At 57 years outdated, Margo Wickersham was identified with stage 1 bladder most cancers. The true property skilled had no identified danger components for the illness and recalled being utterly wholesome till she noticed a bit of little bit of blood in her urine. After receiving the analysis and whereas searching for remedy, Wickersham realized she really had a second, completely different bladder most cancers — a uncommon kind known as plasmacytoid most cancers. In consequence, she needed to have her bladder eliminated completely, an expertise she documented in her guide, Gratitude in the Storm: When Not Dying Is Enough to Keep Fighting.
Whereas plasmacytoid most cancers is rare, bladder most cancers survivors not solely must be careful for recurrence, however all of them too typically face the chance of getting extra cancers.
Bladder most cancers is the 10th most common kind of most cancers worldwide, usually affecting folks over 55 years outdated. Whereas it happens three to 4 occasions extra typically in males, the American Cancer Society estimates that greater than 20,000 American ladies can be identified with the illness in 2024.
What’s extra, bladder most cancers survivors have the best charge of getting a second primary cancer. “I’ve seen sufferers who’ve had a number of urological malignancies, or quickly after we deal with them they usually get higher, they get lymphoma,” mentioned Armine Smith, M.D., director of Johns Hopkins Urologic Oncology at Sibley Memorial Hospital.
In one study greater than 2 million sufferers, about 8% of all most cancers survivors ended up with a second main most cancers, however 34% of these with bladder most cancers had been identified with a second main most cancers inside 20 years. Of these, 25% had been identified with lung cancer, the most typical second main most cancers affecting bladder most cancers survivors.
What are second main cancers?
Second main cancers are utterly new cancers that may have an effect on survivors months or years after main cancers. They’re completely different from metastatic cancers, which begin in a single organ and unfold to different organs. “Despite the fact that the most cancers has moved on to a unique organ, it retains the traits of the unique most cancers cells,” Smith mentioned. “The bladder is lined with urothelial most cancers cells, and most bladder cancers are urothelial. If this urothelial most cancers leaves the bladder and goes to lymph nodes, liver, lungs, and so on., it can retain its urothelial traits.”
Second cancers, in distinction, are unrelated to the first most cancers, so they’re additionally unrelated to relapses or recurrence of the first most cancers.
Along with lung most cancers, among the most common second cancers bladder most cancers survivors are at elevated danger for embrace a second (unrelated) bladder most cancers, as in Wickersham’s expertise, or most cancers of the renal pelvis/ureter, kidney, vagina, rectum, pancreas, larynx and esophagus.
“What we don’t know is whether or not it’s actually the bladder most cancers placing folks at increased danger of second most cancers, or if it’s the publicity that led to the bladder most cancers that’s additionally liable for the second most cancers, or if it’s as a result of we as urologists comply with these sufferers for a really very long time and choose up these sorts of recent diagnoses over time,” Smith mentioned.
Threat components for growing second main most cancers
Whereas scientists don’t know all the explanations bladder most cancers survivors get extra secondary cancers, the reason for the first most cancers might put folks at increased danger for extra cancers.
“As a result of bladder most cancers is taken into account to be an exposure-related most cancers, there are some issues that may have an effect on the person’s danger for growing different cancers that could be associated to that publicity,” Smith defined.
Smoking is the largest danger issue. Publicity to different carcinogens, together with dyes corresponding to these used within the textile, paint, and salon industries (assume: hair dye), and chemical substances used within the auto trade, additionally places folks in danger. However some, like Wickersham, can nonetheless get bladder most cancers and second cancers regardless of having no identified exposures to tobacco or different chemical substances.
Moreover, Smith says, genetic mutations corresponding to these in folks with Lynch syndrome might put a small variety of sufferers prone to growing a number of cancers.
“Despite the fact that bladder most cancers just isn’t a genetic one, there are some genes that put folks in danger for growing bladder or urothelial most cancers,” Smith mentioned. “And people genes can be related to uterine, colorectal and a few GI malignancies.”
With regards to race, white individuals are about twice as probably as different teams to get bladder most cancers, however one study discovered that Asian Pacific Islander bladder most cancers survivors have an elevated danger of getting a second most cancers.
The way to scale back danger of a second most cancers
Whereas it’s not possible to eradicate danger, Smith advises following the American Cancer Society screening guidelines in place for lung most cancers, GI cancers and gynecological cancers.
“There are preventive measures folks can take simply to make themselves wholesome total and put them at much less danger of growing a wide range of malignancies,” she mentioned. “This contains bodily exercise, consuming entire meals, not consuming an excessive amount of purple meat — particularly charred purple meat — limiting alcohol and avoiding tobacco.”
It’s additionally essential to go to healthcare suppliers recurrently after present process remedy for bladder most cancers and talk with them about any new signs that could possibly be proof of a second most cancers.
This instructional useful resource was created with help from Astellas and Pfizer.
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