Improves quality of life and we think that it will improve the efficacy of immunotherapy without deterioration in survival.”

“The international DISCUS study may change the way we treat patients around the world today”

Grande advances that “we are very excited about how the study is going today” and is confident that soon they will be able to offer results. “The DISCUS study may change the way we treat patients around the world today,” she says.

Relationship with other tumors

Bladder tumors can in turn give rise to other bladder tumors that can appear at the same time –synchronous tumors– or sequentially in time –tumors metachronous–. Because they often appear in men over the age of 55, it is not uncommon to see how Bladder tumors are associated with prostate cancer.

In the case of families with inheritance or family aggregation, it is possible to find that the women from the same family, in addition to being able to have a higher incidence of bladder cancer, they also have it from breast, pancreatic, colon, or endometrial cancer.