Bladder Cancer Can be Diagnosed Early – According to the American Cancer Society, 82,290 Americans will be diagnosed with bladder cancer in 2023. Approximately 90% of people diagnosed with bladder cancer are older than age 55, and 73 is the average age of diagnosis. “The vast majority of bladder cancer patients are diagnosed with cancer that’s not imminently life-threatening, but they tend to be aggressive,” says urologist Mark Tyson, M.D., M.P.H. “So bladder cancers, even if they’re not life-threatening when they’re first diagnosed, tend to recur, and sometimes cause the patient to have to undergo numerous procedures and treatments and those kinds of things. There is a subset, probably about 20% of patients, who do have an aggressive and 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 overall health and risk factors—such as smoking—make a significant impact on outcomes.
“The type of bladder cancer that most patients are diagnosed with is urothelial carcinoma,” says Dr. Tyson. “There are other types of cancers of the bladder, like adenocarcinomas and small cell carcinomas, but urothelial carcinoma is the most common. Some urothelial carcinomas have what’s called variant histology, and these can be plasmacytoid, micropapillary, microcystic. These are tumors that generally increase the aggressiveness of the urothelial carcinoma. But in addition to the cell type, you’d also need to know the grade and the stage of your tumor. These tumors are generally graded as low grade and high grade, with high-grade cancers being more aggressive. The grade, the stage, and the type of cancer are all used to determine the type of treatment that 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’s bleeding,” Dr. Tyson says. “So, patients will usually either be told that they have blood in the urine on a test done by a primary care physician or otherwise, or they’ll see blood in their urine. And those types of situations require immediate urologic evaluation. This is one of the big problems with delays in diagnosis. We think that there’s something else that’s causing the bleeding and we delay urologic evaluation which can lead to delays in care. So, if bleeding occurs, it does require 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 they’re first diagnosed, and that might be a change in their urinary symptoms. This isn’t a common presentation, but frequency and urgency and nocturia, particularly those irritative voiding symptoms, are a little more common with pretty aggressive disease. We’ll see this more commonly with some of the variants, not necessarily the routine urothelial carcinomas, but some of the more esoteric types of the disease. Those can sometimes present with dramatic changes in voiding function. But generally, it’s bleeding.”
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 the validation of a non-invasive early detection tool,” says Florence Le Calvez-Kelm, IARC scientist and principal investigator of the study published in The Lancet. “This test could significantly improve and simplify the way in which 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 non-invasive biomarkers for the early detection of bladder cancer,” study’s co-first author Ismail Hosen says. “If the findings are validated, large trials conducted in individuals at high risk of developing bladder cancer should be designed to address the health and cost benefits of screening for TERT promoter mutations for the global bladder cancer burden,” says Mahdi Sheikh, a postdoctoral scientist at IARC and the co-first author of the study.
“We think that about 50% of all bladder cancers are caused by smoking, it comes to most patients as a surprise to learn that because they usually think of smoking as a disease
that affects the lungs,” says Dr. Tyson. “But indeed, the chemicals that are inhaled are excreted into the bladder and held into the bladder and before they’re voided, and that causes changes to the urothelium, which really occurs anywhere along the urinary tract from the kidneys all the way down 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, urothelium is the inner lining of the bladder. But urothelium, like I said, is anywhere along that tract, and so you can develop a urothelial carcinoma, much like a bladder cancer in the kidneys or the ureters, which is the tube that drains the kidneys, or the urethra. So, the smoking is the most important risk factor, but there are others too. We think that particularly patients that were raised in rural communities where there are pesticides in the groundwater, arsenic based pesticides, lots of folks live on wells, they tap those wells, like my parents live on a well in a farming community.”
There are several different methods for treating bladder cancer, depending on the stage of detection. Surgery to remove tumor cells, chemotherapy to destroy cancer cells, immunotherapy to help bolster the immune system, and radiation therapy using high-energy waves to kill cancer cells are all typical methods of treatment. Promising new research shows treatment using antibody-drug conjugates and checkpoint inhibitors could be a highly effective alternative for people who cannot have chemotherapy.
“Although bladder cancer cases are going down, the death rates haven’t changed significantly,” says Memorial Sloan Kettering Cancer Center (MSK) genitourinary oncologist Jonathan Rosenberg. “Having these new treatment options available brightens the outlook considerably for many bladder cancer patients. While immunotherapy has gotten more attention in recent years, antibody-drug conjugates might end up making the bigger positive impact, at least in the near future.
“The emergence of checkpoint inhibitors has been a revolution for some people who have highly aggressive, life-threatening bladder cancer. But immunotherapy still doesn’t work in enough patients. We have to find better ways to improve response rates and survival. Even if checkpoint inhibitors and antibody-drug conjugates don’t represent a cure for bladder cancer, anything that could help people live longer or delay progression of the disease — 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. “Elderly age is a significant risk factor for cancer in general. Repeated exposures to risk factors, including smoking, may result in an accumulation of genetic changes that can contribute to bladder cancer development,” says oncologist Petros Grivas, MD, PhD. “A man has about a 1 in 26 chance of developing bladder cancer during his lifetime, while a woman’s risk is about 1 in 90,” says Dr. Grivas, adding that the risk is higher for men as they are more likely to smoke tobacco or be exposed to dangerous chemicals.
“Certain professions, such as firefighting, machining and truck driving may increase risk because people in these professions have more exposure to toxins and chemicals; smoking can further increase this risk. A higher level of awareness and community involvement may contribute to more effective research with new meaningful treatments and life-saving drugs.” Dr. Grivas recommends not smoking, staying adequately hydrated, eating a healthy diet, and protecting against chemical exposure to help prevent bladder cancer.