Every year 9,000 Canadians are diagnosed with bladder cancer – making it the fourth most common cancer among men and 12th most common among women, Bladder Cancer Canada reports.
Despite five-year survival rates ranging anywhere from 16 per cent to 95 per cent (depending on the stage), consistent incidence rates and a high rate of recurrence, not many are aware of the cancer that claims the lives of about 2,300 Canadians every year.
As Monday marked the beginning of Bladder Cancer Awareness Month in Canada, Global News sat down with Dr. Wassim Kassouf of the McGill Urology Health Centre and Bladder Cancer Canada, who offered up five things he believes people should be aware of when it comes to bladder cancer.
1. There are two types of bladder cancers
Patients can be diagnosed with one of two types of bladder cancers: nonmuscle-invasive and muscle-invasive. According to Bladder Cancer Canada, the majority of patients are diagnosed with the former.
The nonmuscle-invasive form of bladder cancer means the cancer hasn’t grown into the surrounding muscles of the bladder. To treat it, patients often undergo surgery to remove the tumours from the inside of the bladder and receive an insertion of drugs into their bladder.
“Approximately three-quarters of the bladder cancers are this type,” Kassouf explains. “With that patient population, the cancer tends to reoccur, and uncommonly progresses and spreads.”
The second type, muscle-invasive bladder cancer, is a more aggressive form and is considered life threatening. About 25 per cent of people with bladder cancer are diagnosed with this type, and the mortality rate in the first five years is 40 per cent.
Treatment often includes removing the bladder, as well as nearby organs – the prostate for men and the uterus and ovaries for women.
2. The patient profile
There are about 80,000 Canadians living with some form of bladder cancer, Bladder Cancer Canada states.
According to Kassouf, men are more likely than women to get this cancer.
As well, people who smoke are highly likely to get bladder cancer.
“The smoke gets excreted into the urine and urine stays in the bladder, so over many years, it predisposes that lining of the bladder to become cancerous – the carcinogens [in cigarettes] induce cancerous development of those cells,” Kassouf said. “The reason for a higher incidence in men is partly because there’s more men that smoke. Otherwise, we’re not exactly sure [why this cancer impacts more men than women].”
This type of cancer also tends to affect patients in their 60s and 70s, Kassouf points out.
“Although patients can be affected by bladder cancer, it’s most commonly seen in the older population,” he says.
3. Be aware of bloody urine
“It’s a cancer that’s often unrecognized,” Kassouf says. “Awareness surrounding bladder cancer has been – up until a few years ago – quite limited.”
Finding blood in the urine is the most common symptom in bladder cancer patients and occurs in more than 80 per cent of cases.
“On occasion, some patients can have blood in their urine once and then it will never reoccur again until a year later. So if you see blood in the urine, you should seek medical attention to make sure there’s nothing serious going on.”
Other symptoms include bladder spasms, burning urination and increased urgency or frequency of urination.
“These symptoms overlap a lot with other types of benign conditions and are often not specific to bladder cancer,” Kassouf explained.
4. The survival rates
In Canada, the five-year net survival rate – the probability of surviving cancer in the absence of other causes of death – sits at around 73 per cent, according to the Canadian Cancer Society.
“If you look at the invasive-muscle type, 40 to 50 per cent will die within the first five years,” Kassouf said. “If you have the noninvasive-muscle type, about 10 to 15 per cent of cases may progress to the muscle-invasive type and becomes dangerous.”
However, if broken down further by each stage of cancer, the five-year survival rate varies widely.
- Stage 0: 95 per cent
- Stage 1: 85 per cent
- Stage 2: 55 per cent
- Stage 3: 38 per cent
- Stage 4: 16 per cent
It’s important to note that the prognosis for each patient depends quite a bit on several factors including their health history, the type of cancer, the stage, certain characteristics of the cancer, the treatments chosen and how the cancer responds to treatment.
5. An expensive cancer
Bladder cancer is the most expensive cancer to treat on a per-patient basis, Kassouf says.
In fact, treatment for bladder cancer costs Canada about $400 million, Dr. Alexandre Zlotta of Mount Sinai Hospital told Global News in 2013.
“Because many [bladder cancers] tend to be superficial, they reoccur – requiring invasive procedures such as a cystoscopy, it tends to be the most expensive cancer to treat,” Kassouf says.
Sitting at number 20 (out of 24 cancers), research funding for this disease is one of the most underfunded in Canada.
“Considering its commonality, there hasn’t been a lot of progress in bladder cancer and a big reason is because it’s heavily underfunded from a research perspective,” Kassouf says. “This is compared to other cancers with similar incidences and mortalities.”
In fact, the Canadian Cancer Society’s 2016 report says there are more new cases of women being diagnosed with bladder cancer than there are women being diagnosed with cervical cancer, oral cancer, stomach cancer or brain cancer.
For men, they’re less likely to be diagnosed with non-Hodgkin lymphoma, kidney and renal-pelvis cancers, melanoma or leukemia than they are with bladder cancer.
— With files from Carmen Chai and Beatrice Politi