Bladder Cancer
Bladder Cancer
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A common malignancy growing across regions
Bladder cancer is the 9th most common cancer type globally, with the global number of incidents projected to climb to more than 760.000 by 2030.
The world’s 9th most common cancer type
Bladder cancer is the most common malignancy involving the urinary system and the world’s 9th most common cancer type. In 2022, more than 600.000 people were diagnosed with bladder cancer worldwide and more than 220.000 people died from the disease.
These numbers mark a 7.1% increase from data reported in 2020. Two of the most important factors contributing to the increasing incidence is the aging population and the advancement in diagnositc teqhniques.
Men are diagnosed at roughly four times the rate of women, making bladder cancer the 6th most common cancer type among males. Bladder cancer primarily affects older adults, with the average age of diagnosis around 73 years.
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What causes bladder cancer?
As with many types of cancer, one of the leading risk factors of the disease is smoking. Those who smoke may be up to four times more likely to get bladder cancer.
People who work with certain chemicals may also be at risk – leather workers, hairdressers, mechanics and painters, among other occupations.
Caucasian men may also be at greater risk.
But the simple truth is that many will develop bladder cancer for no known reason.
How is bladder cancer diagnosed?
The earlier bladder cancer is diagnosed, the better the outcome of treatment. Since there is no “screening” test for bladder cancer at this time, most people are diagnosed after they show some symptoms, such as blood in the urine. Because symptoms such as blood in the urine can be a sign of other conditions, such as a urinary tract infection (UTI), there can be a delay in diagnosing bladder cancer.
Disease progression
Most bladder cancers originate in the transitional epithelial cells lining the bladder (Non-Muscle Invasive Bladder Cancer or NMIBC). If untreated or inadequately treated, these tumors can progress to invade the surrounding connective tissue and muscle (Muscle-Invasive Bladder Cancer or MIBC).
Approximately 70% to 80% of patients with newly diagnosed bladder cancer will present with NMIBC. Of the patients diagnosed with NMIBC, 50-70% will recur despite adequate and timely treatment. , Without treatment, 10–20% will progress to muscle invasive disease.
Early detection, proper diagnosis, treatment regimen and close monitoring are crucial to prevent progression from NMIBC to MIBC.
Current guidelines from both AUA, and EAU recommend transurethral resection of bladder tumor (TURBT) and intravesical BCG as first-line for intermediate- and high-risk NMIBC. TURBT alone is considered insufficient.
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Bacillus Calmette-Guérin (BCG) – a go-to therapy
BCG immunotherapy plays a crucial role in reducing recurrence and progression of NMIBC. BCG strains, including those used for tuberculosis prevention and NMIBC treatment, have been proven to be safe and effective.
According to European Association of Urology (EAU) 2024 guidelines, intravesical immunotherapy with BCG is superior to intravesical chemotherapy in reducing recurrences and in preventing or delaying progression to MIBC.
The American Urology Association (AUA) guidelines, recommend BCG-based therapies as the first-line treatment for Intermediate and High-risk NMIBC.Both EAU and AUA provide guidelines for optimal use.
BCG therapy procedure
Recommended BCG therapy begins with an induction phase and is followed by a maintenance phase.
Induction Therapy
After Transurethral Resection of Bladder Tumor (TURBT), BCG is typically administered once a week for 6 weeks. The goal is to eliminate remaining cancer cells and enhance the immune response against bladder cancer.
Maintenance Therapy
If patients respond well without serious adverse events, BCG can be continued in a maintenance phase, typically lasting 1–3 years. This involves fewer treatments (usually 3 weekly instillations every 3-6 months) to help prevent recurrence.
Recommended BCG therapy procedure
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Always ask a healthcare professional for advice about medicines, or visit one of the references for more information.
References
International Agency for Research on Cancer on Bladder Cancer
https://gco.iarc.who.int/media/globocan/factsheets/cancers/30-bladder-fact-sheet.pdf
National Library of Medicine
https://pmc.ncbi.nlm.nih.gov/articles/PMC7151633/