At age 57, Margo Wickersham was diagnosed with stage 1 bladder cancer. The real estate professional had no known risk factors for the disease and remembered being completely healthy until she detected a little blood in her urine. After receiving the diagnosis and while seeking treatment, Ella Wickersham learned that she actually had a second, different bladder cancer, a rare type called plasmacytoid cancer. As a result, she had to have her entire bladder removed, an experience she documented in her book. Gratitude in the storm: when not dying is enough to keep fighting.
Although plasmacytoid cancer is rare, bladder cancer survivors not only have to watch for recurrence, but all too often face the risk of contracting additional cancers.
Bladder cancer is tenth most common type of cancer worldwide, which usually affects people over 55 years of age. Although it occurs three to four times more often in men, American Cancer Society estimates that more than 20,000 American women will be diagnosed with the disease in 2024.
What’s more, bladder cancer survivors have the highest rate of receiving a second primary cancer. “I’ve seen patients who have had multiple urologic malignancies, or shortly after we treat them and they get better, they get lymphoma,” he said. Armine Smith, MDdirector of Johns Hopkins Urologic Oncology at Sibley Memorial Hospital.
In A study Looking at more than 2 million patients, about 8% of all cancer survivors ended up with a second primary cancer, but 34% of those with bladder cancer were diagnosed with a second primary cancer within 20 years. Of those, 25% were diagnosed with lung cancer, the second most common primary cancer affecting bladder cancer survivors.
What are second primary cancers?
Second primary cancers are completely new cancers that can affect survivors months or years after the primary cancers. They are different from metastatic cancers, which start in one organ and spread to other organs. “Although the cancer has moved to a different organ, it retains the characteristics of the original cancer cells,” Smith said. “The bladder is lined with urothelial cancer cells and most bladder cancers are urothelial. If this urothelial cancer leaves the bladder and reaches the lymph nodes, liver, lungs, etc., it will retain its urothelial characteristics.”
Second cancers, on the other hand, are not related to the primary cancer, so they are also not related to relapses or recurrence of the primary cancer.
In addition to lung cancer, some of the most second common cancers Bladder cancer survivors have an increased risk of including a second (unrelated) bladder cancer, as in Wickersham’s experience, or cancer of the renal pelvis/ureter, kidney, vagina, rectum, pancreas, larynx, and esophagus.
“What we don’t know is whether it is actually bladder cancer that puts people at higher risk for a second cancer, or whether it is the exposure that led to bladder cancer that is also responsible for the second cancer, or whether It’s because we, as urologists, follow these patients for a long time and detect these types of new diagnoses over time, Smith said.
Risk factors for developing a second primary cancer
While scientists don’t know all the reasons why bladder cancer survivors get more secondary cancers, the cause of the primary cancer may put people at higher risk for additional cancers.
“Because bladder cancer is considered an exposure-related cancer, there are a few things that can affect an individual’s risk of developing other cancers that may be related to that exposure,” Smith explained.
Smoking is the biggest risk factor. Exposure to other carcinogens, including dyes such as those used in the textile, paint, and hairdressing industries (think hair dye) and chemicals used in the automotive industry, also puts people at risk. But some, like Wickersham, can still suffer from bladder cancer and second cancers despite having no known exposure to tobacco or other chemicals.
Additionally, Smith says, genetic mutations like those in people with Lynch syndrome can put a small number of patients at risk of developing multiple cancers.
“Although bladder cancer is not genetic, there are some genes that put people at risk of developing bladder cancer or urothelial cancer,” Smith said. “And those genes may also be associated with uterine, colorectal, and some gastrointestinal malignancies.”
In terms of race, whites are about twice as likely as other groups to get bladder cancer, but A study found that bladder cancer survivors from Asian Pacific Islanders have an increased risk of developing a second cancer.
How to reduce the risk of a second cancer
While it is impossible to eliminate risk, Smith advises following the American Cancer Society Screening Guidelines current for lung cancer, gastrointestinal cancer and gynecological cancer.
“There are preventive measures that people can take just to be healthy in general and reduce the risk of developing a variety of malignancies,” he said. “This includes physical activity, eating whole foods, not eating too much red meat (especially charred red meat), limiting alcohol, and avoiding tobacco.”
It is also important to visit healthcare providers regularly after undergoing treatment for bladder cancer and report any new symptoms that may be evidence of a second cancer.
This educational resource was created with the support of Astellas and Pfizer.
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