Margo Wickersham, 57, was diagnosed with stage 1 bladder cancer. The real estate professional had no known risk factors for the disease and remembers 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 in fact had a second primary cancer, separate from bladder cancer, a rare type of cancer called plasmacytoid cancer. Consequently, she had to have her bladder completely removed, an experience she documented in a book,Gratitude in the storm: when not dying is enough to keep fighting [Gratitud en la tormenta: Cuando no morir es suficiente para seguir peleando].
Plasmacytoid cancer is rare, not only do bladder cancer survivors need to be alert for any recurrence, but they too often face the risk of having additional cancers.
Bladder cancer is 10th most common type of cancer worldwide, effects shared by people over 55 years of age. Although it occurs three to four times more frequently in men, American Cancer Society It is estimated that more than 20,000 American women will be diagnosed with the disease in 2024.
In addition, bladder cancer survivors have the highest chance of having a second primary cancer. “I’ve seen patients who had various urologic malignancies or feel better soon after we treat them and then get lymphoma,” he said. Armine Smith, MDdirector of the department of urologic oncology at Johns Hopkins Sibley Memorial Hospital.
is A study which looked at more than 2 million patients, approximately 8% of all cancer survivors had a second primary cancer, but 34% of those with bladder cancer were diagnosed with a second primary cancer within the next 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 that start in one organ and spread to others. “Even though the cancer has spread 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, the liver, the lungs, etc., it will retain its urothelial characteristics.”
Second primary cancers, in contrast, are unrelated to the primary cancer, so there is no relationship when it comes to relapses or recurrences of the primary cancer.
In addition to lung cancer, some of the second most common primary cancers Bladder cancer survivors are most at risk for developing include a second (unrelated) primary bladder cancer, as Wickersham did, or renal, kidney, vaginal, rectal, pancreatic, uterine, or pelvic cancer. the larynx and esophagus.
“What we don’t know is whether it is bladder cancer that increases people’s risk of getting a second primary cancer or whether it is some exposure that caused the bladder cancer that is also responsible for the second primary cancer, or whether it is because “We urologists follow patients for a very long period of time and we detect these types of diagnoses over time,” Smith said.
Risk factors for a second primary cancer
Although scientists don’t know all the reasons why bladder cancer survivors have more second primary cancers, the cause of the primary cancer could put people at higher risk of additional cancers.
“Since bladder cancer is considered an exposure-associated cancer, there are a few things that can affect a person’s risk of developing other cancers that may be related to exposure,” Smith explained.
Smoking is the most important risk factor. Exposure to other carcinogens, including dyes such as those used in the textile, paint, and beauty salon industries (e.g., hair dyes) and chemicals used in the automotive industry, also put people at risk. people. But some people, like Wickersham, can still get bladder cancer and second primary cancers despite having no known exposure to tobacco or other chemicals.
Additionally, Smith says that genetic mutations such as those in people with Lynch syndrome could expose a small number of patients to a risk of developing various cancers.
“Although bladder cancer is not a genetic type, there are some genes that expose people to a risk of developing cancer.” urothelial or bladder,” Smith said. “And his genes may also be associated with some uterine, colorectal and GI malignancies.”
When it comes to race, white people are twice as likely as other groups to have bladder cancer, but A study organisms that Pacific Islander bladder cancer survivors of Asian ancestry have an increased risk of having a second primary cancer.
How to reduce the risk of a second primary cancer
Although it is impossible to eliminate the risk, Smith advises following screening guidelines for the American Cancer Society implemented for lung, GI and gynecological cancers.
“There are preventive measures that people can take just to improve their overall health and have less risk of developing various malignancies,” he said. “This includes physical activity, eating whole foods, avoiding eating too much red meat, especially charred red meat, limiting alcohol consumption, and avoiding tobacco.”
It is important to visit healthcare providers regularly after having bladder cancer treatments and tell them if there are any new symptoms that may be evidence of a second primary cancer.
This educational resource was prepared with the support of Astellas and Pfizer.
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