Bladder Cancer & The Elderly
Cancer is a disease that occurs more frequently in later life, and the proportion of cancers that occur in the elderly is increasing relative to younger age groups. By 2030, over 70% of all cancers are expected to occur in people aged over 65 years. Proposed mechanisms for the increased incidence of cancer in the aging population include an accumulation of genetic and cellular damage, prolonged exposure to carcinogens, and fundamental changes in the host environment. The presence of age-related physiological changes in elderly patients, presents clinicians with challenges that require specific knowledge of geriatric oncology.
Bladder cancer illustrates the association between cancer and aging, and occurs most commonly in the elderly: the median age at diagnosis is 69 years for men and 71 years for women. Bladder cancer is also the fourth and eighth most common malignancy in men and women, respectively, and the number of diagnosed cases is increasing annually in the US. In 2008, a Californian tumor registry study showed that the incidence of bladder cancer peaks at the age of 85 years, with a rate of increase roughly 10-fold higher than that seen in younger age groups. Advanced age may be associated with worse outcome, but stage and grade at diagnosis remain key determinants of prognosis.
Bladder cancer is a type of cancer that begins in your bladder — a balloon-shaped organ in your pelvic area that stores urine. Bladder cancer begins most often in the cells that line the inside of the bladder. Bladder cancer typically affects older adults, though it can occur at any age. The great majority of bladder cancers are diagnosed at an early stage — when bladder cancer is highly treatable. However, even early-stage bladder cancer is likely to recur. For this reason, bladder cancer survivors often undergo follow-up tests to look for bladder cancer recurrence for years after treatment.
Most cases of bladder cancer appear to be caused by exposure of the bladder to harmful substances which, over the course of many years, lead to abnormal changes in the bladder’s cells. Tobacco smoke is a common cause, it is estimated that half of all cases of bladder cancer are caused by smoking. Contact with certain chemicals previously used in manufacturing is also known to cause bladder cancer. However, these substances have since been banned. In cases of non-muscle invasive bladder cancer, it is usually possible to remove the cancerous cells while leaving the rest of the bladder intact. This is done using a surgical technique called transurethral resection of a bladder tumour (TURBT). This may be followed by a dose of chemotherapy medication directly in the bladder to reduce the risk of the cancer returning.
The association between aging and cancer is well exemplified by bladder cancer:with advancing age, the risk of developing bladder cancer increases, and patients’ clinical presentation and outcomes worsen. Care for elderly patients with bladder cancer requires specific knowledge of many key geriatric clinical issues in order to determine optimal treatment plans. While numerous studies have tried to address the role of urologic intervention for elderly patients with bladder cancer, many studies fail to incorporate a component of true functional assessment. Additionally, further research is necessary to better understand the basic mechanisms that predispose elderly patients to develop this costly and life-threatening disease.