Bladder neoplasms

What is it?

Bladder cancer is a neoplasm of the urothelial epithelial cells lining the bladder. It is the ninth most common neoplasm in the world, with more than 100,000 cases registered in Europe alone. It is three times more frequent in men than in women. In more than 80% of cases it manifests itself as a superficial disease, while in the remaining cases it has onset as an infiltrating tumor. The risk of recurrence of this cancer is around 70%. The main risk factor is cigarette smoking, which is the cause of 50% of cancer cases. Additional risk factors include occupational exposure to substances contained in paints and dyes (aromatic amines, aniline, etc.), local irritants (recurrent bacterial or fungal infections), systemic chemotherapy, pelvic irradiation, etc. Bladder neoplasms are divided into superficial and muscle infiltrating (when the detrusor muscle of the bladder is infiltrated).

Which are the symptoms?

Symptoms are often non-specific, overlapping with other urinary tract diseases. The most common symptom of onset is hematuria, which is the presence of bright red blood in the urine, sometimes accompanied by the formation of clots. Other possible symptoms include increased urination frequency, urgency, dysuria (burning during urination) and pelvic pain.

  • Red urine (hematuria)
  • Increased frequency to urinate
  • Urgent urination
  • Burning or pain during urination
  • Pelvic pain

How is it diagnosed?

When these symptoms are present, it is recommended to visit urologist who will prescribe the following tests: 
Urinalysis and urine culture: to identify signs of bladder inflammation or bacterial infection;
Cytological examination for tumor cells on 3 different urine samples;
Ultrasonography of the urinary system: allows an accurate assessment of the entire urinary system; can detect a bladder neoplasm of even a few millimeters, estimating its location and size;
Urethrocystoscopy with flexible instrument: it allows a direct visualization of the vesical lumen, identifying with precision the site and the size of the neoplasm; it is also possible to take biopsy samples;
Abdomen CT with contrast medium and urographic poses: it is a fundamental examination in planning the correct therapeutic approach. Infusion of an intravenous iodinated contrast agent allows for complete visualization of the excretory system from the kidney to the bladder, providing information on the presence of any dilatation of the kidneys and ureters in case of bladder neoplasia obstructing the urinary tract. It also helps to estimate the degree of infiltration of the neoplasm in the thickness of the bladder wall and evaluate the possible involvement of pelvic lymph nodes. 
Abdomen MRI: provides a more accurate estimate of the local aggressiveness of the disease.

Suggested exams

How is it treated?

In case of bladder neoplasia, the first step is to define whether it is superficial or infiltrating diseas. An endocopic transurethral resection of the bladder lesion (TURV) is then performed in the operating room under spinal anesthesia. Subsequently:

  • If the disease is superficial, it will be treated with multiple intravesical instillations of immunotherapy (BCG) or chemotherapy (Mitomycin) at defined intervals. 
  • If the disease is infiltrating, radical cystectomy is indicated, preceded in most cases by neo-adjuvant therapy with chemotherapeutic or immunotherapeutic drugs. 

Very small and superficial lesions can be treated by laser photocoagulation. 

Several new innovative clinical trials for the treatment of both superficial and infiltrating bladder disease are currently underway at San Raffaele.

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