Smoking and Bladder Cancer

Saturday morning trivia time. What do Mrs. Peacock from Clue, Jerry/Daphne from Some Like it Hot, and Kojak all have in common? Eileen Brennan, Jack Lemmon, and Telly Savalas, the iconic actors that portrayed these roles, all battled bladder cancer. Seeing as May is Bladder Cancer awareness month, I thought we should take a look at the disease that strikes an estimated 430,000 people globally each year, with three quarters of those cases developing in men.

Risk Factors

I was pretty shocked to discover that smoking is the number one risk factor in the development of bladder cancer, providing at least a 3 times risk for development of the disease. Having this information, I set out to find out why. We know that the knee bone is connected to the leg bone – but how is cigarette smoking, and thus the lungs, connected to the bladder? A study by Freedman, et al in 2011 sought to understand if the connection between smoking and bladder cancer was stable over the years, despite falling smoking rates. They explained that although tar and nicotine levels in cigarettes have fallen in recent years, the levels of β-napthylamine have increased. Why is that important? Well, β-napthylamine is known to be carcinogenic to the bladder, thereby providing that connection.

Standard Treatments

Typical treatments for bladder cancers involve surgery, radiation, chemotherapy, intravesical therapy, and immunotherapy, or a combination of the above, depending upon staging and other factors. It is interesting to note that some of the first commonly used immunotherapies in modern times were used for recurrent bladder cancers. Surgery for these cancers can involve removal of a single tumor if caught early, or can go so far as a radical cystectomy – or the removal of the entire bladder, among other structures – which obviously brings with it a whole host of side effects and lifestyle impacts. Take a look at Rethinking Radical Cystectomy for more information on how thoughts about this procedure may be changing.

Managing Quality of Life

Although the five-year survival rate of bladder cancer is relatively high at 77%, the effects of the treatments needed to achieve these survival rates take a definite toll on the quality of life of patients and their loved ones. In Heroes in Scrubs, my friend Jenniffer talked with me about how cancer care takes on a holistic view – making sure that patients are healthy in all aspects of their lives, from finances to fitness to social support, to name only a few. In agreement with her view, this graphic from Mossanen, Brown, and Schrag (2018) gives an excellent representation of what goes into managing quality of life for bladder cancer patients.

We saw above that smoking is the #1 risk factor for the development of bladder cancer; as such, lifestyle modifications are necessary in those individuals to aide in their healing and prevention of recurrences. The readiness of a patient to make these changes is described in The Transtheoretical Model of Change, with frequently heard terms as “contemplating change”, “ready to change”, etc.

Innovations

Some great things are happening in bladder cancer research. Tests are being perfected that can detect bladder cancer in the urine, as well as the development of vaccines to target these cancers. From newly approved drugs to heating chemo drugs to experimental bladder cancer treatments the possibilities are myriad.

If you or a loved one are suffering from bladder cancer, we encourage you to look at our page listing bladder cancer advocacy groups, as we know how life changing this diagnosis can be. Sometimes only someone that has been there can truly understand your feelings and needs. Also check out our listing of clinical trials that you can discuss with your physician.

Sources:
https://www.europeanurology.com/article/S0302-2838(16)30280-9/fulltext
https://onlinelibrary.wiley.com/doi/full/10.1111/bju.14158
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3441175/
https://www.cancer.net/cancer-types/bladder-cancer/statistics
https://www.cancer.org/cancer/bladder-cancer/about/new-research.html