Bladder cancer accounts for 3% of urological cancers, yet it is the most diagnosed urological neoplasm after prostate cancer

Bladder cancer, who is at risk

Bladder cancer is a cross-cutting disease that affects both men and women with a significant incidence in patients aged 60 to 70 years.

According to the epidemiological curve, the cases occurring each year in men are more or less the same, a sign that we have probably reached a plateau (stabilisation) of this curve, while the first diagnoses of bladder neoplasia in women are increasing, albeit slowly.

The symptoms of bladder cancer

Certainly the most important symptom to pay attention to is the presence of blood in the urine, or haematuria, which affects both men and women.

In fact, it is found in 80-90% of those diagnosed with bladder cancer.

Haematuria can be of the following types

• macroscopic, i.e. visible to the naked eye;
• microscopic, detectable only by specific urine tests.

Other important, albeit less frequent, symptoms are irritative urinary disorders, such as:

• feeling of urinating often
• presence of a very urgent urge;
• perception of having to urinate a lot only to excrete a few drops.

Finally, some aggressive tumours that occlude the outlet of urine from one of the 2 kidneys may cause a dull pain in the flank, particularly on one side of the back.

But these are rather sporadic and unusual signs.

There are lifestyle and lifestyle-related risk factors:

• occupational: if, for example, one works daily in contact with dangerous substances and is not adequately protected;
• environmental: as in the case of schistosomiasis, an infection caused by a parasitic worm that lives in the fresh waters of subtropical and tropical regions;
• genetic: one may have a predisposition to this kind of neoplasm, but not a genetic mutation.

One of the most predisposing factors, however, is certainly cigarette smoking, which has a huge influence: an estimated 50% of cases.

The harmful substances from a cigarette, after being filtered by the kidneys, end up in the urine, which, being in contact with the inner wall of the bladder, can give rise to cell mutations resulting in the formation of a neoplasm.

The risk is proportional to the amount of cigarettes smoked and the years of this bad habit.

It should be pointed out that passive smoking also unfortunately exposes people to the risk of bladder neoplasia.

With regard to e-cigarettes, on the other hand, there is no reliable data yet because there is a lot of research undergoing scientific validation.

Diagnosis of bladder cancer

To diagnose a bladder neoplasm there are first level investigations, such as ultrasound, which is simple and non-invasive, but with very good specificity, and urinary cytology, which consists of collecting 3 urine samples on 3 different days.

If there is a diagnostic suspicion, it is a good idea to move on to second-level investigations, such as CT scans, when, for example, ureteral or kidney involvement is suspected, or cystoscopy, even if only outpatient, which allows a direct diagnosis.

An examination, the latter, which is much more tolerated than in the past thanks to the introduction of flexible fibre-optic cystoscopes that are much less invasive.

Finally, molecular tests are little used for several reasons.

In any case, as with all neoplastic diseases, diagnosis must be timely and early.

Urothelial carcinoma

The most frequent form of bladder neoplasm is called urothelial carcinoma, which originates from the innermost part of the bladder, from the skin lining the bladder.

However, the same skin also lines the ureter and a small part of the kidney, so prolonged back pain should not be underestimated.

Types of bladder cancer

In the bladder area, the neoplasm is almost always considered malignant.

It is divided into:

• high-grade form, tending to be aggressive;
• low-grade form, less aggressive.

Rarer forms of bladder cancer are, on the other hand, associated with other factors such as schistosomiasis (referred to earlier), which results in squamous cell carcinoma, fortunately rare in our latitudes.

Another important classification of bladder tumours, which can only be determined following their removal by endoscopy, is that which distinguishes them into superficial, only the first layer, or infiltrating, when the tumour has taken root).

The stagnation of this disease is crucial because the therapies, in one case or another, change radically.

Therapies and treatments

Treatments for bladder cancer are more or less the same as in past years, although new drugs and treatment protocols are being tested.

Following the first-level diagnosis, endoscopic resection of the bladder is performed.

This is a surgical procedure performed after anaesthesia, whereby the location of the tumour and the number of bladder lesions are identified with a camera instrument, and these are removed (resection) using electric current.

Subsequently, based on the histological examination, which is necessary to determine whether the tumour is superficial or infiltrating, treatment is carried out.

In the case of a superficial tumour, and thus with less chance of recurrence, one opts for intravesical chemotherapy or immunotherapy.

If, on the other hand, it is an infiltrating neoplasm, i.e. a high-risk tumour, total removal of the bladder is inevitable. This is a demolishing operation that consists of removing the anterior pelvic organs (the bladder, prostate and seminal vesicles in men, the bladder, uterus, ovaries and anterior wall of the vagina in women).

The next step involves the removal of the lymph nodes adjacent to the bladder which, in most cases, are the first site of metastasis.

Once the bladder has been removed, various surgical techniques, also known as urinary shunts, either internal or external, come into play to carry the urine outside, effectively reconstructing the reservoir function that the bladder originally had.

Screening and prevention

Adopting appropriate lifestyles certainly helps, as does scheduling regular screening and prevention checks from the age of 40 onwards.

In the presence of symptoms, such as pain or frequent urination, it is a good idea to perform an ultrasound and a urinary cytological examination, which is normally used to search for abnormal cells.

If they are negative or show normal values, it is likely that the symptoms can be traced back to an infection, ruling out more serious pathologies.

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Source:

GSD