Study Sees Trend Towards More Metastatic Bladder Cancer At Diagnosis

A new study has revealed a disturbing trend towards increased metastatic bladder cancer at the time of diagnosis.

The findings show an about a 1.7% yearly increase over the study period—1998 to 2006—in which metastatic disease appears at bladder cancer diagnosis, known as “stage migration,” explained Renal and Urology News. The study found that being female, one’s single/divorced/widowed status, and having a high tumor grade were the best predictors of metastatic disease at diagnosis, noted Renal and Urology News.

“We are not sure why there is a trend towards increased metastatic disease at the time of bladder cancer diagnosis, but we think it may be due to the availability of more sensitive diagnostic imaging methods for patients presenting with some sort of urological symptom,” said Daniel Liberman, MD, urology resident at the University of Montreal Health Center, at the 25th Anniversary European Association of Urology Congress, wrote Renal and Urology News.

“Diagnostic technology is improving and expanding exponentially,” he said. “We are catching smaller lesions and smaller advanced cancers than we did before. We used to have computed tomography (CT) scans that provided slices that were 4 mm in depth, but the resolution is better nowadays, so that we can see CT slices that are 1 mm in depth,” Dr. Liberman added. Dr. Liberman and his team analyzed data from 22,327 patients who were diagnosed—across all stages—with bladder cancer and who were also in the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) 17 registry, a database compiled between1988 and 2006 that includes about 25% of the population of the United States.

Deemed the fourth most common cancer in men and ninth most common in woman, said Dr. Liberman, bladder cancer is muscle-invasive at diagnoses in 20 – 40% of all cases, according to Renal and Urology News. Risk factors for bladder cancer are smoking; occupational exposure to carcinogens seen in the rubber, chemical, and leather industries; being a man; being older; being Caucasian; suffering from specific parasitic infections; coming from a family who has a history of bladder cancer; or having a personal history of the disease, said Midland Daily News.

About 71,000 cases of bladder cancer are diagnosed every year in the U.S. and these lead to about 14,000 deaths; most are known as “transitional cell carcinomas” and are typically detected when very superficial, said Midland Daily News. Bladder cancers are generally scraped off the bladder or removed via biopsy; 50 – 70% of these cases will recur and 10 – 20% will become invasive. About 25% have metastasized to the lymph nodes by diagnosis, said Midland Daily News. Tragically, once cancer metastasizes—becomes invasive—the prognosis for recovery is considered poor.

Typically, bright red or cola-colored blood in the urine signals bladder cancer, which occurs in about 80% of those diagnosed; however, sometimes the blood is only detectable by microscope (urinalysis), said Midland Daily News. Frequent urination, usually in small amounts—which is often confused with either a urinary tract infection or a large prostate (benign prostatic hypertrophy or BPH)—and frequent urinary tract infections can signal bladder cancer. When in more advanced stages, bladder cancer can cause abdominal or back pain, weight loss, and anemia.

In addition to urinalysis, screening tests can include cytology (checking for tumor cells in the urine) and analyzing urine for other chemical biomarkers, Midland Daily News explained. The United States Preventive Services Task Force (USPSTF) has said sufficient evidence exists to recommend routine screening for those in high-risk groups; however, noted Midland Daily News, early detection and treatment does not improve morbidity or mortality and may lead to false-positive results that can cause harm, such as bladder perforation; bleeding; infection; and excessive tests, especially testing that involves radiation exposure.

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