Bladder cancer

What is it?

Bladder cancer is a neoplasm of the cells of the urothelium lining the bladder. It is the ninth most common cancer in the world, with more than 100,000 cases in Europe alone. It is three times more common in men than in women. In more than 80% of cases, it appears as a superficial disease, and in the remaining cases it begins as an infiltrative tumor. The risk of recurrence is about 70%. The main risk factor is cigarette smoking, which causes 50% of tumor cases. Other risk factors are occupational exposure to substances in paints and dyes (aromatic amines, aniline, etc.), local irritants (recurrent bacterial or fungal infections), systemic chemotherapy and pelvic radiation exposure.

Which are the symptoms?

Symptoms are often nonspecific, overlapping with other diseases of the urinary system. The most common initial symptom is hematuria, which is bright red blood in the urine, sometimes accompanied by clot formation. Other possible symptoms are rapid urination, urgency, dysuria (burning when urinating) and pelvic pain.

  • Red urine (hematuria)
  • Increased frequency of urination
  • Urge urination
  • Burning or pain during urination
  • Pelvic pain

How is it diagnosed?

In the presence of these symptoms, it is recommended to contact an urologist, who will prescribe the following tests: urinary test and urine culture to detect signs of bladder inflammation or bacterial infection; cytology to look for cancer cells in 3 different urine samples; bladder ultrasonography which allows an accurate assessment of the entire urinary tract, can detect a neoplasm in the bladder even as small as a few millimeters, assess its location and size; urethrocystoscopy with a flexible instrument which allows direct visualization of the bladder lumen and precise location and size of the neoplasm; it is also possible to take biopsy samples; abdominal CT with contrast agent and urographic poses which is a basic study for planning the right therapeutic approach.

Intravenous administration of an iodinated contrast agent allows complete visualization of the excretory system from the kidneys to the bladder, providing information on the presence of renal and ureteral dilatation in cases of bladder neoplasia, urinary tract obstruction. The degree of infiltration of the neoplasm into the bladder wall is also assessed, and possible involvement of the pelvic lymph nodes is evaluated. Magnetic resonance imaging of the abdomen allows a more precise assessment of the local aggressiveness of the disease.

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How is it treated?

In the case of bladder neoplasia, the first step is to determine whether the disease is superficial or infiltrating. The first step is to determine whether the disease is superficial or infiltrative. Next, endocopic transurethral resection of the bladder lesion (TURB) is performed in the operating room under spinal anesthesia. Subsequently: if the disease is superficial, multiple intravesical instillations of immunotherapy (BCG) or chemotherapy (Mitomycin) at regular intervals. If the disease is infiltrating, radical cystectomy is indicated, which in most cases is preceded by neoadjuvant therapy with chemotherapy or immunotherapy drugs. Very small and superficial lesions can be treated with laser photocoagulation. Several innovative new clinical trials for the treatment of both superficial and infiltrative bladder diseases are currently underway at San Raffaele.

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