How bladder cancer is different in women and young people

bLadder cancer is one of the most commonly diagnosed forms of cancer in the United States. About 1 in 40 Americans born today will develop this cancer at some point in their lives, and most people This will be male over 60 years old. bladder cancer It is the fourth most common cancer in American men, accounting for more than 6% of all cancers in men.

But while men are three to four times more likely to develop bladder cancer than women, the disease tends to be more deadly in women. Women are also more likely to be diagnosed with larger bladder tumors. Why? These are questions that medical researchers have puzzled over for years, but the answers remain elusive. “We know that women are more likely to be diagnosed with advanced disease than men, but whether their cancer is more biologically active or not,” said Dr. Whether it was missed for a longer period of time, we don’t know.” professor and bladder cancer specialist at the University of Colorado Cancer Center. These sex differences are particularly striking because, for many other cancers — such as those of the head, neck, esophagus, stomach, liver, and pancreas — women tend to do better. male.

Unanswered questions also haunt research on bladder cancer in young adults. Again, bladder cancer tends to appear more in men than in women. And again, women tend to experience malignancies and growths more than men. However, some of the most common risk factors for bladder cancer in older adults—a history of smoking, as well as previous exposure to dyes or pesticides—do not appear to be contributing factors to these problems. young people with bladder cancer. “Young patients with no history of smoking or other obvious illnesses are more common. [risk] exposure,” said Kukreja. “We often don’t know why they get it.”

Finding the cause of these age and sex disparities is an important area of ​​bladder cancer research. Finding answers can lead to improved treatments and outcomes.

Why do women with bladder cancer get worse?

Some cancers—such as pancreatic cancer—can be difficult to detect because they cause little if any health effects. That’s rare for bladder cancer, which often causes symptoms that are hard to ignore. “Usually, patients see blood in their urine and that prompts them to see a doctor,” says Dr. Yair Lotan, a urologist at the University of Texas Southwestern Medical Center in Dallas.

According to a 2014 study in the journal Evilhematuria (blood in the urine) is the most common initial symptom bladder cancer symptoms. That study found that up to 35% of people had blood in their urine—enough to make their urine pink, red, or cola-colored—cancer turned out to be the cause. Although there is a strong link between bloody urine and bladder cancer, women with blood in their urine may be less likely to be referred to the appropriate specialist than men. “If a man reports blood in his urine, he is almost always referred to a urologist,” says Lotan. “Women are more likely to be treated with antibiotics for urinary tract infections.” Some analyzes have found that women with bladder cancer who report blood in their urine are more than twice as likely to be initially misdiagnosed with a urinary tract infection as men. This happens in part because UTIs are more common in women than men, and bloody urine is the main symptom of a UTI. But it can be a costly mistake. “Balve cancer is a deadly disease, so any delay makes all the difference,” says Kukreja. Even a one-month delay can have a significant impact on treatment and survival, she adds.

Misdiagnosing a UTI may partly explain why women with bladder cancer tend to have worse outcomes than men. But they are not the whole story. Research has found that after first noticing blood in the urine, women with bladder cancer go on average 85 days before being properly diagnosed. For men, the average waiting time was 74 days. Statistically speaking, that difference is significant. But it is not large enough to fully explain the sex disparity in disease outcomes. Biology also seems to play a part. “There have been some studies on hormonal factors,” says Lotan. Specifically, some studies have found that estrogen receptors in the lining of the bladder may play a role in the formation of cancer cells. The researchers also found that male sex hormones (androgens) also seem to affect the growth of bladder cancer cells. It is possible that these sex-dependent biological features alter bladder cancer behavior in ways that help account for different incidences and outcomes.

There may also be some gender-related differences in the cancer itself. “When we talk about cancer, we often describe it by its primary location,” says Dr. Nicholas Cost, urologist and co-director of the surgical oncology program at Children’s Hospital Colorado. “Although that’s one way to describe it, it’s common to have several different types of cancer even within one organ.” In other words, bladder cancer is not a disease. Like other forms of cancer, it can have many different subtypes—subtypes that can respond differently to treatment and may be associated with better or worse outcomes. It is possible that the types of bladder cancer that develop in women are different from those that develop in men, and this may explain why women with the disease tend to get worse. However, research to date has not been able to identify consistent sex-based differences in cancer mutations or other underlying characteristics that explain differences in outcomes.

