The part of the excretory system in the body, the bladder, primarily stores urine. Urothelial cancer has varied prevalence depending on the gender, with males at three to four times higher risk of development and 25% faster progression. However, practical cases indicate women presenting later stages of bladder cancer which hinders the bladder cancer treatment progression.
The Role of Gender and Age in the Development of Bladder Cancer –
The different rates of cancer due to gender may be due to the following reasons-
● Enzymatic behaviour on sex-steroids
● Anatomy of bladder and pelvis
● Cellular and physiological response to environmental substances such as tobacco and other carcinogenic chemicals
● Diagnostic methods
● Carcinogenic exposure and its route of entry
● The disparity in the treatment and management
The effects are seen as aggressive tumour progression among females with diagnosis at later stages. Multiple tumours of varying lengths often accompany the condition. Based on the treatment methods, like chemotherapy and immunotherapy, reoccurrence and increased progression are witnessed among females. The high mortality rate in females compared to men owes to a better prognosis in the latter.
The studies indicate the prevalence of non-muscle-invasive bladder cancer among males more than among females. However, findings are most likely relevant in early pathology and progressed with no such difference at the later metastatic stage. Women were also found to be more likely to receive intravesical therapies than males.
The overall gender bias is significant through menopause and receptors of sex steroids, which vary among males and females. Oestrogen receptor beta expression can contribute to carcinogenesis in female reproductive parts near the bladder. However, only one study has considered the mentioned receptor.
Studies also focus on the differences in the healthcare system between the two genders, which directly links with the lack of training and knowledge along with more care required for females. The bias was even seen towards females in referral to a urologist in the case of hematuria complications which delays the proper diagnosis and treatment, yielding recognition at more advanced levels.
The analyses indicate diagnoses other than bladder cancer on presentation of symptoms like change in micturition pattern and recurrent haematuria among women, with usual treatment offered through antibiotics. Lack of proper testing adds to poor outcomes.
The comparative risk analysis study witnessed worse outcomes after cystectomy, which involves the removal of the bladder. Multiple conflict findings indicate no such difference; hence, the factor requires more thorough knowledge before being counted as the risk factor.
Role of age in bladder cancer
The UCB prevalence is seen more among the middle-aged and older population, and cancer may safely be related to old age (around 70). However, age is a strong independent risk factor associated with bladder cancer. Studies indicate eleven times more cancer risk and fifteen times more mortality risk in a population above 65.
Multiple reasons have been hypothesised:
● Carcinogen exposure increase with age
● Accumulation of particulate due to pollution
● Cellular changes contributing to cancer
● Delayed symptoms during uncontrolled growth and symptoms appearance
● Changes in micturition patterns with age provide more time for interaction between urine carcinogens and tissues.
● Less water intake due to frequent urination increases the urine concentration possessing carcinogens.
● Organ malfunctioning or deterioration due to age
Age advancement may accompany the genetic expression pattern that naturally leads to cancer development with the decreased capability of DNA repair in case of spontaneous or induced mutations. Though the aggressiveness of tumours is not yet specified by available research, the mortality rate is increasingly associated with age.
The recurrence possibilities also increase with age in comparison to the young group. Another factor adding to poor results in the elderly can be associated with meek dosage and therapies given to them, which may not work with advanced disease stages. The non-muscle-invasive UCB treatment is associated with better outcomes, irrespective of age. But the comorbid conditions are associated with risks.
The recurrence and multiple resection procedures are seen to perform well among the former group. Though the muscle-invasive UCB treatment is associated with complications for different organs that hinder the treatment and recovery, further leading to morbidity and mortality. RC and Urinary diversion are bladder cancer treatment methods that also pose challenges at an older age due to the lack of properly functioning organ systems, which is a prerequisite in these treatment methods.
Additionally, the methods are associated with the onset of morbidities (development of other related diseases) and recovery challenges in the long term. In otherwise healthy individuals, reports suggest alleviating morbidity and mortality rates depending on perioperative care. Similarly, chemotherapy is also associated with morbidity, which may result in mortality through either cancer or other organ failure in the elderly.
Irrespective of the treatment method, the expert advice is customised based on the patient’s needs. The specialists at BLK Max Hospital known as Best Cancer Hospital in Delhi offer their dedication and experience to find the best possible strategy to combat cancer and increase longevity.
Conclusion
UCB prevalence and treatment methods differ on a large scale among populations based on gender and age. Gender-associated bladder cancer is more crucial and requires attention among females. The differences can be reduced with an expert opinion on the development of associated symptoms. Healthy older adults respond well to non-muscle-invasive treatment options. But, the muscle-invasive and comorbid conditions due to different therapies may not be a beneficial treatment method.
