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Currently, with more than 21,000 cases diagnosed in 2015, bladder cancer ranks fifth in terms of incidence in our country

  • Patients who smoke have a different tumor gene profile than non-smoking patients, which means that the treatment of both patients varies within the same type of tumor.

  • Giving up smoking is key even when the tumor has been diagnosed, since a clear relationship has been observed between the improvement in terms of survival and response to treatment and stopping smoking


In 2015, more than 21,000 cases of bladder cancer were diagnosed in our country (17,439 in men and 3,564 in women), which places this tumor in fifth place in terms of incidence in Spain, according to data published by the Spanish Society of Medical Oncology (SEOM). A position that is fundamentally due to smoking because, explains Dr. Pilar Lopez Criado, a medical oncologist at MD Anderson Cancer Center Madrid, "more than 90% of cases of bladder cancer have a direct relationship with tobacco”.

Such is the relationship between this tumor and tobacco that Dr. Lopez Criado says that "bladder cancer would be a rare disease if people did not smoke"; a statement that the doctor extends to other types of tumor such as esophagus or head and neck, which would decrease exponentially. And, although there is always talk about the relationship between lung cancer and smoking, the reality is that it is the cause of up to 14 types of cancers in active smokers, ten fewer than in passive smokers, a group the doctor warns that we should not forget either.

The expert recalls the importance of stopping smoking, even though the cancer has already been diagnosed. As the doctor points out, "today we know that giving up smoking is a good prognostic factor that implies a better evolution of cancer in terms of response and survival”.

Tobacco conditions the oncological treatment of patients

Currently, the discovery of the genome has revealed that smoking cancer patients have a completely different genetic profile than non-smoking cancer patients, since "tobacco generates mutations that do not exist in people whose cancers do not depend on tobacco", points out Dr. Lopez Criado, who further says that "smoking changes the molecular profile, which has a direct impact on treatments; for example, while immunotherapy is more effective in smokers because they are people with a much higher mutation load, treatments aimed at a specific genetic alteration are more common in non-smoking patients". In addition, concludes the doctor, "in general, non-smoking cancer patients have an overall higher survival rate."

In addition, there are tumors such as small cell lung cancer, urothelial carcinomas or squamous tumors of the lung and head and neck that appear almost exclusively in active smokers and even in passive patients. These tumors are usually associated, and it is not uncommon for a patient who develops multiple tumors, that is, who develops lung cancer and, over the years, a cancer of the throat or bladder - and not only sequentially, but sometimes, simultaneously. "Having lung cancer does not exempt you from having another type of tumor," emphasizes the doctor.

Comorbidities in smoking oncological patients

Although practically 90% of cancer patients stop smoking, the treatment of a patient qualified as a heavy smoker (more than 2 packs / day) implies more difficulties than the treatment of a non-smoker patient, since he/she usually has more vascular problems (arterial and venous) and associated respiratory (COPD, respiratory failure of any kind, respiratory infections ...).

 In cases where the patient does not stop smoking, the treatment is even harder, since the tolerance to drugs is worse and they are patients with reduced pulmonary reserve, which is why they do not tolerate radiotherapy well and have a higher incidence of respiratory problems and infections. Likewise, respiratory complications increase, the incidence of problems in the mouth increases (gingivitis, infections  and so on) and, normally, the nutritional status of the patient also worsens.

 For these cases, MD Anderson Madrid has a pulmonology service made up of professionals specialized in helping patients to stop smoking and in advising them on the best way to cope with their illness on a physical level.

 For the psychological part, very important in these patients who usually carry an important sense of guilt, the center also has a Psycho-oncology Service. "Usually these feelings of guilt are not affected, but these professionals do help the patient feel protected and not feel alone in the face of the illness," says Dr. Lopez Criado.