One last notable difference between men and women concerns bladder cancer risk factors. Even when the researchers controlled for environmental exposures, such as tobacco use, they found that sex-based differences in incidence persisted. “Even women who smoked for 30 years still have a quarter of the risk than men and we can’t narrow down the reasons why,” Lotan said.

It is clear that men and women get bladder cancer differently. Experts are still figuring out why this happens.

Read more: Latest breakthroughs could help bladder cancer patients

Bladder cancer in young people

Bladder cancer is very rare in people 20 years of age and younger. Less than 1% of bladder cancer patients fall into this age group, and the prognosis for these patients tends to be better than that of adults.

“What we found was that the majority of tumors were low-grade non-cancerous tumors,” said Dr. Jonathan Epstein, professor of pathology, oncology and urology at Johns Hopkins University School of Medicine. This is the lowest-risk type of bladder cancer, he explains, and young people with these tumors rarely die from the disease. In many cases, the tumor is surgically removed and no other treatment (such as chemotherapy) is needed.

Epstein says it’s not clear why children develop these cancers. He and his colleagues looked for links with parental smoking history or occupational exposure, as well as genetic factors, but they didn’t find any. “It’s basically just bad luck,” he said.

To a lesser extent, some of these similar patterns appear in younger people — those under 50 — with bladder cancer. For example, some studies show that these cancers are milder, meaning they spread more slowly, than bladder cancer in older adults. There is also some evidence that survival rates are better in this age group than in older patients. However, numerous studies in this area have produced conflicting results. “The tumors in younger patients may be less aggressive, but it is difficult to know because the incidence in this age group is so low,” says Lotan. He says there are other non-cancerous factors that might better explain any apparent differences between younger and older bladder cancer patients.

For starters, it’s possible that younger, healthier adults are diagnosed at an earlier stage than older adults, which could lead to better outcomes. Younger patients may also receive different treatments than older adults who are dealing with other health problems, and this can lead to improved survival numbers. “If a patient is 85 years old and their life expectancy is between 1 and 5 years, we can treat them less positively than patients in their 40s or 50s,” says Lotan. , at this point, it’s hard to say whether bladder cancer in young adults is actually milder.

Researchers also have difficulty establishing a strong link between bladder cancer and smoking or other environmental risk factors in adults younger than 50 years of age. “With an older patient who has smoked for 30 years, it’s a lot easier to find these associations,” says Lotan. “With young patients, we often wonder why they have this disease.”

Read more: How does it feel to be part of a clinical trial for bladder cancer?

Detecting bladder cancer earlier

cancer screening rarely simple. The benefits of finding cancer early must be carefully evaluated and weighed against the cost—in dollars, time, resources—of performing thousands of potentially unnecessary screenings. Although there is some evidence that screening people with known risk factors for bladder cancer may be helpful, it is not current standard practice. That means it’s important that people don’t ignore the symptoms of bladder cancer—symptoms that can be missed or misunderstood in women, young people, and those less likely to get it. statistical disease.

“Early detection is really important,” says Kukreja. The job of identifying bladder cancer is largely left to a person’s doctor or care team, she said, but there are things people can do to make sure their cancer is caught as early as possible.

For starters, don’t ignore signs of blood in your urine. “Blood in the urine is never normal, so you need to see a doctor,” she said. While a number of things – urinary tract infections, kidney stones, even intense exercise – can lead to bloody urine, no one should skip seeing a doctor if they develop this symptom. She added: “It always warrants attention. Other bladder cancer warning signs include pain or burning when urinating, urinating more than usual, or difficulty urinating. Again, all of these symptoms are more likely to be caused by a UTI or some noncancerous problem, but that doesn’t mean you should ignore them. “Until you see a provider, you can’t understand what’s going on,” she said.

While these are useful safeguards, it is important to reiterate that bladder cancer is less common in women than in men and rarer in young people and adults under age 50.
are working to learn more about how this cancer behaves in these atypical groups. But there are still many unanswered questions.

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